Pain Management
Definitions of Pain
Common Barriers
Important Terms
Morphine Myths
Duty to Relieve Pain
Five Principles
Fifth Vital Sign
Pain Assessment
Begin with the patient
Types of pain

Symptom Management
Important Pain Management Terms

There is a clear distinction between addiction and physical dependence on a medication prescribed for a patient in pain; prejudice and inexperience perpetuate the belief that these conditions are the same.

The psychological condition characterized by compulsive use despite harm; life is not improved by use of the drug.

Physical Dependence
A normal condition that can occur when pain medications are used appropriately. Routine use of opioids can cause physical symptoms to develop once the drug dosage is decreased or discontinued and do not indicate addiction. McCaffrey and Pasero (1999) define physical dependence as a “neurophysiological response to the chronic presence of a drug”. In an attempt to maintain homeostasis when a medication is administered repeatedly, the body reacts by adapting to the drugs effects. Accordingly, when that drug no longer is there to counteract the body’s adaptation mechanisms, physical symptoms such as anxiety, sweating, nausea, vomiting, lacrimation, cramps, insomnia, rhinorrhea, and irritability can occur. These symptoms are seen as “proof” of addiction, instead of the body’s normal process of returning to a state of balance.

When a drug with a relatively short half-life like morphine is discontinued, these symptoms occur from six to twelve hours and peak at about seventy-two hours after the drug is discontinued. In drugs with a longer half-life, these symptoms may not appear for up to 48 hours.

Routine use of an opioid can cause the dosage to lose effectiveness. The dose may need to be repeated sooner than ordered, and the overall pain relief may diminish. In this case, the dosage is gradually titrated upwards until effectiveness is again achieved: There is no ceiling to morphine dosage.