Definitions of Pain
Duty to Relieve Pain
Fifth Vital Sign
Begin with the patient
Types of pain
Common misconceptions that can interfere with pain management
Myth: Morphine will cause the patient to become addicted
True addiction is extremely rare when pain medications are used appropriately with a sound pain management plan. The symptoms that can occur if the medication dosage is reduced or discontinued are those of physical dependence, not addiction.
Opioid pseudo-addiction, a syndrome in which the patient mimics some addictive behaviors, can occur when pain has not been adequately assessed and the pain medication is not titrated well to the patient’s pain.
Myth: Morphine will cause harmful respiratory depression
When titrated to a patient’s pain, clinically significant respiratory depression does not occur.
When titrated properly, tolerance to the respiratory effects of morphine develops quickly. Pain antagonizes the depressing effect of the morphine. This is true even in patients with COPD.
It is important to remember that respirations may naturally decrease at the end of life.
Myth: Morphine will hasten death
There is no evidence that morphine hastens death when properly titrated to the patient’s pain.
If death does occur soon after a dose of morphine is given, death would most likely have come anyway, and the morphine allowed the patient to experience death with more comfort.
Myth: The patient will be “out of it”, or too sedated
Morphine, after the initial dosing, usually does not cause over-sedation. Again , proper titration is important
When initiating morphine therapy, or significantly increasing the dosage, there is an initial period of sedation, usually not longer than a few days. Mild stimulants such as coffee or methylphenidate can help relieve the sleepiness.
Myth: If given too soon, it won’t work when it is really needed.
If a dosage increase is needed to maintain pain control, it is usually because there has been disease progression, not because tolerance to the morphine has developed.
Most patients can be maintained of a stable dose or morphine for long periods of time.
Morphine has no analgesic ceiling. Appropriate titration of medication assures proper pain management.