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Types of Pain

• Acute pain: sudden onset, usually subsides once treated
• Chronic pain: lasts 3 months or more, persistent or recurring, often difficult to treat

Tolerance and Dependence

• Tolerance: physical adaptation to a drug, requiring higher doses for the same effect
• Physical dependence: physiological adaptation of the body to the presence of an opioid
• Opioid tolerance and physical dependence are expected with long-term opioid treatment

Adjuvant Drugs

• Assist primary drugs in relieving pain
• Examples: NSAIDs, anti-depressants, anti-convulsants, corticosteroids
• Gabapentin or pregabalin (anticonvulsants) are used for neuropathic pain

Opioid Ceiling Effect

• Maximum analgesic effect is reached, and increasing doses do not improve analgesia
• Examples: Pentazocine, Nalbuphine

Opioid Drugs

• Used to alleviate moderate to severe pain
• Indications: often used with adjuvant analgesic drugs to assist primary drugs with pain relief
• Used for cough suppression, treatment of diarrhea, and balanced anesthesia

Contraindications

• Known drug allergy
• Severe asthma
• Respiratory insufficiency, elevated intracranial pressure, morbid obesity, or sleep apnea
• Paralytic ileus

Adverse Effects

• Most serious: CNS depression
• Nausea and vomiting
• Urinary retention
• Diaphoresis and flushing
• Pupil constriction
• Constipation (in patients with severe opioid use)
• Itching

Management of Overdose

• Naloxone (Narcan): used for suspected acute opioid overdose, opioid-induced respiratory depression
• Naltrexone: used for alcohol and opioid addiction, comes in oral form

Withdrawal Symptoms

• Anxiety, irritability, chills, and hot flashes
• Joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, and confusion

Opioid Drugs

• Methadone: used for detoxification, can cause cardiac dysrhythmias
• Morphine Sulfate: used to treat severe pain, often used in hospital settings
• Codeine Sulfate: natural opiate alkaloid, often combined with acetaminophen
• Fentanyl: synthetic opioid, used to treat moderate to severe pain
• Hydromorphone (Dilaudid): schedule 2 drug, 1 mg of IV med is equivalent to 7 mg of morphine
• Methadone Hydrochloride (Dolophine): schedule 2 drug
• Oxycodone Hydrochloride: analgesic agent, structurally related to morphine, class 2

Non-Opioid Analgesics

• Acetaminophen (Tylenol): analgesic and antipyretic effects, little to no anti-inflammatory effects
• Dosage: maximum daily dose for healthy adults is being lowered to 300mg/day, 2000 mg for older adults and those with liver disease
• Contraindications: drug allergy, liver dysfunction, G6PD deficiency
• Overdose management: RECOMMENDED antidote is ACETYLCYSTEINE REGIMEN

Patient Education

• Inform patients to make slower motions and dangle feet on the edge of the bed to avoid orthostatic hypotension
• Contact physician immediately if vital signs change, patient condition declines, or pain continues

Nursing Process

• Assessment: perform a thorough history, obtain baseline vital signs and I&O
• Pain assessment: rate pain on a 0 to 10 or similar scale, using appropriate scale for age and cognition

Nursing Implications

• Medicate patients before pain becomes severe to provide adequate analgesia and pain control
• Pain management includes pharmacologic and non-pharmacologic approaches
• Patients should not take other medications OTC without checking with their physicians
• Instruct patients to notify physician about signs of allergic reaction or adverse effects

Opioid Nursing Implications

• Oral forms should be taken with food to minimize gastric upset
• Ensure safety measures, such as keeping side rails up to prevent injury
• Withhold dose and contact physician if patient's condition declines or vital signs are abnormal
• Monitor for adverse effects, therapeutic effects, and respiratory depression

Herbal Products

• Feverfew: related to the marigold family, anti-inflammatory properties, used to treat migraine headaches, menstrual cramps, inflammation, and fever