Pain Control

Key Points

• Analgesics should be given regularly and in adequate doses. When given for severe pain, analgesics do not cause addiction or respiratory depression.

• Oral morphine is the drug of choice for severe pain.

• NSAIDs are recommended for bone or joint pain; antidepressants or anticonvulsants for burning or shooting pain; anticholinergics for cramping abdominal pain or bladder spasms; and antihistamines for restlessness and generalized discomfort. • Prevention and treatment of constipation is required for all patients receiving opioids.

Pain can be physical, psychological, emotional, or spiritual. It can also be a combination of chronic, somatic, visceral, and neuropathic pain. Somatic and visceral pain accounts for about two thirds of patients with pain and responds to conventional opioids. About 35% of patients have some degree of neuropathic pain, a shooting or stabbing, electric shocklike pain. Chronic pain is influenced by memories of past pain and the anticipation of future pain. The fear of worsening pain may distort the patient's perception of current discomfort. Frustration and anxiety may accentuate the pain. All these factors can lower the patient's pain threshold and greatly magnify even minor disturbances (Twycross, 1993).

Failure to treat the whole person often results in inadequate pain control for patients with terminal cancer. Fatigue, insomnia, anxiety, boredom, and anger all contribute to a lower threshold for pain. Rest, sleep, diversion, and companionship all help to increase the patient's tolerance for pain.

Analgesics should be given in adequate amounts to provide comfort. The approach of giving analgesic doses as needed should be abandoned in the treatment of dying patients, because it contributes to a lower pain threshold and a need for increasing doses to relieve the pain. When medication is given regularly in adequate doses, the anxiety and fear that accentuate pain are avoided, and lower doses of the drug are effective, because the patient no longer fears recurrent or "breakthrough" pain.

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