Tuesday, March 29, 2005

Pain Medication Myths

There are many common myths about pain medications, particularly opioids (aka narcotics) such as morphine. Many sites out there are already working to dispel these myths. But I would like to focus on just three of these myths. Please see the references at the end of this post for more myths.

1. If I take pain medications, I'll become addicted.

With no prior history of drug addiction, people have an extremely minimal chance of developing an addiction. I have heard figures lower than 1%. There is a phrase thrown around a lot in hospice and palliative care when people express concerns about addiction: "Pain is the antidote to addiction." People who have problems with addiction generally are using the medication to treat psychological problems, not to treat actual physiological pain. In addiction, drugs are a form of escape. Taking the medication to legitimately treat pain will not make someone an addict.

2. I should only take pain medications when the pain is absolutely intolerable.

Pain medications are much more effective when pain is minimal. The stronger the pain, the more difficult it is to alleviate. Therefore, treating the pain before it gets severe is essential for good pain control. Most women have realized if they wait to take ibuprofen until after their menstrual cramps are in full-swing, they require much higher doses of medication than if they take one or two ibuprofen as soon as they feel the first hint of menstrual cramps. And then if the ibuprofen is continued on a schedule, cramps are often avoided. Every type of pain works that same way. Many people take pain medications around-the-clock on a scheduled program to prevent their pain from getting too high. And then take extra medicine when the around-the-clock medication doesn't work (referred to as "breakthrough pain).

3. If I take pain medication, I will die sooner.

First of all, whoever passes this myth on must be simply inhumane. To me, it sounds like telling someone who's dying that it's not okay to treat their pain. This myth has been said to be based in a fear that the person will overdose or stop breathing from the pain medication. Pain medications are always initiated at the smallest dose and then increased in order to find the appropriate dose for the patient and their level of pain. Morphine, a common drug used in palliative care settings, is also used to treat difficulty breathing. So contrary to the fear that the morphine will make someone stop breathing, it actually instead makes breathing more comfortable.

I recently had a patient, Mr. Tenaci, who was dying of rectal cancer. He was having severe rectal pain primarily due to frequent diarrhea. As soon as I would enter his room, he would send me away.

Mr. Tenaci: I'm sorry. I'm in too much pain. I can't talk right now.

Mia: Can I give you some pain medication?

Mr. Tenaci: No, I don't want any. I'm just going to lay down in bed. But please bring me a hot pad.

Each time I entered his room, he responded the same, quickly turning me away. He was mildly irritable at times, which didn't surprise me since he seemed to be in so much pain. (Another reason to treat pain - so you can avoid that irritability that may make it difficult to resolve relationships with loved ones). He apologized repeatedly for not smiling, siting again his pain as the reason for his mood. Finally, I got him to admit why he wouldn't take the pain medicine.

Mr. Tenaci: Someone told me I would die more quickly if I took pain medicine.

Mia: You must have been very afraid to take any pain medicine then. But let me assure you, that's not true. Though even if it were, wouldn't you want to enjoy what time you have, rather than spend all of your time in pain?

Mr. Tenaci grew quiet and a thoughtful look crossed his face. He still didn't say anything.

Mia: Well, I'll let you think about that. But if you change your mind, let me know.

Fifteen minutes later, Mr. Tenaci's call light was on. He was ready for pain medicine. I explained that there were two medications he could and should take - a long-acting medication that wouldn't start immediately but would last a long time and a short-acting medication that would work immediately but wouldn't last very long. I tried to convince him to take one of each, but he quickly brushed that idea aside with a wave of his hand. So I decided on the long-acting medication. As it was rather late at night, Mr. Tenaci fell asleep shortly thereafter.

A few hours later, when I checked in on Mr. Tenaci again, he sat smiling in bed.

Mia: How are you doing?

Mr. Tenaci: Great. I have no pain.

His smile was bright and filled his entire face.

Mr. Tenaci, knowing it was the end of my shift: So, will I see you again tonight?

He sounded hopeful. And for the first time all shift, he let me stay in his room while he shared with me about his life.

When people say "there is nothing that can be done" when curative measures to treat someone's illness have run out, they are so wrong. There is always something we can do and something we can hope for. We can hope for comfort and happiness and good quality of life for whatever time we have left.

Dispelling more of the myths about pain medications:
-Myths About Controlling Pain by the Mayday Fund
-Common Myths About Pain by the Hospice Foundation of America
-Pain Control on Hospice Net

No comments: