Mary Beth Kean DNP RN-BC CNS CRRN
Helen Ross Petty
Elizabeth Huss RN BSN
Objectives
Upon Completion of this activity participants
will be able to:
1. Recall definitions of pain, dependence,
tolerance, pseudoaddiction, addiction and
aberrant drug related behavior
2. Describe the types and pathophysiology of
pain
3. Describe the impact of untreated pain
Objectives continued
4. Discuss pharmacologic treatment of pain
5.Discuss non pharmacologic management of
pain
6. Integrate objectives 1-5 into case studies
(ACP
Medicine 2005)
The vicious cycle of cancer pain
Perception
of pain
Chronic pain d/t
disease or injury
Better than you were
before pain
Forgiveness
Analgesia: as measured on a scale
Adverse side effects
Activities of daily living/ Affect
Aberrant behaviors
Risk considerations
 Acute pain
 Obstructive sleep apnea
 Liver failure
 Renal failure
Risk considerations cont.
 Chronic pain
 Effect on mood
 Neuroedocrine effects
 Aberrant drug behaviors
Equianalgesic conversion chart
Name
Oral
Parenteral
Usual starting
oral dose
Morphine
30
10
15-30
Dilaudid
7.5
1.5
4-8
Oxycodone
20
_
10-20
Demerol
300
75
Methadone
10
5
Not
recommen
ded
5-10
Humans are multidimensional:
 Body: biology, physiology
 Energy
 Mind
 Society
 Spirit
Case study
74 y/o male dx with metastatic lung cancer
 admitted to hospice
 Home pain medications: long acting
morphine to 100 mg q 12.
 unable to swallow with decreased LOC
taken to the ED
 ED MD ordered morphine iv 4 mg q 4 prn
and ativan IV q4 prn (12 mg IV morphine
in 24/hr)
References:
• Gourlay,D., Heit,H, & Abdulaziz,A. (2005) Universal Precautions
•
•
•
•
in pain medicine: a rational approach to chronic pain. Pain
Medicine 6(2)
Passik,S & Kirsh,K. (2003) The need to identify predictors of
aberrant drug related behavior and addiction in patients being
treated with opioids for pain. Pain Medicine 4(2)
Proceedings from the conference: Principles and practice of pain
medicine. Harvard Medical School & Beth Israel Deaconess
Medical Center, Boston (2005)
Morgan, B. (2006) Knowing How to play the Game: Hospitalized
substance abusers strategies for obtaining pain relief. Pain
Management Nursing 7(1)
Wolf, C . (2004)Pain: moving from symptom control toward
mechanism –specific pharmacologic management. Annals of
Internal Medicine. 140 (6)
Websites:
 www.hopweb.org A tool from Johns Hopkins Center
for Cancer Pain Research which facilitates appropriate
conversions from one opioid or route of administration
to another.
 www.cancer.gov/cancertopics/coping/paincontrol.pdf
A free booklet from the Federal Government on pain
control.
 www.arthritis.org Website of Arthritis Foundation. Go
to “pain center” for tips on understanding pain and
pain management