For example, pain from sickle cell crisis can be debilitating and require the
patient to receive a narcotic analgesic such as morphine. This medication blocks
the pain and creates a euphoric effect giving the patient relief from the pain of
the disease.
However, fear of inducing addiction or respiratory depression interferes with
pain management. Addiction is rare in clinical practice. Some patients who are
treated with opioid analgesics can develop a tolerance to the medication requir-
ing an increased dose to maintain pain relief. However, the need to increase the
dose of the medication is usually related to an increase in pain due to disease
progression or complications. Physical dependence on a medication occurs
when the physiological condition of the patient is altered.
Increased doses of opioid analgesics also expose the patient to adverse side
effects such as respiratory depression. Opioid analgesics can cause some
respiratory depression. However, this effect usually does not occur with long-
term use such as with cancer patients. Prescribers avoid this side effect by
titrating doses over time to deliver pain relief without adversely affecting the
respiratory system.Influences on Administrating Pain Medication
The concerns about addiction and the potential for adverse side effects of opioid
analgesics influence how the medication is administered. Patients may avoid or
postpone taking pain medication until the pain is unbearable for fear of becom-
ing addicted or developing a tolerance for the medication. This is especially
true with patients who suffer chronic debilitating diseases. They realize pain
increases as the disease progresses and they are fearful that the medication will
lose its effectiveness.
Some healthcare providers are also hesitant about administering pain medica-
tion for some of the same reasons patients refuse to take the drug. Furthermore,
healthcare providers might be skeptical that the patient is actually in pain since
pain is subjective and difficult to measure in the clinical setting.
Many studies have demonstrated that women, the elderly, children, and those
addicted to illegal drugs are at greater risk for being undertreated for acute pain.
These studies indicate that some healthcare providers believe females react emo-
tionally and pain is not as severe as reported. Others believe the elderly and chil-
dren do not feel pain as acutely as other patients. And many healthcare providers
believe addicts are simply seeking drugs to forego withdrawal symptoms even
when it is clear that the addict is suffering pain from an acute injury or illness.(^306) CHAPTER 16 Narcotic Agonists