Cancer pain and moderate to severe pain that cannot be relieved with
other drugs are still frequently managed with opioids, such as morphine.
Also termed “narcotics”, the professional designation “opioid” is
preferred. Opioids are effective, easily titrated, and have a favorable
benefit-to-risk ratio. Large doses of opioids may be needed to control
severe pain, and extended courses may be necessary if the pain is
chronic. Tolerance and physical dependence are normal physiologic
consequences of extended opioid therapy and must not be confused with
addiction.
Effective pain management is best achieved by a team approach involving
the patient, his/her family, and health care providers. As soon as pain
begins, it is important that a patient talks to a health care provider
who is knowledgeable in pain management. Besides mitigating suffering,
pain control is critical because even when the underlying disease
process is stable, uncontrolled pain prevents patients from working
productively, enjoying recreation or taking pleasure in their usual role
in the family and society.
The goal of the initial assessment of pain is to characterize the pain
by location, intensity, and aggravating and relieving factors.
Frequently a 10-point Numeric Pain Intensity Scale or Visual Analog
Scale is used ot facilitate communications between the patient and
health care professionals, and to monitor the adequate therapy. Regular
follow-up should occur and routine recording of pain intensity along
with other vital signs is recommended.
Because many patients have persistent or daily pain, it is often
important to use medications on a regular schedule rather than only “as
needed.” Around-the-clock administration of analgesics allows each dose
to become effective before the previous dose has lost its effectiveness.
Patients may also be prescribed “as needed” doses for breakthrough pain.
