Miscellaneous
Our first episode! Part 1 of the ins and outs of choosing pain medications. Today we choose between narcotic pain meds for your patients: not a secret anymore! We discuss deciding between IV and PO and which opiate to use, how it works, the side effects and clinical problems associated. Purpose of pain = warning the body something is wrong. Pain is unmeasurable & surrounded by fear culture. Choosing pain meds based on route. IV: faster onset (only about 5 mins) & lasts 4-6hrs & only available in hospital setting IM: variable absorption & good if no IV access PO: slower onset (takes about 30 mins to digest) & lasts about 6-8hrs & can prescribe for home Opiates: bind to 3 main receptors to block pain signals Mu- analgesia, physical dependence, euphoria, resp depression, mast cell degranulation Kappa- analgesia, very little dependence, diuresis, dysphoria Delta- analgesia, sedation, generally unknown Opiates are equivalent in their analgesia effects. So how we choose between them? Side effects-- its all about the side effects. See the attached PDF Pain Chart for individual agents. 4 effects of opiates you need to know: Constipation- opiates decrease gut peristalsis which can lead to bursting the intestines! Write for stool softeners Sensitization- chronic blockage of pain receptors lead to increasing the amount of pain receptors present on cells which amplifies even the smallest signal. These patients really do feel more pain and are less able to handle pain. Addiction- two models of thinking: disease model vs psychological. Either way, prevent addiction as much as possible by not giving refills and only prescribing low # of pills for home. Withdraw- As for withdraw, typical opiate withdraw syndrome consists of: sweating, vague abdominal pain, diarrhea. Withdraw is not fatal. Pseudoallergies- Most ‘allergies’ to opiates are side effects and not real IgE mediated allergies. If you want to know more here is a really good article on the topic. For a rotation or clinic friendly reference as promised: PDF Pain Chart Or if you'd like to learn about alternative pain medications, check out next week's episode Choosing Pain Meds- Non Opiates Do you have any questions or feedback? Do you think I missed something? Let me know in the comments section below!