Common Opioid side Effects Opioids do come with a side effect profile, just like any other medication. However, many of these side effects are short lived and can be managed with short term use of other medications or can be avoided with our “start low - go slow” approach to opioid use:
Constipation: is probably the most common side effect. However, our residents who take opioids daily are able to avoid this side effect and have their pain managed effectively, by simply optimizing their bowel regimen. Our physicians will include an order for a stimulant laxative when starting a resident on an Opioid.
Nausea/Vomiting: can first occur when
starting an opioid or with major dose changes, but usually does not persist beyond the first couple of days. Medications to control nausea and vomiting can be used in these first couple of days to manage this side effect. If nausea and vomiting persist despite these medications - don’t worry, it doesn’t mean that opioids aren’t the right drug for you or your family member or there is an allergy present, it just means your body doesn’t tolerate one particular opioid very well. Most commonly residents who do not tolerate one opioid are rotated to another and do very well.
Pruritus (Itching): can occur when opioids
Pain Management Program
References 1. Forbes, K. (2006), Opioids: Beliefs & Myths - Journal of Pain & Palliative Care, 20(3), 33-35 2. Patterson, C. (2008), Seven Myths About Opioid Use - Nursing, 38(11), 60-61 3. Vallerand, A.H. (2003), The Use of Long Acting Opioids in Chronic Pain Management - The Nursing Clinics of North America, 38(30), 435-445
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Useful websites 1. http://prc.candianpaincoalition.ca/en/ 2. www.arthritis.ca
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Opoids: 101.5 Breaking up the Myths on Opioid Analgesic Use in Pain Management
Contact Providence Manor Pain & Symptom Management Team For more information on material presented or pain/symptom management: Lynne Hendry Quality Improvement Facilitator Tel: 613-549-4164 ext. 3150
For specific resident enquiries: Contact the Registered Nurse in your Resident Home Area
are initially started, due to histamine release and occasionally persist. Antihistamines can be use for opioid-related pruritus. If pruritius is severe or persistent, the resident is rotated to another opioid analgesic instead.
www.providencecare.ca April 2012
A Guide for Residents and Family Members We are very fortunate at Providence Manor to have an amazing team of nurses and physcians knowledgeable in pain and symptom management, as well as Sharon Preston, Palliative Pain and Symptom Management Nurse Consultant, ready to help with pain management for our residents.
What are Opioids? Opioids are a class of pain medications frequently used to manage acute, chronic and end-of-life pain and suffering. Opioids target opioid receptors which are found throughout our bodies and effect the pain transmission cycle. Our bodies make natural opioids - you may have heard of them (i.e. endorphins). Opioids are recommended by the World Health Organization as the next steps to pain management, if pain is not controlled by nonopioid analgesics such as Tylenol or Ibuprofen. Examples of common opioids include: Morphine Hydromorphone (Dilaudid) Fentanyl Opioids come in different forms (pills, liquids, subcutaneous, patch [transdermal]) so that there are quite a few options available to meet each resident’s individual needs.
WHO ladder? (by mouth-by the ladder-by the clock) Step 1 (0-3 on the numeric pain scale) Mild pain = non- opioid ex. Tylenol Step 2 (3-6 on the numeric pain scale) Opioid for Mild to moderate pain Step 3 (7-10 on numeric pain scale) Opioid for Moderate to severe pain
Common Opioid Myths & Misunderstandings Opioids are a misunderstood class of drugs due to a variety of reasons, including portrayals in the media as well as their “off label” use on the streets. People often refer to opioids as “narcotics,” which they are not narcotics are drugs that “blunt the senses.” It is doubtful that you have ever heard a police unit called the “opioid squad!” Myth 1: If I or my family member takes opioids for their pain, I/they will become addicted Addiction is defined as a disease characterized by behaviours focused on abnormal use of a drug (compulsive and not solely for pain) and continued use despite physical or psychosocial harm. Addiction rarely occurs with the use of opioids for pain management. Research has shown that the incidence of addiction was less than 1% for individuals using opioids for pain manage- ment. Physical dependence does, however, occur - it means that an abrupt stop or reduction in pain medication may cause symptoms of withdrawal (this is not addiction). A fear of becoming “addicted” has led to many people living with unmanaged pain.
Myth 2: Opioids will cause heavy sedation Because pain can cause sleep deprivation, after opioids are started they help relieve pain and subsequently help a person sleep - once a person catches up on lost sleep, continued treatment with an adequate dose of opioids will allow them to return to normal mental alertness and orientation.
Myth 3: Opioids should be avoided in elder persons Pain has no age limit. Because the elderly may be more susceptible to side effects of opioid analgesics, they are commonly prescribed doses of opioids that are ineffective in managing their pain or are not prescribed them at all. Residents and their family members are often concerned that opioids will “snow” them or they will cause increased confusion and a sense of lost control. This is usually because a higher dose of opioid was initially used or one particular opioid did not agree with the person. At Providence Manor we follow the “start low, go slow approach”- meaning we give the smallest dose of opioid needed to effectively manage our residents’ pain and avoid unwanted side effects or rotate them to another opioid if side effects develop.
Myth 4: Effective pain management can be achieved on an “as needed” basis Many residents suffer from chronic conditions that need consistent around the clock dosing of medication to prevent the “peak and valley effect” (non steady release of pain control throughout the day) of pain control. Pain medications like opioids provided “around the clock” or “daily” have a much better impact on pain management with fewer side effects.
Myth 5: Opioids will cause respiratory depression and hasten death Many opioids are used to treat shortness of breath when breathing is very quick and uncomfortable. Respiratory depression is dependent on how much opioid is used. Using the “start low, go slow approach” we give enough opioid to effectively manage shortness of breath and pain, without intentionally decreasing respiration or hastening death.