Morphine: Preventative Pain Control
I. Introduction
Narcotic analgesics, especially morphine are underused for pain control with in the medical field. This underuse is because medical professionals, including doctors, fear patient addiction, side effects and possible lose of their licenses. These fears deny adequate healing and a better quality of life to those who would benefit from a more effective use of these drugs, as done in hospice care.
II. PAIN:
Pain not only involves the physical reaction to damaged tissue, but also involves an emotional and cognitive response by the person experiencing the pain (Backer, 1994). A person's prior experience will influence how pain is managed. Pain is a signal that something is not
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Pain is not inevitable and can be treated. To live a life hampered by pain when treatment is available, is to cheat one out of the full quality of life that is possible.
Pain effects the body through the nerves. The phenomena of pain is conveyed from a peripheral part of the person, through afferent nerves to a part of the brain, similar to sight, touch, and hearing. These signals are then interpreted by the brain as pain (Murphy, 1981). The nerve cells used to relay pain messages to the brain are specific nerve cells called nociceptors. These nerves do not send messages until "the stimulus reaches noxious levels," (McClesky, 1992).
Pain can be acute or chronic. Acute pain is intense, short in duration and generally a reaction to trauma. Chronic pain does not go away, and can range from a dull ache to excruciating agony. Terminal and non-terminal illnesses can both be causes of chronic pain. Tissue damage is not always found in chronic pain, but those who suffer from it are rendered "nonfunctional by incapacitating pain," (Murphy, 1981).
Chronic Pain
Chronic pain has four mechanisms. Nociception is a neural signal of threatened or damaged tissue, and is the classical pain pathway. Central pain states are thought to be caused by abnormal activity in neurons in the afferent pathway. The mechanism for this is not completely understood, and a person may perceive pain where there is no tissue damage. Behavioral pain is communicated by a
The perception of pain and the emotions that control intensity differ in individuals. Since feeling pain is somewhat adaptive, when one experiences it, he or she becomes aware of an injury and tries to remove oneself from the source that caused the injury. For this reason, pain is considered neuropathic or inflammatory in nature. Thus, when pain is the outcome from the damage caused to the neurons of the peripheral and central nervous system, then that pain is neuropathic. However, if the pain signals any kind of tissue damage, then the pain is inflammatory in nature. Due to various types of pain, the interpretation of pain by neurons and the source of that pain
“Pain is much more than a physical sensation caused by a specific stimulus. An individual's perception of pain has important affective (emotional), cognitive, behavioral, and sensory components that are shaped by past experience, culture, and situational factors. The nature of the stimulus for pain can be physical, psychological, or a combination of both.” (Potter, Perry, Stockert, Hall, & Peterson, 2014 p. 141) As stated by Potter et al, the different natures of pain are dealt with differently depending on many factors. Knowing this, treating pain can be very difficult as there is no single or clear cut way of measuring it; “Even though the assessment and treatment of pain is a universally important health care issue,
The reason that this drug can be so intense and dangerous is because it falls into the category II narcotics. Many commonly known narcotics include opium, morphine, and heroin. The addiction rate of any of these drugs is phenomenal. Narcotics are central nervous system depressants that relieve pain without causing the loss of consciousness. They can also produce feelings drowsiness, mental confusion and euphoria. The analgesic effects of narcotics result from the drugs’ effects on the emotional aspects of pain. Many patients that experience intense pain say that after the administration of the narcotic, their pain is as intense as ever but no longer as bothersome. Because narcotics block the emotional side effects of pain they make it much more bearable.
To most people, pain is a nuisance. But to others, pain controls their life. The feeling discomforts us in ways that can sometimes seem almost imaginable. These feelings can lead to many different side effects if not dealt with or diagnosed. These effects can include depression, anxiety, and incredible amounts of stress. The truth about pain is that it is vital to our existence. Without the nervous system responding to pain, we would have no idea if we were touching a hot stove, being stuck by a porcupine's needles, or something else that could leave a lasting effect upon our bodies without us even knowing anything about it. This warning system helps to alert us when there is
Fun fact, in the UK, some hospitals use diamorphine, a generic name of heroin to prescribed as a strong pain medication in patients suffering from myocardial infarction, post-surgical pain, and chronic pain, including end-stage cancer and other terminal illnesses. It is still given over there, instead of using Morphine, because some hospital state it a lot better from pain
Opioid abuse, misuse and overdose is a problem in The United States. You can’t turn on the TV or read a newspaper without some mention of the epidemic. This issue has caused the practice of prescribing or taking narcotic pain medication to be looked at under a microscope. Patients are fearful to use some necessary pain medication, because they may become addicted. Other patients who genuinely do have pain and need medication are having a tougher time obtaining the help they need. The problem of abuse and addiction is tough to solve since for some people the medications are the only way they can function and live a semi-normal life. A patient with pain may be hesitant to visit the doctor and
Next, there is an extensive history of opioid use for pain management, and other symptom management as well. Morphine can be traced back to Civil War veterans trying to manage pain and, consequently, being addicted. “‘Drugs were already on the scene and being consumed at alarming rates long before the start of the war,’ said Mark A Quinoes, a scholar who studied drug abuse during the Civil War.” It was not until 1898 that heroin was on the market for commercial sale, considered a “wonder drug,” it began to spread in use along with users that found out injecting it would increase its effects. There was little known about these new opioids, they were even used as cough suppressants. Heroin worked for what is was being used as, a pain suppressant, and there were few other options. In 1914 the Harrison Narcotics Tax Act imposed a tax on importing and selling opium or coca leaves. In 1924 doctors were avoiding using opioids after being aware of their addictive nature which lead heroin becoming illegal. Without this opioid, doctors had to get creative when treating World War II soldiers, this sparked research into nerve blockers. These nerve blockers managed pain without the use of surgery. This was, unfortunately, not the end of the opioid. While these results were shocking the pharmaceutical industry still faces much leniency from the federal
Morphine, a well-known pain reliever used intravenously in the pre-hospital setting, is the most widely used by first responders. As stated by The University of Chicago, “now more than 230 tons of Morphine is used each year for medical purposes including pain relief for patients with chronic pain or advanced medical illness and post-operative analgesia” (Medicine). Freidrich Wilhelm Adam Serturner, a pharmacist’s assistant, first discovered Morphine in 1805 (Medicine). According to The University of Chicago, “Serturner found that opium with the alkaloid removed had no effect on animals, but the alkaloid itself had 10 times the power of processed opium. He named that substance morphine, after Morpheus, the Greek god of dreams, for its tendency to cause sleep” (Medicine). Morphine, according to Pharmacology Examination & Board Review, is defined as an “Opioid analgesic prototype: strong mu receptor agonist” and it belongs to a classification of drugs that is “derived from the alkaloids of the opium poppy and includes opiates, opiopeptins, and all synthetic and semi-synthetic drugs that mimic the actions of the opiates” (Trevor, Katzung and Masters). The relief of pain is made
Everyone suffers some pain in their lives from injuries of various severities and this is usually a person’s only reference point for the experience of pain: it is caused by an injury, it hurts for some time, and the pain fades as the injury heals. One day you wake up and the pain is gone. Now imagine instead of healing, the pain lingers and gets worse, not by the day, but by the hour. So, by the end of the day, you just want to crawl up in a ball and cry yourself to sleep. Chronic pains persistent, pervasive, and permanent nature is almost incomprehensible and I suffered through it for the better part of 8 years.
Chronic pain can be mental, emotionally and physically debilitating. Chronic pain affects us on many different levels. Your brain senses pain from sensory, emotional and cognitive angles. The brain is wired to expect severe pain, and it swiftly initiates a strong pain response. Neuropathways rely on past experiences that help the brain deal with similar threats. Our cognitive and emotional responses can jumble our actual pain signals. Similar physiological treatments are prescribed for an emotional response and actual pain.
Pain can be characterized by its duration (from momentary to chronic), location (e.g., muscle, viscera), or cause (e.g., nerve injury, inflammation). Characterization of pain by duration may be arbitrary (i.e., when does pain become chronic?), but is useful because most significant human pain conditions are long-lasting, whether referred to as persistent or chronic. (National Academies Press (US); 2009.)
No the brain does not perceive acute and chronic pain differently. The perception of pain is subjective to each individual person based on his or her own mood, emotional state, and prior experience. A functional magnetic resonance imaging (fMRI) shows that there is no difference between someone with chronic pain compared to a person with an acute pain. The fMRI shows that pain perception and related brain stimulation patterns were virtually undistinguishable between chronic and acute pain.
I will first begin informing you about the psychological reality of chronic pain by explaining what chronic pain, how it begins, and who is affected by it. This will help the reader understand some background information that will comprehend how it affects individuals. Next, I will present how prevalent chronic pain is and how it effects society, this will help to explain why this is concern should no longer be ignored. I will then begin discussing the most common psychological effect of chronic pain, a lower quality of life. This will begin the discussion of how medical complications effect how one perceives things and then overall mental well-being. This will then Segway into discussing how the mental stress of medical concerns, and a concern
Pain, as IASP defines is “an unpleasant sensory and emotional experience associated with actual or potential damage to tissue, or described in terms of such damage." The person perceives pain due to different nociceptors present at the peripheral and central nervous system. Pain due to corrosive chemicals and temperature are detected through Transient Receptors Potential Vanilloid receptors like TRPV1(Caterina et al., 1997) and Mechanical pain is detected through receptors like TRPVA1(Lennertz et al., 2012) these are present at the periphery and are present at the axons of first order nerve fibers. These nerve fibers are of two kinds Aδ fibers (myelinated and fast conducting) and C fibers (non-myelinated and slow conducting) which are in the
Pain is a complex, unpleasant, and disruptive sensation. The day-to-day pain people experience from a paper cut or a flu shot results from the activation of nociceptive receptors at the site of tissue injury, which is known as nociceptive pain. Some individuals also have experience with a different type of pain, one that is chronic, intractable, disabling, and it arises “as a direct consequence of a lesion or disease affecting the somatosensory system” (Treede, 2008). This form of pain is neuropathic pain.