Nursing: Opioid and Indications - Research Paper Example

Nursing: Opioid and indications Pain, primarily is an inescapable aspect of the human life. Nevertheless, no way exists to objectively determine the pain experienced by an individual. Pain is a subjective issue, which is informed by every person’s specific psychological, physical, historical, cultural and social circumstances and experiences. The pain-relieving power of opium has been known for millennia, and so has its likelihood for abuse as well as addiction. Consequently, the mass manufacture of opium together with the discovery of morphine alkaloid in the 19th century resulted in the fast increase of commercial and widespread distributing of Opioid compounds, legal or otherwise. Over the past three decades, Opioids use for the management of cancer pain, suffering and acute pain that results due to terminal conditions has taken its position and been accepted in medical practice. This paper seeks to analyze the use of Opioids in medical pain relieve and their side effects. Key words: Opioids, pain, opium, terminal condition, side effect Opioids Use and Indications Opioids can be described as any chemicals like morphine that resemble opiates as far as their pharmacological effects are concerned. The pain killing effect of an Opioid is because of reduced pain perception, reduced pain reaction and increased tolerance to pain. In general an Opioid can result in suppression of cough, which may be an indication of administration of Opioid or an unintentional side effect. Some of the likely Opioids side effects comprise of respiratory depression, sedation, constipation as well as a strong euphoric sense. Opioid dependence may develop with continued administration resulting in withdrawal syndrome after sudden discontinuation (Mandal, 2013). Opioids that are morphine-like are popular for their addictive effects as well as their euphoria producing ability, encouraging some people to use them for recreational purposes. Between 28-38 million people in 2013 used Opioids for recreational purposes which is approximately 0.6-0.8 percent of worldwide population aged between 15-65.Opioids operate usually by attaching to Opioid receptors which principally are found in the peripheral and central nervous system as well as along the gastrointestinal tract. Such receptors as these mediate both the somatic and psychoactive Opioids effects. Consequently, Opioids are categorized amongst the oldest recognized drugs, with the therapeutic opium poppy use predating recorded history. Even though the phrase opiate is regularly used as a substitute for Opioid, the phrase opiate is appropriately restricted to the natural alkaloids that are available in the resin of opium poppy whereas Opioid may be used to refer to both synthetic substances and opiates and Opioid peptides. Opioids have for thousands of years been utilized as a way of offering pain relief. Nevertheless, there are numerous other uses of Opioid which depends on the effect mediated by the different Opioid receptors (Alleman, 2014). Opioids have numerous clinical uses and some of them comprise of pain relief-which is employed to curb acute pain experience after surgery and is one of the most popular indications for use of Opioid within the clinical settings. The second use is in case of trauma or injury where basically the pain that occurs due to trauma or injury can be suppressed using Opioids, with the exception of head injury in which case it should be used with caution. Opioids can also assist in reducing cancer pain particularly in end or advanced stages .This is referred to as palliative care and is at times the method used in management of terminal pain. Opioids can also manage pain that is especially caused by severe disabling and chronic disease, for instance the degenerative rheumatoid arthritis condition can also be effectively managed by using Opioids. Thus, such chronic illnesses can cause unbearable pain that may result in severe distress as well as disability unless it is managed by using Opioids (Alleman, 2014). The other major use of Opioids is in anesthesia which constitutes 3 key aspects; analgesia or pain relief, surgery memory loss together with relaxation of muscle so as to facilitate not only surgery but also manipulation. Thus, the analgesic effect exhibited by anesthesia is mostly attained by use of Opioids. Because one of the side effects of Opioids is cough suppression, some Opioids may be used for this particular purpose, particularly when it regards non-productive and dry cough. Popular cough suppressants comprise of codeine, hydrocodone, hydromorphine and ethylmorphine. Nonetheless, these Opioids may have other side effects but a derivative of an Opioid known as dextromethorphan is regularly taken as cough suppressant. The other notable side effect of Opioids is constipation which can be used in the suppression of diarrhea. Nevertheless, Opioids are not largely used in controlling infective diarrhea because of the risk of life threatening and serious consequences. Thus such drugs as loperamide and diphenoxylate are used in the treatment of irritable bowel as well as other organic diarrhea causes. Lastly Opioids like buprenorphine and methadone can be utilized in helping to wean addicts off potent Opioids like heroin. For instance, methadone is administered in small doses after withdrawing from heroin so as to minimize Opioid dependency but without resulting in serious withdrawal symptoms. Serious anxiety can be treated using such Opioids as oxymorphone and dihydrocedeine (Mandal, 2013). The Louisiana Legislature in 2014 adopted numerous regulations relative to not only scheduling but also use of definite controlled substances. The state has seen very recent changes not only in laws but also rules at both state as well as federal level in regard to controlled substances in an endeavor to influence narcotic/Opioid misuse and use. An email was sent on 17th July 2014 by the Louisiana State Board of Nursing (LSBN) to every APRN that have their licenses in Louisiana and have prescriptive authority explaining changes in regulations relating to Soma and Tramadol. Changes were also made for the categorization of hydrocodone products. Thus, Act 397 (SB 618) took effect on 1st August 2014 in Louisiana. This act moved carisoprodol (Soma) products in the Louisiana Uniform controlled Substances Law from Schedule 4 category to Schedule 2 category which basically is more restrictive, with the only exception relating to a blend product with codeine (Alleman, 2014). Additionally a federal act came into effect on 18th august 2014 and placed tramadol (Ultram) products in schedule 4 of the controlled substances in federal list. This product initially was a non-controlled one and the APRNs can no longer prescribe it in Louisiana as far as management of non-cancer related chronic pain. Eventually, on 21st august 2014 the US Drug Enforcement Administration(DEA) claimed that it will remove majority of hydrocodone products from schedule 3 to schedule 2 which happens to be more restrictive. Consequently, this came into effect on 6th October 2014. Moreover, APRNs lacking privileges of controlled substances no longer were they allowed to prescribe tramadol (Ultram).Consequently, all licensed APRNs operating in Louisiana and having no full Schedule 2 authority are no longer able to prescribe the substances classified in that schedule. Thus, APRNs having a need for additional or initial controlled substance privileges so as to offer suitable services in their patient population can apply to get the privileges by adhering to the provided instructions as well as filling out an application form. Finally, LSBN no longer updates APRNs prescribing schedules automatically. The document requesting the necessary changes must be submitted physically (Alleman, 2014). 2. Schedule II-the substances that are classified in this schedule usually have a high probability of being abused something that may result in serious physical and psychological dependence. Some of the most known examples comprise of such narcotics as methadone, hydromorphone, oxycodone and meperidine. Other examples comprise of opium, morphine, codeine as well as hydrocodone (Alleman, 2014). Some of the side effects of substances in this category are; swollen tongue, throat, lips or face, difficulty in breathing, pounding heartbeats, seizure ,having feelings of passing out and wheezing. Other mild side effects comprise of nausea, constipation, vomiting, dizziness, lighting, flushing, drowsiness, dry mouth and sweating. Some of the above side effects might reduce after one has been using the medication for some time. However, if some of the side effects worsen or persist, it’s advisable that one informs their pharmacist or doctor promptly (Alleman, 2014). Schedule III drugs on the other hand have a possibility for abuse which is much less than those in schedules I and II with abuse resulting in low or moderate physical dependence and at times high psychological reliance. Schedule III substances comprise of products that have less than 90 mg of codeine per unit of dosage such as buprenorphine and Tylenol, benzphetamine, ketamine as well as anabolic steroids like Depo-testosterone. Some of the widespread side effects related with Schedule III substances include deepened voice may be experienced in women, severe acne, hair loss, oily hair and skin, liver sickness(liver cysts and tumors),heart diseases such as stroke and heart attack, altered moods, suicidal tendencies, increased aggression irritability, depression and kidney disease. Other side effects include hypertension, azoospermia, gynecomastia, shrinking as well as reduction of testicles, infertility, irregular menstruation, stunted height and growth in teenagers (Hanson et al, 2014). Schedule IV substances comprise of substances that have a low possibility for abuse compared to schedule III substances. Examples of substances in this category comprise of alprazolam (Xanax) , clorazepate (Traxene), lorazepam(Ativan), temazepam (Restoril) as well as midazolam (Versed).Some of the notable side effects of substances in this category comprise of; dizziness, drowsiness, memory problems ,insomnia, slurred speech ,irritability, trouble in concentrating, headache, sweating, blurred vision and sweating (Goldberg & Ernst,2012). 3. Pain can be described as an uncomfortable sensation or unpleasant feeling in someone’s body. Whenever pain is present in someone’s body it is an indication that there is something that is not right. Pain can be categorized as either chronic or acute pain. An acute pain starts suddenly and generally is extremely sharp in its quality. An acute pain acts as a warning to the body that a disease is in the offing. There are several causes of an acute pain which comprise of broken bones, surgery, dental work, labour together with childbirth and cuts or burns.An acute pain can be mild and only last for a moment and may on the other hand be severe and last for several weeks or even months. In most instances, an acute pain does not stay for more than 6 months and it usually disappears whenever the underlying cause has healed or treated. Nevertheless, unrelieved acute pain may result in chronic pain (Sams, 2006). On the other hand, chronic pain continues in spite of the fact that there has been treatment and healing of the injury. Thus, pain signals usually remain active within the nervous system for days, weeks, months and even years .Some of the physical effects comprise of tense muscles, feeling tired, lacking energy as well as appetite changes. Emotional effects comprise of anger, depression, anxiety as well as fear of being re-injured. Such kind of fear may prevent one’s ability to resume normal leisure or work activities. The following are some of the common complaints from chronic pain patients; cancer pain, headache, arthritis pain, psychogenic pain and neurogenic pain (Sams, 2006). 4. No evidence exists to support individual cause in explaining any particular substance abuse condition. Nevertheless, research has established links between definite factors as well as the ensuing development of substance linked problems. These factors constitute genetic factors which have demonstrated that if a person has a first degree family member having Opioid addiction, then s/he is most likely to have the condition as compared to the ones without a similar history in their family. The second factor is indirect genetic influences and research shows that some likely causes might operate via genetic influences. Thus, for instance, some temperamental features such as impulsivity and novelty seeking are believed to be innate and have been associated with a high risk of addiction to Opioids. In addition, our nature also has a major influence on what kind of individuals one hangs around with. Whereas peers have a main influence on what kind of choices we make on our substance consumption, we are the ultimate decision makers on the peer group that we will belong to. The other factor is coping factor which basically is experienced by persons having difficulty in enduring negative mood situations because of failing to learn efficient coping mechanisms during their childhood as well as their adolescence especially when distressed. Thus in their search for relief, they may be led to abuse Opioids so as to get the pleasant effects capable of counteracting their bad moods. The following are signs of opiate addiction and abuse which can be classified under psychological/mood symptoms, behavioral symptoms and physical symptoms. Some of the psychological/mood symptoms include anxiety attacks, psychosis, depression, euphoria, irritability, lowered motivation as well as an increase in general anxiety. Behavioral symptoms comprise of abandoning of essential activities, a lot of time spent in acquiring, using or recuperating from the substance, failed endeavors to reduce the quantity taken and using of Opioids for prolonged or a longer amount of time than intended. Physical symptoms on the other hand comprise enhanced alertness, increased energy, increased heart rate, reduced appetite, physical agitation, more sexual arousal, constriction of blood vessels, difficulty in sleeping as well as over arousal. Opioid abuse has the following effects; constipation, fatigue, bronchospasm, nausea, psychological and physical dependence, chest pain, death results due to over use. Drug dependence and drug abuse represent varying ends of similar disease process. Thus, drug abuse can be described as an intense craving to use increasing quantities of a specific substance(s) to the omission of other things or activities. On the other hand, drug dependence can be said to be the physical need or rather addiction of a body to a particular agent. Thus, there is practically no distinction between addiction and dependency. Over a certain period, this dependence leads to behavior problems, physical harm and relationship with individuals who abuse drugs. Whenever drug abuse is stopped, there are certain withdrawal symptoms that are experienced (Koob & Arends, 2014). 5. The following is necessary for comprehensive pain assessment prior to prescribing a patient with opiates. First and foremost the nurse practitioner should screen the patient for pain which is done by routinely screening every patient for by questioning them about pain presence. The nurse should note pain terminologies such as ‘discomfort’ ‘hurt’, ‘ache’ which are used by the patient in describing pain and assess each word used during the continuing assessment. Thus, screening must take place at first contact and be done repeatedly as indicated and depending on the patient’s setting, condition, care goals and so forth. The second necessary step is analysis of pain assessment source. The nurse should make use of self-report as the main source of assessment. In addition; pain reports of family as well as healthcare providers should be included for adults and children incapable of giving self-report. Eventually pain assessment must comprise assessment of behavioral pain indicators especially for non-verbal persons. The third recommendation is use of parameters for assessing the pain. The nurse should choose a systematic tool for pain assessment and should assess pain parameters including; location together with radiation, pain onset, duration as well as timing, pattern and quality, precipitating factors, alleviating and aggravating factors, and a description of a patient’s present pain as well as its history. The third recommendation entails tools for rating pain intensity. The choice of a suitable pain assessment tool is on the basis of its appropriateness of use with the given patient population. A similar tool must be utilized whenever assessment of pain is done (Grantham & Brown, 2012). The fifth recommendation comprises of comprehensive pain assessment parameters which constitute of physically examining the patient, using the appropriate diagnostic and laboratory data, understanding and effects of present sickness, pain history, behavioral and physiological pain indicators, effects on daily living activities, all previous and present pain treatments, their efficiency as well as their undesirable effects, pain meaning as well as distress that the pain has caused both present and past, coping responses to pain and stress, multidimensional effects, patient’s expectations and preferences/beliefs/myths/hopes regarding pain management techniques. The sixth recommendation includes timing of pain reassessment-the nurse should reassess pain regularly based on the form and intensity of treatment plan and pain. Thus, reassessment of pain is done with every new pain report, any change in pain presentation as well as when pain is not relieved by past efficient strategies. Consequently pain is then reassessed when the peak effect has been reached after intervention. In case of acute post-operative pain, assessment must be regularly done as established by the operation together with pain severity, with every new pain report or instance of unanticipated pain (Grantham & Brown, 2012). The seventh recommendation constitutes pain reassessment parameters which comprise of parameters within the standard pain re-assessment. The nurse should analyze present intensity of pain, quality as well as location, pain intensity at its worst point in the previous 24 hours on movement as well as at rest, degree of pain relief attained-response (pain reduction on intensity rating scale), and obstacles to executing the treatment plan, pain effects on daily living activities such as cognition, mood and sleep, undesirable effects of pain treatment medications such as sedation, constipation, confusion and nausea, display of physical/aberrant dependence, tolerances, pseudo addiction and addiction and finally strategies that may be used in relieving pain, both non-pharmacological and pharmacological (Grantham & Brown, 2012). The eighth recommendation entails assessment of unanticipated severe pain-unanticipated pain should be immediately assessed, especially if abrupt ,associated with changed vital signs such as tachycardia,dyspnea ,hypotension and fever or related with changes in mobility, function or behavior. The ninth recommendation comprises of pain assessment documentation which must be done routinely and regularly on standardized forms accessible to every clinician carrying out the care. The nurse involved should teach families and patients to document assessment of pain on the suitable tools whenever care is offered. This will ensure their involvement in the treatment plan in addition to promoting continuity of efficient pain management across the board (Grantham & Brown, 2012). Finally the last recommendation involves advocacy for control of pain which should be done on patient behalf for treatment plan changes whenever there is no relieve of the pain. The healthcare practitioner should discuss with the interdisciplinary healthcare team as regards identification of any need for change within the treatment plan. Thus the healthcare practitioner should support his/her suggestions with suitable evidence, offering a clear justification for the requirement for change which may comprise; pain intensity as recorded by an appropriate scale, changes in pain severity cores in the past 24 hours, changes in quality and severity of pain after analgesic administration as well as length of time that the analgesic is effective, the quantity of regular as well as breakthrough pain medication administered in the past 24 hours, the pain relief objectives for the patient, presence/absence of undesirable effects together with recommendations for particular changes to the treatment plan which is supported by relevant evidence (Thorson, et al,2014). Some of the modalities/referrals that would be helpful to my patient include nurse practitioners(NPs) together with physician assistants(PAs) are any patient’s best hope as far as dealing with the rising number of primary care doctors reluctant to offer suitable pain management for those persons ailing from chronic pain. Thus the NPs and PAs are increasingly taking an active role and at present most pain clinics are headed by these interventionlists whose key focus is invasive procedures and at times pharmacologic treatment. Pain clinics on recognizing the importance of medication management are increasingly employing PAs and NPs to not only do assessments for the patients but also to prescribe pain drugs (Schneider, 2008). References Alleman, J. (2014). Changes in Controlled Substance Schedules . Louisiana Association of Nurse Practitioners , p1-5. Grantham, D. & Brown,S. (2012). Pain Assessment and Management:Clinical Practice Guidelines. Winnipeg Regional Health Authority , p1-30. Hanson,G.,Venturelli,P.,& Fleckenstein,A.(2014). Drugs and Society. New York,NY: Jones & Bartlett Learning . Joseph Goldberg, C. E. (2012). Managing the Side Effects of Psychotropic Medications. New York,NY: American Psychiatric Association. Koob,G.& Arends,M. (2014). Drugs, Addiction, and the Brain. New York,NY: Elsevier. Mandal, A. (2013). Opioid Uses. Medical News:The Latest Developments in Life and Sciences & Medicine , p 1-3. Sams, T. (2006). ABCs of Pain Relief and Treatment: Advances, Breakthroughs, and Choices. New York,NY: iUniverse. Schneider, J. (2008). Emerging Role of NPs and PAs in Pain Management. Practical Pain Management Communications Inc , p1-4. Thorson, D., Biewen, P., Bonte, B. & Epstein, H. (2014) Acute Pain Assessment and Opioid Prescribing Protocol. Institute for Clinical Systems Improvement. Read More