Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-05T03:27:46.033Z Has data issue: false hasContentIssue false

Cessation of Long-Term Morphine Analgesia - A Case Study

Published online by Cambridge University Press:  25 February 2009

David T Cowan
Affiliation:
Academic Department of Anaesthesia, Northwick Park Hospital and Florence Nightingale School of Nursing & Midwifery, King's College, London.
David Wright
Affiliation:
Dept of Anaesthesiology, Duke University Medical Centre, N. Carolina, USA.
Get access

Background

With regard to the problematic use of opioid analgesic drugs, attention is focused not only on those who began using opioids for recreational purposes, but also on those who may become iatrogenically addicted to opioids administered for pain control. It has been suggested that narcotics opioids cause psychological and physical dependence after relatively small therapeutic doses, for a relatively short period of administration Glatt 1974 and that physical dependence may even start to manifest after a single therapeutic dose Qones 1980. Despite these claims, some patients report that they are able to benefit from relatively long-term opioid analgesia without experiencing the effects of problematic drug use that are associated with recreational drug users (Cowan et al 2001, 2002). This issue has obvious implications for anaesthetic and recovery room practitioners who routinely administer opioids to patients in their care. In view of this, the following case study report may be of interest to such practitioners.

Type
Research Article
Copyright
Copyright © British Association of Anaesthetic and Recovery Nursing 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association. (1994): Diagnostic and Statistical Manual of Mental Disorders, 4th edition.American Psychiatric Association, Washington DC.Google Scholar
Brena, S.f. and Sanders, S.H. (1991): Controversy corner: Opioids in non-malignant pain: Questions in search of answers. Clinical Journal of Pain 7, pp. 342345.CrossRefGoogle Scholar
Butler, S.h. (1994): Opiates for chronic painpresent American controversy. Proceedings of the 24th Interational Narcotics Research Conference, Sweden 1993. Regulatory Peptides 50, Supplement 1, pp. 295296Google Scholar
Cowan, Dt, Allan, L.G, Griffiths, P. and Libretto, S.E. (2001): Opioid drugs: a comparative survey of therapeutic and 'street' use. Pain Medicine 2: pp.193203CrossRefGoogle ScholarPubMed
Cowan, D.t, Allan, L.G. and Griffiths, P. (2002): A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients. International Journal of Nursing Studies 39: pp. 5969.CrossRefGoogle ScholarPubMed
Fishbain, D.a., Rosomoff, H.L. and Rosomoff, R. S. (1992): Drug abuse, dependence, and addiction in chronic pain patients. The Clinical Journal of Pain 8, pp. 7785.CrossRefGoogle ScholarPubMed
Glatt, M. (1974): Drugs, Society & Technical Publishing, pp. 203Google Scholar
Halpern, L.m. and Robinson, J. (1985): Prescribing practices for pain in drug dependence: A lesson in ignorance. Advances in Alcohol and Substance Abuse 1–2, pp. 135–162. Handelsman,CrossRefGoogle Scholar
Cochrane, L., Aronson, Kj., Ness, Mj., Rubinstein, R., KJ. and Kanof, P.D. (1987): Two new rating scales for opiate withdrawal. American. Journal of Alcohol Abuse 13, pp. 293308.Google Scholar
Haythornewaite, Menefee, J. A., Quantrano-Piacentini, L. A., A. L. and Pappagallo, M. (1998): Outcome of chronic opioid therapy for non-cancer pain. Journal of Pain and Symptom Management 15, pp. 185–94.Google Scholar
Himmelsbach, C.K. (1939): Studies of certain addiction characteristics. Journal of Pharmacology & J.H. (1990): Drug addiction and drug abuse. In: Goodman Gilman, P.. (Eds.), The Pharmacological Basis of Therapeutics, 8th Edition. Pergamon press, Oxford, pp. 522530.Google Scholar
Jonasson, T.. (1998): Analgesic use disorders among orthopaedic and chronic pain patients at a rehabilitation clinic. Substance Use and Misuse 33, 13751385.CrossRefGoogle ScholarPubMed
Jones, R.T. (1980): Dependence in non-addict humans after a single dose of morphine. Endogenous and Exogenous Opiate Antagonists Pergamon, New York, pp. 557560.CrossRefGoogle Scholar
Large, S.A. (1995): Opioids for chronic pain of non-malignant pain origincaring or crippling. Healthcare Analysis 3, pp. 5- 11. Lexicon of Alcohol and Drug Terms, (1994): World Health Organisation, Geneva Maruta,CrossRefGoogle ScholarPubMed
Swanson, R.E.(1979): Drug abuse and dependency in patients with chronic pain. Mayo Clinic Proceedings 54, 241244.Google Scholar
McQuay, H.J. (1997): Opioid use in chronic pain Acta Anaesthesiology Scandinavia 41, pp. 175–83.CrossRefGoogle Scholar
McQuay, H.J. (1999): Opioids in pain management. Lancet 353, pp. 22292232.CrossRefGoogle ScholarPubMed
Melzack, R. (1990): The tragedy of needless pain. Scientific American 262, pp. 1925.CrossRefGoogle ScholarPubMed
Morgan, J.P. (1985): American opiophobia: Customary underutilization of opioid analgesics. Advances in Alcohol and Substance Abuse 5, pp. 163–73.CrossRefGoogle ScholarPubMed
Portenoy, R.K. (1996): Opioid therapy for chronic non-malignant pain: A review of the critical issues. Journal of Pain and Symptom Management 11, pp. 203217.CrossRefGoogle Scholar
Redmond, J.H. (1984): Multiple mechanisms of withdrawal from opioid drugs. Annual Review of Neuroscience 7, pp. 443478.CrossRefGoogle ScholarPubMed
Wang, B.L. (1974): Rating the presence and severity of opiate dependence. Clinical Pharmacology & Therapeutics 16, pp. 653658.CrossRefGoogle ScholarPubMed
Zilm, D.H. and Sellers, E.M. (1978): The quantitative assessment of physical dependence on opiates. Drug and Alcohol Dependence 3, pp. 419428.CrossRefGoogle ScholarPubMed