| Barrier | Nursing Consideration |
| Fear of addiction | - Explain that addiction is uncommon in patients taking opioids for pain.
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| Fear of tolerance | - Teach that tolerance is a normal physiologic response to chronic opioid therapy. If tolerance does develop, the drug may have to be changed (e.g., morphine in place of oxycodone).
- Teach that there is no absolute upper limit to pure opioid agonists (e.g., morphine). Dosages can be increased, and patient should not save drugs for when the pain is worse.
- Teach that tolerance develops more slowly to analgesic effects of opioids than to side effects (e.g., sedation, respiratory depression). Tolerance does not develop to constipation. Thus a regular bowel program should be started early.
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| Concern about side effects | - Teach methods to prevent and to treat common side effects.
- Emphasize that side effects such as sedation and nausea decrease with time.
- Explain that different drugs have unique side effects, and other pain drugs can be tried to reduce the specific side effect.
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| Fear of injections | - Explain that oral medicines are preferred.
- Emphasize that even if oral route becomes unusable, transdermal or indwelling parenteral routes can be used rather than injections.
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| Desire to be “good” patient | - Explain that patients are partners in their care and that partnership requires open communication by both patient and nurse.
- Emphasize to patients that they have a responsibility to keep you informed about their pain.
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| Desire to be stoic | - Explain that although stoicism is a valued behavior in many cultures, failure to report pain can result in under treatment and severe, unrelieved pain.
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| Forgetting to take analgesic | - Provide and teach use of pill containers.
- Provide methods of record keeping for drug use.
- Recruit caregivers to assist with the analgesic regimen.
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| Concern that pain indicates disease progression | - Explain that increased pain or the need for analgesics may reflect tolerance.
- Emphasize that new pain may come from a non–life-threatening source (e.g., muscle spasm, urinary tract infection).
- Institute drug and nondrug strategies to reduce anxiety.
- Ensure that patient and caregivers have current, accurate, comprehensive information about the disease and prognosis.
- Provide psychologic support.
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| Sense of fatalism | - Explain that pain can be managed in most patients.
- Explain that most therapies require a period of trial and error.
- Emphasize that side effects can be managed.
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| Ineffective medication | - Teach that there are multiple options within each category of medication (e.g., opioids, NSAIDs), and another medication from the same category may provide better relief.
- Emphasize that finding the best treatment regimen often requires trial and error.
- Incorporate nondrug approaches in treatment plan.
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