|Fear of addiction|
- Explain that addiction is uncommon in patients taking opioids for pain.
|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.
|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.
|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.
|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.
|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.
|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.
|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.
|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.
- 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.