Pain & Opioids: Common Myths and Misconceptions
Opioids are among the most misunderstood medications in modern medicine. Let us clear the air by busting some of the most common myths and misperceptions.
Myth: Healthcare providers should wait until closer to the person’s end of life to use opioids for fear they will not work if they are started too early in the disease trajectory.
Fact: It is important to consider that pain does not necessarily worsen at end-of-life. Skillful pain management approaches need to be used at all stages of the disease journey3. Opioids do not have a ceiling dose (aside from dose limiting side effects) and this allows clinicians to safely titrate the amount of opioid and switch between opioids if needed1,2,3.
Myth: Persons who are experiencing pain will always have an elevated blood pressure and pulse
Fact: Our bodies work to maintain homeostasis overtime so that physiological adaptations to pain can occur quickly so that individuals will no longer exert a corresponding change to blood pressure and pulse rate. Self report about pain is the gold standard when possible 1,3.
Myth: Persons who are experiencing pain never fall asleep
Fact: The ability of a person to fall asleep does not automatically indicate that pain is not present. A person can be sleeping and still have pain 1,3.
Myth: Most people overstate/exaggerate their pain level
Fact: Everyone will express their experience of pain uniquely. Ensuring we remain unbiased in our attitudes towards their expression is critical for clinicians working to support pain management1,2,3.
Myth: You can usually tell by looking at a person if they are experiencing pain
Fact: Pain is a subjective experience that we are not able to always recognize in others for a variety of reasons. Self-report remains the gold standard when possible 1,3.
Myth: Addiction will occur any time opioids are used
Fact: It is rare for an individual to become an addict when opioid use is managed responsibly in end-of-life care. Addiction is a psychological issue. When a person takes medication for pain, it does not have the same effect than if the person was not in pain. The objective is to match the pain medication with the amount of pain experienced 1,3. The need to increase the dose over time is not an indication of addiction, but most often a progression of disease and the development of tolerance to the medication 1,2.
Myth: Opioids cause severe side effects
Fact: Constipation, nausea & vomiting and drowsiness are common side effects experienced when a person starts or increases an opioid. Generally within 72 hours the body has a chance to adjust to the new dose and symptoms of nausea, vomiting and drowsiness are relieved without further intervention 1,3. When taking opioids on a regular basis, you will always have to take a medication to prevent constipation1. Be sure to record and report any side effects and request support as needed 1
Resources
- HPC Consultation Services of WW. Essential Pain Management: Using a Palliative Approach Course. https://hpcconnection.ca/education/courses/ww-hpc-courses/essential-pain-management/
- Michael’s Hospital Palliative Care Unit (2008). Some common myths about morphine…and other opioids. Toronto, ON: St. Michael’s Hospital. Jovey
- D. (2002). Managing Pain: The Canadian Healthcare Professional’s Reference. Toronto, ON: Healthcare & Financial Publishing
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