Nurses’ understanding of pain treatment is essential for its effective management. Yet effective pain control often eludes those who most need it particularly when opioid analgesics are involved.
Last month NICE clinical guideline on prescribing opioids to relieve pain was published. It highlighted that up to two-thirds of people with cancer that experience pain need strong opioid and the number is similar in many other advanced and progressive conditions. Yet pain remains under-treated in these groups of patients.
Opioids, especially morphine are vital drugs in our treatment of pain but the public and many health professional misunderstand and misinterpret their use. Myths surround morphine: it is often viewed as a drug of last resort for those who have no hope. We have all seen relatives shake their heads and whisper “They’ve started him on morphine” or met patients who tolerate pain and pride themselves on resisting their opioid medication because they do not want to become addicted. How many nurses believe you can’t give opioids to patients with COPD? Yet they are vital drugs in the management of breathlessness at the end of life.
The Harold Shipman case has left its mark on how prescribers view opioids and I wonder if fear of scrutiny has resulted in an over cautious approach or avoiding prescribing opioid drugs at all. Yet these anxieties should not exist in a health service that has considerable expertise in pain control and palliative care. All health professionals should be able to access this expertise and be confident in their understanding of pain, the drugs used to treat it and their ability to communicate this to patients.
The new NICE guidance highlighted the vital role nurses have in demystifying opioid analgesia for patients and ensuring they understand the benefits and side effects of treatment. To do this, nurses need to challenge their own beliefs and anxieties about these drugs and ensure they approach this vital part of care as knowledgeable practitioners.