Review Article

Cancer Pain Management: Opioid Analgesics, Part 2

Rita J. Wickham, PhD, RN, AOCN®

Rush University College of Nursing (Adjunct Faculty), Chicago, Illinois

Author’s disclosures of potential conflicts of interest are found at the end of this article.

Rita Wickham, PhD, RN, AOCN®, 8039 Garth Point Lane, Rapid River, MI 49878. E-mail: rita.j.wickham@gmail.com


J Adv Pract Oncol 2017;8:588–607 | https://doi.org/10.6004/jadpro.2017.8.6.3 | © 2017 Harborside Press®


  

ABSTRACT

Opioid analgesics are the cornerstone of moderate to severe cancer pain management, and do not have ceiling doses unless unmanageable adverse effects occur. Oral, short-acting pure μ agonists such as morphine are most frequently used, but other agents and administration formulations allow finding the right opioid and dose for most patients. In addition, clinicians must understand the metabolism, pharmacokinetics, and elimination of particular drugs to individualize opioid selection, select initial doses, and appropriately escalate doses to satisfactory pain relief or uncontrollable toxicity. Anticipation and proactive management of possible adverse effects, particularly constipation, confusion or delirium, opioid-specific adverse effects, and opioid abuse, are also integral to primary and secondary prophylaxis and management.




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