The first step is to determine, using an immediate preparation, what dose is required to relieve the patient's pain. It is important to use rescue dosing if the pain suddenly increases. During chronic dosing of opioids, respiratory depression is not a concern. However, up to one-third of patients can have nausea. Urinary retention, multifocal myoclonus, and constipation can be problems.
Constipation is caused by slowed bowel motility.
Thus, it must be treated with drugs that increase bowel motility and not just bulking agents. Another barrier to the use of opioids is the clinician s fear of being accused of improper prescribing. Adequate clinical chart notes including response to the medication, unwanted effects, dose adjustment, and the number of medication units dispensed are excellent antidotes to this fear. That team includes the administrator, the nursing supervisor, the primary care nurse, the physician, the pharmacist, the dietician, the social worker, and the physical therapist. Each of these professionals has a specific part to play.