Comparing Morphine IV Patient Controled Analgesia with Fentanyl Iontophoretic Transdermal System

Regarding Fentanyl patch 50 mcg #10 and Percocet 10/325 mg #90, CA MTUS Chronic Pain Medical Treatment Guidelines and ODG do not support ongoing opioid treatment unless prescriptions are from a single practitioner and are taken as directed; are prescribed at the lowest possible dose; and unless there is an ongoing review and documentation of pain relief, functional status, appropriate medication use, and side effects. This is a chronic pain patient with a 2010

Fun fact, in the UK, some hospitals use diamorphine, a generic name of heroin to prescribed as a strong pain medication in patients suffering from myocardial infarction, post-surgical pain, and chronic pain, including end-stage cancer and other terminal illnesses. It is still given over there, instead of using Morphine, because some hospital state it a lot better from pain

Initial approval of short-acting opioid prescriptions for the treatment of pain related to post-surgical procedures is limited to a maximum of 14 days of therapy for patients of all ages. Renewal approval of short-acting opioid prescriptions is limited to patients younger than 18 years of age and may not exceed 7 days of

According to the systematic review covered by Apfel, Turan, Souza, Pergolizzi & Hornuss, 2013 there is a significant reduction in postoperative nausea and vomiting and opioid use when using intravenous acetaminophen. The reviewers used Medline and Cochrane databases to conduct their search along with a hand search of abstracts to identify randomized-controlled trials using intravenous acetaminophen. The review was to determine if the acetaminophen was going to have a significant decline in nausea and vomiting following surgical procedures as

Narcotic analgesics, especially morphine are underused for pain control with in the medical field. This underuse is because medical professionals, including doctors, fear patient addiction, side effects and possible lose of their licenses. These fears deny adequate healing and a better quality of life to those who would benefit from a more effective use of these drugs, as done in hospice care.

Opioid abuse, misuse and overdose is a problem in The United States. You can’t turn on the TV or read a newspaper without some mention of the epidemic. This issue has caused the practice of prescribing or taking narcotic pain medication to be looked at under a microscope. Patients are fearful to use some necessary pain medication, because they may become addicted. Other patients who genuinely do have pain and need medication are having a tougher time obtaining the help they need. The problem of abuse and addiction is tough to solve since for some people the medications are the only way they can function and live a semi-normal life. A patient with pain may be hesitant to visit the doctor and

3Transdermal delivery of fentanyl has a variety of advantages compared to other delivery systems. Unlike oral administration, transdermal fentanyl avoids first–pass hepatic effect of the liver, which can prematurely metabolize drugs. In comparison with oral opioids, transdermal fentanyl has a lower incidence and impact of adverse effects such as constipation and vomiting, it also enhances patience compliance (as administration is every 72 hours). Transdermal delivery of fentanyl is also more convenient in comparison to hypodermic injection which can be very painful but also exert dangerous medical waste and increase disease transmission with the re use of needles (which is very common in developing countries).

Considerable cautions have been obtained throughout the United States to decrease the misuse of prescription opioids and helps to minimize opioid overdoses and related complications. Even though the pain medications have a significant part in the treatment of acute and chronic pain situations, it sometimes happen that the high dose prescription or the prescribed medications, without having enough monitoring, can create bad outcomes. It is always a dilemma for the providers to find who is really in need of pain medications and to identify those who are questionably misusing opioids.

In 2014, more people died from drug overdoses then in any other year on record. A substantial amount of deaths were due to drug overdose on opioids, according to the CDC. (2015:64). In 1901, surgeon Racoviceanu-Pitesti published his first report on opioids for intrathecal anesthesia. In 1979, a report on the use of morphine as a treatment for pain was made, by Behar and his colleagues. Epidural and spinal opioids are today part of a routine regimen for intra- and postoperative anesthesia, according to Fisher (2003:683). Historically opioids have been used as painkillers, however the potential for misuse is huge; when these are used repeatedly, it increases the risk of developing an addiction. The use of illegal opiate drugs such as heroin

There is a growing concern for the use of opiates in pain management and other medical treatments. Due to illegal use and abuse of the opiates, there has been an increase in overdose and dependency throughout the nation and even the world. The use of opiate substances can include pain management and even cough suppression in severe cases; however, the side affects make the drugs appealing to those with substance abuse problems. President Donald Trump has declared the opioid epidemic a national public health emergency, which has led to the discussions of how to control the abuse of these substances (Merica). Despite the growing concern about opioid use, there are some benefits in the use of opioid substances in pain management. Many argue,

In the United States, opioids have become a major component in healthcare because they are an exceptional method of relieving pain. For those who are recovering from a recent inpatient surgery or those with cancer who are in a great deal of pain, it is a necessity. A known problem with opioids is that they are addictive, which leads to overuse of the medication by the patient. Opioids are also highly sought after as a street drug, this leads to patients exaggerating their pain level in order to receive more pills and selling their excess medication to others. Doctors will often prescribe opioids to patients who do not need such an aggressive form of pain relief, for example, people with arthritis or who have gone through a minor outpatient surgery. This can lead to a long-term use of these pain relieving drugs and possible addiction, which goes against the original purpose of opioids. In order to solve America’s dependence on opioids, medical professionals must go back to the original method of prescribing them, that is, only short-term use for people recovering from surgeries or in pain due to cancer, instead of a long-term solution for acute pain.

There are many various kinds of prescription of pain relievers, which include: opioids, corticosteroids, antidepressants and anticonvulsants (anti-seizure medications). Among them I would like to focus on opioid medications and its side effects. Opioid medications are narcotic pain medications that contain natural poppy plant, synthetic opiates such as; methadone, fentanyl, tapentadol and tramadol, as well as the semi- synthetic opioids such as; oxycodone, hydrocodone, oxymorphone, hydromorphone and heroin. Opioid prescriptions are morphine (C17H19NO3), heroin (C21H23NO5), codeine (C18H21NO3) and thebaine (C19H21NO3). They are highly addictive substances are called opiates. Opioid medications have been used for hundreds and thousands of years to treat both pain and mental health problems. It is also use in a short-term pain after surgery. According to the survey in the past two decades, the prescription of opioid in the United States has been increased to the higher levels that is more than 600% (Paulozzi & Baldwin, 2012). However, that opioid medications are very dangerous to the patients’ respiratory system, other parts of the internal body and even can cause death. It should be only being use after wise discernment and with a great care.

Opioid medications are frequently prescribed for severe pain. Opioids includes the pain medications like oxycodone, hydrocodone, morphine, and fentanyl as well as the illegal drug heroin (American Society of Addiction Medication, 2016). Many people rely on these drugs to relieve their pain from surgery, active cancer, chronic pain and end of life care (WebMD, 2017). Studies from the 2012 National Health Interview show that over 11% of adults report having chronic pain (Dowell, Haegerich & Chou, 2016). The opioid epidemic is a significant issue for nursing on the main respect that there is currently a problem with over- prescribing of narcotics and the millions of people addicted to opioid medications

Opioid addiction is so prevalent in the healthcare system because of the countless number of hospital patients being treated for chronic pain. While opioid analgesics have beneficial painkilling properties, they also yield detrimental dependence and addiction. There is a legitimate need for the health care system to provide powerful medications because prolonged pain limits activities of daily living, work productivity, quality of life, etc. (Taylor, 2015). Patients need to receive appropriate pain treatment, however, opioids need to be prescribed after careful consideration of the benefits and risks.

Pitakanen et al (1992) in a study evaluated the effect of adding fentanyl to prilocaine for IVRA and reported no significant benefit on duration of postoperative analgesia [10].