An older client with muscle wasting, renal disease, and advanced cancer pain asks for stronger pain medication than immediate-release oral morphine. What is the most important consideration when recommending a pain medication change to the health care provider for this client?
1. If the narcotic dose is increased, constipation is more likely.
2. Sleeping through meals is more likely when narcotic doses are increased.
3. Extended-release oral morphine should be considered for this client.
4. A Fentanyl transdermal patch provides excellent relief for cancer-related pain.
3. Extended-release oral morphine should be considered for this client.
Explanation: 1. Constipation does increase with increased narcotic amounts. This is a side effect that can be aggressively prevented and is not a reason to undertreat pain.
2. First, the client may become relieved enough to enjoy eating; sleeping through meals is not guaranteed with narcotic doses. Second, the client with muscle wasting likely has very far progressed disease and malnutrition will be difficult to correct in the presence of pain, wasting, and renal failure whether pain is controlled or not.
3. Morphine is a commonly used and versatile opioid for the treatment of moderate to severe pain. Short- and long-acting formulations exist, and the drug can be delivered via many routes including oral form. The amount of immediate-release medication used can help determine the dose of extended-release morphine to prescribe.
4. Fentanyl patches work well to provide sustained pain control. However, this is not the next option for this client. A client who has lost a great deal of weight, such as occurs with muscle wasting, may not have enough tissue to correctly absorb the medication transdermally.
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