Narcotic pain relievers: organ damage, lucidity?


Question from BMiller: How do you convince a spouse with metastatic breast cancer to take a narcotic pain reliever when she fears harm to her liver or losing touch with everyday events?
Answers - Neal Slatkin If we considered all pain medications that might be used to relieve pain, the opiate or narcotic pain medications are really the safest. Now, I understand that that statement defies conventional wisdom. However, opiate use is not associated with liver damage, kidney damage, or damage to the heart, the lungs, the bone marrow, or any other significant organ system toxicity.

It is true that some patients become sleepy on the opiates or even confused. There are multiple approaches to be taken to that problem. Sleepiness should certainly not be a reason not to take medications.

If sleepiness is an issue, I would encourage your spouse to speak to her practitioner or pain specialist about alternative opiates, alternative pain-relieving procedures, other medications that may be added to allow the lowering of dosages of opiates, or other medications that can help reverse the sleep-inducing effects of the opiates.
Michelle Rhiner The opiates are, indeed, safe to the various organs. But we must differentiate between the opiates that are combined with Tylenol, for example, and those opiates that are pure opiates and do not have any other aspirin, Tylenol, or anti-inflammatory drug combined with them. With combined opiates, you need to worry about effects on the liver or kidneys. If the opiate is combined with something like Tylenol or aspirin, there's a ceiling to how much you can use. You can have liver toxicity if you exceed a certain amount per day.
Jennifer Griggs, M.D., M.P.H. It's ironic that the drugs we take without a second thought like acetaminophen (brand name: Tylenol) and aspirin are actually the ones Michelle is bringing up that pose more of a hazard than those we think of as stronger.
Michelle Rhiner Sharing that information with your spouse should help to convince her that opiates are far safer medications and certainly very effective in relieving the pain.
Jennifer Griggs, M.D., M.P.H. Some patients need to hear this message several times before it sinks in. You can enlist the help of your wife's nurse and physician in helping her think about managing her pain.

On Wednesday, January 21, 2004, our Ask-the-Expert Online Conference was called Pain Management: Getting the Relief YOU Need. Neal Slatkin, M.D., Michelle Rhiner, N.P. and moderator Jennifer Griggs, M.D., M.P.H. answered your questions about the best ways to deal with the physical pain and discomforts associated with breast cancer and breast cancer treatment.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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