Chapter 9

Drugs for Pain Control,

Migraines, and Skeletal
Muscle Spasms

Understanding Pharmacology, 3rd ed.

Workman
 Learning Objectives—Lesson 9.1
(1 of 3)

1. Explain the physiology, pathophysiology, origins,

and transmission patterns for various types of pain.
2. Describe the names, actions, usual adult dosages,
possible side effects, and adverse effects of opioid
and nonopioid drug therapy for general pain
management.
3. Describe the priority actions to take before and after
giving drug therapy for general pain management.
4. Prioritize essential information to teach patients who
are taking drug therapy for general pain
management.
 Learning Objectives—Lesson 9.1
(2 of 3)

5. Explain the names, actions, usual adult dosages,

possible side effects, and adverse effects of drugs
for migraine headache.
6. Describe priority actions to take before and after
giving drugs for migraine headache.
7. Prioritize essential information to teach patients who
are taking drugs for migraine headache.
8. List the names, actions, usual adult dosages,
possible side effects, and adverse effects of drugs
to manage skeletal muscle spasms.
 Learning Objectives—Lesson 9.1
(3 of 3)

9. Describe the priority actions to take before and after

giving drugs for skeletal muscle spasms.
10. Prioritize essential information to teach patients who
are taking drugs to manage skeletal muscle
spasms.
11. Explain appropriate life span considerations for drug
therapy to manage general pain, migraine
headache, and muscle spasms.
 Pain
 Unpleasant sensory and emotional
experience associated with tissue damage
 We perceive pain with all our senses
 How we feel and react to pain depends on our
emotional makeup
 Pain is often both underreported and
undertreated
 Pain intensity: How much pain patient feels
 Review of Pain Physiology and
Pathophysiology
 Acute pain tells us something is wrong
 Damage stimulates nerve endings and sends a
message to the brain
 Nociceptors trigger message sent to brain
that allows perception of pain
 Nociceptors can be activated when body
chemicals called mediators bind to them
 The brain perceives pain on different levels
 Pain Perception
 Pain threshold: The smallest amount of tissue
damage that makes a person aware of having
pain
 Pain tolerance: Person’s ability to endure pain
intensity
 Behavioral and emotional factors as well as
physical factors affect a person’s pain tolerance
 Always ask patient about their pain
 Types of Pain
 Acute pain has a sudden onset, an
identifiable cause, a limited duration, and
improves with time; triggers physical
responses
 Chronic pain persists or increases with time,
may not have an identifiable cause, and does
not trigger physiologic responses
 Cancer pain has many causes and is
complex
 Issues Related to Analgesic
Drug Therapy
 Analgesics: Drugs of any class that control
pain
 Opioids
 Nonopioid miscellaneous drugs
 Usually given on an “as needed” basis with a
range of doses
 Doses are given on a schedule or patient
punches in a small IV dose
 Controlled Substances
 Controlled substances have ingredients that
may be addictive
 Five schedules of controlled substances
 The drugs most likely to lead to addiction are in
schedule I
 Those with the least potential for addiction are in
schedule V
 Federal government requires that all schedule II
and some schedule III drugs be carefully
controlled
 Administering Analgesic Drugs
 Check before:
 Pain intensity using preferred pain scale
 When the patient last received the drug
 Check after:
 Amount of pain relief (check in 30 min, then
hourly)
 Teaching priorities:
 Best pain relief occurs when drugs are taken on a
regular schedule rather than PRN
 Reduce dose but maintain schedule if pain is
lessened
 Opioid Agonists (Narcotics)
 Change a person’s perception of pain and
have the potential for dependence
 Opioids have an increased risk of causing
patient harm if used in error
 Tolerance can occur with long-term use
 More drug is needed to achieve the same degree
of pain relief
 How Opioid Agonists Work
 Work by binding to opioid receptor sites in the
brain and other areas
 The main opioid receptors are mu (OP3), kappa
(OP2), and delta (OP1)
 Opioids only alter the perception of pain
 Side effects:
 Constipation, nausea/vomiting, drowsiness,
flushing/itching
 Adverse effects:
 Respiratory depression, addiction, dependence,
withdrawal
 Administering Opioid Agonists
(1 of 2)

 Check before:
 Dose, drug name
 Respiratory rate, oxygen saturation
 Check after:
 Respiratory rate and O2 saturation at least hourly,
ask about constipation
 In severe respiratory depression, opioid blocker
may be needed
 Administering Opioid Agonists
(2 of 2)

 Teaching priorities:
 Take with food
 Do not drive or operate heavy machinery
 Change positions slowly
 Take stool softeners/laxatives before constipation
occurs
 Life Span Considerations for
Opioid Agonists
 Pediatric:
 Dosage based on age, size (weight in kg), health, pain
severity
 Pregnancy and lactation:
 Newborn addiction/withdrawal can occur
 If opioids given during labor, baby may need dose of opioid
antagonist
 Avoid breastfeeding if taking opioids for more than 2 days
 Older adults:
 Low vision and increased risk of falling
 Avoid meperidine (Demerol)
 Nonopioid Pain-Control Drugs
 They enhance the pain-control features of
other pain drugs
 Termed adjuvant drugs because they
enhance the pain-control features of other
pain drugs.
 Most have other main uses
 Acetaminophen
 Effective for pain relief
 Acetaminophen is given orally in tablets,
capsules, or liquids or suppository
 Toxic when taken at high doses, too often, or
with alcohol
 Risk for permanent liver or kidney damage
 Pediatric considerations:
 Toxic to the liver and kidneys at high doses
 Parents must read labels to determine the
strength and determine the correct dose
 Nonsteroidal Antiinflammatory
Drugs (NSAIDs)
 NSAIDs can help manage pain associated
with inflammation, bone pain, cancer pain,
and soft tissue trauma
 These drugs act at the tissue where pain
starts and do not change a person’s
perception of pain
 Antidepressants
 Reduce some types of chronic and cancer
pain
 The doses for pain control can be different
from those used to treat depression
 Antidepressants help increase the quantity of
natural opioids in the brain and help reduce
depression
 A patient must usually take one of these
drugs for 1 or 2 weeks before he or she feels
any relief from pain
 Antiepileptic Drugs
 Reduce some types chronic and cancer pain
 Neuropathic pain
 Migraine headaches
 Common drugs
 Gabapentin (Neurontin)
 Pregabalin (Lyrica)
 Doses for pain control are often higher than
those used to control seizures
 Muscle Relaxants
 Used in combination with other drugs for pain
control when part of the pain experience
includes muscle spasms
 Work by depressing the central nervous
system (CNS) and produce significant
sedation
 Medical Marijuana
(Cannabinoids)
 Now legal in some states and used for pain
management, to combat seizure disorders,
Parkinson disease, chemotherapy-induced
nausea and vomiting
 Many varieties of cannabinoid plants and
seem to have different effects
Physiology and Pathophysiology
for Migraine Headache
 Severe, throbbing headaches
 Often occur with nausea, vomiting, extreme
sensitivity to light and sound
 Two stages:
 Constriction of arteries
 Dilation of arteries
 Drug Therapy for Migraine
Headache
 Older migraine drugs
 Triptans
 NSAIDs
 Ergotamine
 Biologic agents
 Derived from living sources to target specific
inflammatory cells, components, or products
 Onobotulinumtoxin A, calcitonin gene-related
peptide antibodies
Calcitonin Gene-Related Peptide
(CGRP) Antibodies
 Intended responses:
 Reduce frequency and intensity of headaches,
increase ability to participate in activities of daily
living, improved quality of life
 Side effects:
 Constipation, fatigue, nausea, weight loss, hair
loss
 Adverse effects:
 Hypersensitivity, elevated liver enzymes
 Administering CGRP Antibodies
 Check before: Know when to take the drug,
when to contact the provider
 Infusions: Mix the solution gently, don’t shake
 Teaching priorities:
 Take as prescribed
 Avoid grapefruit juice
 Monitor for any yellowing of skin or eyes
 Life span considerations:
 Pregnancy and lactation—not recommended due
to lack of evidence of reactions
Physiology and Pathophysiology
of Muscle Spasm
 Involuntary contraction of a single muscle,
group of related muscles, part of a muscle
 Usually occurs when a nerve or nerves
depolarize spontaneously or inappropriately
 Causes include: Pressure on the nerve,
inflammation and swelling, electrolyte
imbalance, irritation or injury
 Skeletal Muscle Relaxants
 Depress the CNS which reduces motor nerve
depolarization
 Intended responses:
 Reduce muscle spasms, pain; increase mobility/
function of affected muscles; improve sleep, rest
 Side effects:
 Drowsiness/sedation, headache, hypotension,
nausea, dry mouth, dizziness, muscle weakness,
constipation, frequent urination
 Adverse effects:
 Interaction with more than 100 drugs
Administering Muscle Relaxants
(1 of 2)

 Check before:
 Level of consciousness, cognition, skeletal muscle
reactivity, ask about seizure disorders, obtain a list
of all drugs the patient takes, assess vital signs
 Check after:
 Level of consciousness, cognition, skeletal muscle
reactivity, blood pressure and other vitals,
especially when changing positions
Administering Muscle Relaxants
(2 of 2)

 Teaching priorities:
 Only take on a short-term basis, do not drink
alcohol or operate dangerous equipment or cars,
take with food or milk, monitor for reactions with
other drugs, avoid the sun
 Life span considerations:
 Pregnancy and lactation—most not recommended
 Older adults—none are recommended