By Deborah B. McGuire, Connie Henke Yarbro
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Chronic pain9 may or may not be associated with tissue damage, persists three months or more, and is usually accompanied by adaptation of the autonomic nervous system. There is not always a clear pattern of onset or cessation. 26, 27, 28, 29, 30 Page 5 The role of endogenous opioids in people's responses to pain has been explored over the past two decades. The major types of these morphinelike peptides are endorphins and enkephalins, 32 and both have opiate agonist properties. Like morphine, they can bind to opiate receptors in the periacqueductal gray areas of the brain.
33 Additionally, because endorphins are neurotransmitters at many synaptic relay points in the pain pathway, they appear to influence transmission of pain impulses at multiple levels of the nervous system, thus modulating perception of and response to pain. 34, 35, 36 A fourth area categorized in this dimension of pain by Ahles and Martin24 includes psychophysiological factors, defined as physiological parameters that may be related to the cause of pain or that may be abnormal because of the effects of coping with pain on a chronic basis.
Coluzzi, MD, MPH Chief, Supportive Care Services City of Hope National Medical Center Duarte, California Nessa Coyle, MS, RN Director, Supportive Care Program Department of Neurology Memorial Sloan-Kettering Cancer Center New York, New York Mary Ersek, PhD, RN, OCN Assistant Professor Seattle University School of Nursing Seattle, Washington Betty Rolling Ferrell, PhD, RN, FAAN Associate Research Scientist City of Hope National Medical Center Duarte, California Bruce A. Ferrell, MD Associate Director for Clinical Programs Sepulveda VA Medical Center Sepulveda, California Regina Schmitt Pink, MS, RN, OCN Oncology Clinical Nurse Specialist University Hospital Denver, Colorado Rose Gates, MS, RN, OCN Acute Pain Clinical Nurse Specialist University Hospital Denver, Colorado Alice Gianella, MA, RN Director, Nursing Education Memorial Sloan-Kettering Cancer Center New York, New York Marcia M.
Cancer pain management by Deborah B. McGuire, Connie Henke Yarbro