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Cardiac Ischemia, morphine and 7/10 pain threshold

MedicASK - Question Number: 401
Question #: 401

Question:

Why is the pain management protocol for cardiac ischemia written in a way to limit pain medication use until the patient reports a 7/10 or greater, especially given that while a patients "pain is what they say it is", as a numeric scale it is still subjective to the patients experience. This encourages providers to lead the patient to a specific end. Thank you.

Answer:

Morphine has been shown in extended case series to trend towards increased mortality in cardiac ischemia patients. The threshold for giving this potentially harmful medication has to be balanced with compassionate patient care and control of refractory pain. Having a higher threshold to give the morphine minimizes the potential for adverse outcomes while still addressing patient distress in the extremes.

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