Letter to the Editor

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To the Editor:

We read your editorial in the September 2006 issue of Pain Management Nursing (Willens, 2006). You certainly had a horrific experience with your pain relief. When you reported to your physician your difficulty functioning with hydrocodone, he/she should have switched you to another opioid, for example, oxycodone. (We assume you did report this because you reported to him/her your unrelieved pain.) Unmanageable and intolerable side effects are the main reasons for switching to another opioid.

We are concerned that relating this experience and then raising questions about patients driving while on opioids will leave the wrong impression on some readers. It encourages them to accept anecdotal evidence instead of research. You are a respected leader in nursing whose remarks carry considerable weight. A balance might have been struck by asking how does excruciating pain affect driving (because there is evidence that it may have an undesirable effect, e.g., Vancleff & Peters, 2006) and mentioning research in both areas of effects of pain versus effects of opioids. No mention was made of the article in Pain Management Nursing that addressed the cognitive effects of opioids, including the effect on driving (Ersek, Cherrier, Overman, & Irving, 2004). This article did not look at all the evidence, but it did conclude that most patients on opioids could drive. A study just published arrived at the same conclusion (Verster, Veldhuijzen, & Volkerts, 2006).

The studies of effects of opioids on driving ability are certainly inconclusive in many ways, but there is a trend in them that suggests driving is safe for most patients. Of course, driving ability should be determined on an individual basis. It has long been suggested that after a patient has been on a stable dose of opioids for 7 days, cognitive functioning usually returns to what it was before opioid use (Bruera, Macmillan, Hanson, & MacDonald, 1989).

There is a widespread misconception that patients taking opioids are unable to function well. This extends not only to driving but also to the nurse on chronic opioid maintenance who wants to return to work. In talking with nurses about their misconceptions, we often find that they are not familiar with the research and reply heavily on anecdotal evidence. Thus, nurses might point to your editorial as clear evidence that patients on opioids should not drive.

We know it was not your intention to mislead nurses about driving ability or other functions while on opioids, but we are concerned that some readers will get the wrong impression. To prevent this possibility in the future, we would like to offer our services in reviewing editorials on pain before they are published.

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References 

1. Bruera E, Macmillan K, Hanson J, MacDonald RN. The cognitive effects of the administration of narcotic analgesics in patients with cancer pain. Pain. 1989;39(1):13–16
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2. Ersek M, Cherrier MM, Overman SS, Irving GA. The cognitive effects of opioids. Pain Management Nursing. 2004;5(2):75–93
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3. Vancleff LMG, Peters ML. The interruptive effect of pain on attention. The Journal of Pain. 2006;7(1):21–22
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4. Verster JC, Veldhuijzen DS, Volkerts ER. Effects of an opioid (oxycodone/paracetamol) and an NSAID (bromfenac) on driving ability, memory functioning, psychomotor performance, pupil size, and mood. Clinical Journal of Pain. 2006;22(5):499–504
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5. Willens JS. Out of the opioid fog: a personal perspective. Pain Management Nursing. 2006;7(3):79
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