In "Fear of Addiction: Out-of-Control Pain" (Ethical Problems, August 2009),* Susan Salladay suggested offering patient-controlled analgesia (PCA) for a patient with metastatic cancer pain who'd refused opioid medications out of fear of addiction. She felt that PCA would help the patient regain a sense of control over her condition. I agree, but I'd also like to suggest some other measures that could be implemented.

Attempting to force or even strongly encourage a patient to take opioids by any route is disrespectful of that patient's beliefs. The patient might be more likely to accept over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs, if appropriate and not contraindicated. Other alternatives include comfort measures, gentle touch massage, visual imagery, and meditation, which can work wonders.

I encourage nurses to respect their patients' wishes and beliefs while they think outside the box for alternative solutions to complex issues regarding pain management.

-M. HEIDI PALMQUIST, BS, LPN, LNC

Tallahassee, Fla.

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