I read with interest the article, Physiology and Treatment of Pain, in the December 2008 issue (2008:38–50), by Jennifer Helms and Claudia Barone. I applaud the authors for addressing the topic of pain, which is most certainly relevant in the critical care setting, but continues to be underrecognized, misunderstood, and inadequately treated despite at least 3 decades of research.

My question is in regard to a statement on page 47; the authors write, “Pain control in intensive care unit patients should encompass use of a variety of pain-relieving approaches. These may include options such as traditional opioids and nonopioid analgesics as well as narcotics and synthetic narcotics.”

I do not understand what the reference to “narcotics” is to convey, because the authors had already referred to opioids, which includes medications such as morphine and hydromorphone, as well as meperidine, a synthetic opioid. The...

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