OPIOID ANALGESICS

Brief History. N.P., a 45-year-old woman, was involved in an automobile accident approximately 6 months ago. She received multiple contusions from the accident, but no major injuries were sustained. Two months later, she began to develop pain in the right shoulder. This pain progressively increased, and she was treated for bursitis using anti-inflammatory drugs. Her shoulder motion became progressively more limited; however, any movement of her glenohumeral joint caused rather severe pain. She was reevaluated and a diagnosis of adhesive capsulitis was made. The patient was admitted to the hospital, and while she was under general anesthesia, a closed manipulation of the shoulder was performed. When the patient recovered from the anesthesia, meperidine (Demerol) was prescribed for pain relief. This drug was given orally at a dosage of 75 mg every 4 hours. Physical therapy was also initiated the afternoon following the closed manipulation. Passive range-of-motion exercises were used to maintain the increased joint mobility achieved during the manipulative procedure.

1. When should the therapist schedule the treatment session so that meperidine is reaching peak effects?

2. What precautions should the therapist use during the initial treatments given the potential side effects of this drug?