Pain management - page 3

How do you maybe a provider that is either unwilling to treat a patients pain or is under treating a patients pain. Example: patient waits 8 hours in the lobby to be seen. Provider orders Motrin... Read More

  1. by   Oldmahubbard
    I think many of the alcohol problems are usually more subtle, and chronic, than the opiods.

    With opiods, it only takes one small mistake, and you are dead.

    People are buying opiods off the street, and they don't have the slightest idea what they are really buying.

    Alcohol is much more predictable.

    Yes it can be deadly, but it is typically a slower process.
  2. by   BassCatchingNurse
    Quote from SobreRN
    I believe the opiate issue is so far overblown it is absurd. Any given story involves white, middle-upper class little Johnny/Janie. I'm also old enough to remember the crack cocaine 'epidemic', we threw inner city crack addicts in jail forever while the upper crust at studio 54 were snorting it off the tables.
    I don't suffer from chronic pain but know people who do and their pain management doctors are the 1st ones who will say they do not prescribe out of fear from the DEA. I think pain, chronic or acute should be doctor-patient. The number one drug problem is still alcohol; it is involved in more homicides/suicides and car accidents than any other drug and is just served up everywhere to anyone with an ID.
    How would everyone like being told they cannot have a 2nd glass of wine or buy more than one beer because other people cannot drink with grace or because they may develop a problem with it. I personally think alcohol is an insidious soul-sucking drug. The only reason that prohibition was repealed after a mere 3 years is the lawmakers wanted to drink legally.
    As for assisting the patient when you think they have a problem that exhibits a bit of hubris I'd say. I used to work ER and found drug seekers rather annoying but I did not appoint myself as their unasked-for 12-step sponsor when they had no desire to get clean. As with all drug addictions de jour it will be something else in a decade. Cannot control people who want to get high, they will find a way.
    You say you think it is overblown, but again, what about the increase use/deaths from overdose as well as the increased use of narcan? Are you saying these stats are made up?

    I am not appointing myself "their unasked for 12 step sponsor"....I am their nurse! So, when someone comes in with a BP 201/110 and not taking their htn meds, you do not educate them on the importance of taking their htn meds? You do not try to figure out why they are not taking it, so that you can help? If someone comes frequently for hyperglycemia, you do not try to educate your patient on the damage that is happening to them? You do not educate them on diabetes and diabetic control...just because they are not asking for it? If they ask you for a high sugar carbonated beverage...do you just run get it? Or, do you HELP your patient by educating them on why they shouldn't have that beverage? I will not kick it out of their hand if a family member brings it to them, but I will HELP them by educating them on why they shouldn't drink it!! That is what nurses do, at least that is what they should do! Same with the cardiac/dialysis/etc pt on a doctor prescribed diet in the hospital that is brought food from outside fast food restaurants. No, you can't slap it out of their hands...but you should not turn a blind eye or say nothing, either! Education is a HUGE part of what we do. Yes, many many times it falls on deaf ears; however, we should keep educating them and pray that when they leave they will start making healthier choices.

    If you agree with the above, then that ALSO applies to narcotic addicts!! We do not give the suicidal patient a knife, and we shouldn't give the addict more of that "da-da-daladine medication" just because they ask for it, right???
  3. by   TAKOO01
    Quote from KeeperMom
    #1: The AMA recommendation is to treat chronic pain with NSAIDs not narcotics. As a provider myself, there is nothing that I can justify prescribing for the patient's chronic pain that he/she doesn't already take at home. And if they take it at home, they can take it at home. If the patient is in continued pain, he should see the MD that prescribes the medication. That is the contract patients sign when they are in pain management. As a provider, I'm also looking at the state-wide pharmacy database to see what the patient has already had filled. I'm not necessarily going to share that info with other staff member either.

    #2: Again, narcotics / opioids are not indicated for a headache. Period. If I prescribe morphine or dilaudid, I'm almost guaranteeing a rebound headache.

    #3: I'd give motrin or maybe even an Ultram and send this pt home with a script for naproxen and a referral to ortho.

    I think we have created a society that feels like we should always be 100% pain free and providers should throw whatever medications at patients to facilitate that. This is partially why we have such an opioid crisis.
    As a provider, I don't have to justify my orders to anyone but the patient and my boss. I realize that sounds very anti-nurse. While I do appreciate what nurses bring to the patient care equation, I would get very tired of being questioned about every little thing I order. Don't be that nurse.

    If you are having an issue with that one provider, I'd talk to him or her about how to best communicate patient needs and your concerns. I would also encourage you to chart and document objectively. Keep it to the facts and your patient's response. You can always chart, "MD made aware of patient's pain assessment. Awaiting further orders."
    This is a great explanation. It helps me to understand a bit about why providers do what they do, and why I should be careful before judging their actions. Thanks.
  4. by   TAKOO01
    Quote from BassCatchingNurse
    Wait...so you honestly believe that the opioid crisis is fictitious? I'm not being sarcastic. I truly am curious how people think. My brother truly believes the earth is flat! I engage in conversations with him all the time, not confrontational...just fascinated.

    So, you think all the data which shows a steep rise in opioid use/deaths is fabricated? The increased use of narcan, both in ER and EMS, is a lie? And, this lie is for the sole purpose of giving a government bureaucracy more money?

    That is interesting. I, personally have spent a decade in ER nursing. I at least perceive that the statistics of opioid use/death and narcan use are true. I also witness what I perceive to be an over use of narcotics within the ER, such as ordering Morphine IV for a c/o "abd pain" before the doctor even assesses the patient or sees any results. I witness doctors prescribing narcotics just because the patient requests it, not because the dx would suggest a need for a narcotic to treat the pain. Of course, sometimes diagnostic test may be negative and the patient is truly in pain, but that is not necessarily something that can/should be addressed in the ER. The ER is not a prompt/urgent/pcp care. It is there for life threatening emergencies, right? Life or limb?

    I learned in nursing school that pain is whatever the patient says it is; however, I also learned that I am to care for the patient as a whole!! My point is...if that patient is "seeking narcotics" then assisting them in obtaining said narcotic is...well...against what I am suppose to be...there to give them the best nursing care that they NEED...not WANT!! Medicine/nursing is a science...not magic...and not about giving patients every test they think they need and every Rx that they want. Sure, giving every patient that walked through the door a full body CT and discharge with narcotics would find many undiagnosed conditions and leave them pain free....but it would also lead to increased cancer, higher insurance cost, and yes....more narcotic addictions!!! You can't always tell the "seeker" from the sincere. What is your solution? Again, I am truly curious.
    I did not make the original comment, but I want to say that I think I understand some of what the poster was trying to say. I believe that the poster was trying to say that with inner city addicts, there was/is no therapeutic intervention, no trip to the ER. You were sent straight to jail, do not pass go. So the "crisis" has always been here. Maybe the drug of choice has changed, but there has been an ongoing drug crisis for many years.Now it's just affecting people who matter to society at large,so they are being treated rather than punished. I will duck my head to avoid the flying objects if I have misinterpreted this....

    ETA : I just read further down the thread, and I see the poster already clarified the point .
    Last edit by TAKOO01 on Feb 8
  5. by   SobreRN
    Quote from BassCatchingNurse
    Wait...so you honestly believe that the opioid crisis is fictitious? I'm not being sarcastic. I truly am curious how people think. My brother truly believes the earth is flat! I engage in conversations with him all the time, not confrontational...just fascinated.

    So, you think all the data which shows a steep rise in opioid use/deaths is fabricated? The increased use of narcan, both in ER and EMS, is a lie? And, this lie is for the sole purpose of giving a government bureaucracy more money?

    That is interesting. I, personally have spent a decade in ER nursing. I at least perceive that the statistics of opioid use/death and narcan use are true. I also witness what I perceive to be an over use of narcotics within the ER, such as ordering Morphine IV for a c/o "abd pain" before the doctor even assesses the patient or sees any results. I witness doctors prescribing narcotics just because the patient requests it, not because the dx would suggest a need for a narcotic to treat the pain. Of course, sometimes diagnostic test may be negative and the patient is truly in pain, but that is not necessarily something that can/should be addressed in the ER. The ER is not a prompt/urgent/pcp care. It is there for life threatening emergencies, right? Life or limb?

    I learned in nursing school that pain is whatever the patient says it is; however, I also learned that I am to care for the patient as a whole!! My point is...if that patient is "seeking narcotics" then assisting them in obtaining said narcotic is...well...against what I am suppose to be...there to give them the best nursing care that they NEED...not WANT!! Medicine/nursing is a science...not magic...and not about giving patients every test they think they need and every Rx that they want. Sure, giving every patient that walked through the door a full body CT and discharge with narcotics would find many undiagnosed conditions and leave them pain free....but it would also lead to increased cancer, higher insurance cost, and yes....more narcotic addictions!!! You can't always tell the "seeker" from the sincere. What is your solution? Again, I am truly curious.
    Alcohol related problems cost society a lot more; @ 10% of drinkers consume @ 90% of the booze out there. They kill themselves and others on the roadways and everywhere else, they beat and kill their spouses. they have no impulse control. If they live long enough they become a costly burden to the healthcare system. They are the #1 offenders in all areas of corrections. Heroin addicts make up maybe 1% of the population, they do not contribute a lot to killing anyone on the roadways or anywhere else. They nod off, sometimes they do not wake up. Sometimes alcoholics do not wake up from a hepatic failure (it just happens a whole lot more often with alcoholics as there are more of them.)
    Then we have people who identify as social drinkers yet they still get DUIs. I can understand judgement impairment from being blind drunk yet, obviously, people have judgement impaired from just a few drinks such they think they are fine to drive.
    My question to you is why we are not declaring an 'alcohol crisis'given the abuse of alcohol is so much more prevalent?
  6. by   BassCatchingNurse
    Sobre RN...You can make the case against alcohol if you wish...but that has little to do with your original comment that the "opioid crisis" was created to funnel money to the DEA. I do not care if you believe it is not real. I was curious as to how you got there. It seems that instead of producing data that shows we do not have a opioid crisis, you decided to show data that you believe shows that alcohol is a "bigger problem."

    Since you asked...alcohol is legal. Therefore, we do not criminalize the use of it. We do criminalize the actions of the one using alcohol, as we should! Now, prescribed opioids used properly...is legal. No one takes issue with this, nor do I. However, improper use/obtaining opioids is illegal; thus, people can/should be held accountable. Do we help? We try. I've seen plenty of misuse/overdose of opioids and have only seen police involvement a few times in a decade!! I do not think people are trying to ruining the lives of these people, except themselves. The real point is...the "opioid crisis" seems very real to me. And, we must first recognize that the problem exists and not compare it to another to determine whether we should act on it. Right? At least that is what I think in my opinion.

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