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In this article I discuss pain medication overuse in hospital setting.by mike_lee Aug 31, '10Is pain scale an objective tool to measure pain level. I’ve never thought so. How often it happens when a nurse asks a patient:
Do you have pain?
A little bit.
How would you rate your pain level on scale from 0 to 10?
Eight or nine.
In this case the majority of nurses do exactly as we are brainwashed to do: document 9 and offer pain medication. The majority of patients do not refuse a pain shot even though they would not request one if a nurse does not push. Does it make sense? A little bit of pain rated as 9???
Several weeks ago I attended “Pain Control Class”. Both doctors and nurse educators talked about pain. I really loved listening doctors. And I learned that doctors did not like prescribe pain medication because of side effects. One doctor said that even though opiods can control pain well, a lot of patients still suffer of withdrawal symptoms a lot. But why patients are not informed about down the road complications? Instead we tell them, “Do not hesitate to request pain medication”. I feel that we, nurses, are pill pushes. We believe we are professionals but we do not know much about medications we give to our patients. It is even not our fault because nursing textbooks do not say anything about it. Probably because they do not want us to know the truth. They just want us to be pill pushers. I remember a 20 years old patient with stones in gallbladder. (He was a pre op) He told me he cannot sleep and requested sleeping aid. I forwarded his request to MD.
How old is he? - asked me MD.
Twenty, replied I.
Doctor did not tell me anything but looking at her face you could see she did not like that young pateint’s request at all. Anyway, she ordered Ambien. Why did she write that order against her conscious? Why not to go to talk to the patient to explain to him all risks and why she did not want to take that med? I think doctors are not free in this country. They are under Big Pharma and are not free to practice common sense.
As I said not only doctors, but nurse educators talked about that topic. And their message was opposite, you know, “Do not hesitate, give pain medication. Pain level is what patient says. But this approach makes a lot of harm. Let’s have a look at my patient who had “a little bit of pain” and rated it 8. I handle this situation according to common sense. I documented “4” and did not offer pain med. The next day I came to work and found out from the report that my patient was confused, pulled out JP drains, talking about conspiracy all the time a had a sitter.
She reported pain 8 out of 10, - told me a night nurse and I had to offer her Percocet. She took it and became confused.
How stupid you are, - thought I about that nurse but did not tell her anything. What can you tell someone who are brainwashed by nurse educators?
Not only doctors but also nurse educators talked about pain at that class. Their message was, “Do not hesitate, give you patient pain medication”. I definitely could see that doctors and nursing theorist are on different pages: nursing theory teaches you to push pain meds as doctors do not like it to do it. By the way, I was surprised. One doctor honestly admitted that some physicians increase dose of pain medication a little every time a patient on narcotics come to appointment to make sure that the patient will come back to him.
And how do you like this statement from nursing textbooks, “Patient’s pain level is not what you think, it is what they report”. All people are different and react to pain differently. Patient can smile and still has pain 10/10. Give him narcotic to control his pain. This statement is a brainwashing. Pain shock kills, so pain 10/10 kills. But our body has a protective mechanism. When you are in severe pain you may loose conscious. So if you lose conscious but still alive it means toy pain level is 9/10. Women in labor experience pain level 8/10 does not kill. By the way, have you ever seen a woman in labor, smiling and laughing? Of course not, because even though we are all different, our reaction to pain is the same. To make a story short, only few category of patients need narcotics to control pain. They are: cancer patients, patients with gun shot wounds, some (not all) post op patients.
Once my patient requested two Percocets. It does not matter how he rated his pain because so called pain scale is not a scientific tool but when I asked he said that his pain related to constipation. I had to give him narcotic. When I visited Europe this summer I told about this case to my friend who is an experienced anesthesiologist. He had a very hard time to believe me that in America patient can get narcotics for constipation pain. And that doctor told me that only a few categories of patients need narcotics. Again they are: cancer patients, patients with gun shot wounds, some (not all) post op patients.
Have a look at a chapter about pain in any nursing textbook. One short paragraph tells you that addiction is possible and 20 pages tell you how important to give your patient pain medication. But I tell you doctors are not so easy about down the road addiction. So why nursing theory ignores this problem??? And in the Internet you can find a lot of hard breaking stories written by people who became drug edicts in hospital. I tried to find official statistic of addictions r/t hospitalization but couldn’t. Probably they do not keep track of it or keep information in secret. I only found out that in Ohio 43,000 patients become addicted each year. I could not find information about other states. But it is a lot!!! And it is not a secret that nowadays the majority of drug addicts switched from street drugs to prescription drugs. And it looks like that Big Pharma when planning production of pain meds, considers not only hospitals needs but also drug addicts needs and it is scary.
Why is it so? I think that the answer is in the Bible and Jesus is only a solution. The Bible says, “For the love of money is a root of all kinds of evil.” (1 Tim 6:10). Big Pharma loves money and for this reason they brainwash customers to believe “the more medication the better”. But it is crime and overusing narcotics is even a bigger crime. Why doctors who claim they are Christians do not speak against this madness? Why Christian nurses are silent? We all are accountable to God for this crime. I remember an instructor in nursing school read a letter to our group written by terminally ill child. I remember only one moment from that latter: a terminally ill child refused pain medication because he realized he would not live long and wanted to enjoy communication with his family. Terminally ill people need to have clear mind as long as possible to reconcile with God. But too often they are over medicated and it is a crime/ I remember 89 years old patient. She was pain free but she had few days to live. Tube feed was discontinued and patient complained about abdominal cramping related indigestion/ (She got only about 50 ml of tube feed). She even did not requested pain medication but her family did it for her and convinced her she needs it. And doctor ordered Delauded 2 milligrams. In this case 0.2 milligrams would be more than enough. This dose made her sleepy and several of her final hours were lost. But for this huge dose, her family could have enjoy meaningful communication with her dying loved one. How does God look at all of this?Last edit by Joe V on Sep 17, '10 : Reason: formatting for easier reading
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mike_lee. (Aug 31, '10). Pain Medication From Common Sense Perspective.. Retrieved Tuesday, Jun 18, 2013, from http://allnurses.com/showthread.php?t=501490
- Sep 15, '10 by cherryames1949Every situation is individual. I have seen more undermedication than overmedication. Pain is still a mystery and a puzzle to many in the medical profession. Fear of addiction is rampant. I have seen a news show that reported that more people are getting addicted and are overdosing on over the counter medications. For people with legitimate medical problems, acute or chronic, we can and must do better. It is the 21st century. I think we should work on finding the best way to alleviate suffering.
- Sep 16, '10 by rn/writerYou have posted so many generalizations in this article that I am finding it hard to take the information seriously.
Charges of wholesale brainwashing and referring to medical folks as pill pushers does little to earn credibility.
I also take issue with this statement:
Let’s have a look at my patient who had “a little bit of pain” and rated it 8. I handle this situation according to common sense. I documented “4” and did not offer pain med.
A pain rating of 4 requires some kind of intervention. It doesn't always have to be pharmaceutical, but if repositioning and ice and relaxation and other measures don't work within an hour, you need to give the ordered meds.
Pain shock kills, so pain 10/10 kills. But our body has a protective mechanism. When you are in severe pain you may loose conscious. So if you lose conscious but still alive it means toy pain level is 9/10
To make a story short, only few category of patients need narcotics to control pain. They are: cancer patients, patients with gun shot wounds, some (not all) post op patients.
You express great fear about patients developing opioid addiction. Yes, it's true that some chronic pain sufferers can become dependent on narcotics to be able to function, but people who are genuinely in pain metabolize pain meds differently from those who are using recreationally. It's also true that some people stay on narcotics longer than they should and change from needing the meds to simply enjoying them. But it seems rather drastic to address that possibility by withholding meds from the get-go.
As I said, I can empathize with your concern, but if you are a nurse, I fear you are short-changing your patients by judging them and making decisions based on a very limited (and distorted) understanding of pain pathophysiology and treatment.
Sorry, but I do not find this a sensible approach at all.Last edit by rn/writer on Sep 29, '10
- Sep 17, '10 by C_perugiaeI wouldn't call this common sense at all. I'm offended by your use of the Bible in this conspiracy theory you have, and that you are arrogant enough to think that somehow you know whether or not a person is in pain. I can guarantee you wouldn't be able to recognize it in me, even if I was really uncomfortable, and if you were my nurse and documented a 4 when I told you it was an 8, I'd be talking to your bosses in no time. I thought nursing was about patient centered compassion (what you call pill-pushing), not deciding that your patients are addicts too stupid to understand the pain scale.
My least favorite part of this article:
"We believe we are professionals but we do not know much about medications we give to our patients. It is even not our fault because nursing textbooks do not say anything about it. Probably because they do not want us to know the truth. They just want us to be pill pushers."
Apparently, you slept through nursing school, because I can guarantee you that your teachers never ONCE told you to just shovel meds into your patients without understanding what you were giving them. As a practicing nurse, I find it disgusting that you weren't aware that opioids can cause constipation. I knew that before I even entered nursing school because it was beaten into our heads during pharmacology class! The rest of the RNs in the US don't need to go to Europe to figure that out because we actually paid attention in school, and know how to use a drug book now and then.
Also, why don't you try proofreading your articles before posting them? I can understand a few mistakes here and there, but an article laced with obvious spelling and grammatical errors does not belong here. If you're not a native English speaker, have someone help you with your writing, so your article is easy to read. If we took the time to read this drivel, you should at least take the time to write it in a convincing manner.
A Brainwashed Pill-Pusher
P.S. This post is most likely going to get deleted, since I'm being pretty harsh, but I want to post it, anyway. I think OP needs to think about his biased opinions more deeply, or at least hide them from plain sight. I hate to think that both of us are considered nurses, because I don't want to share my profession with people who have this sort of attitude.
- Sep 18, '10 by tralalaRNPain management is a HUGE issue for me. In 1986, when my preemie twins were born, one sustained many complications in the NICU. One of the issues was post-hemorrhagic hydrocephalus, for which she received a ventriculostomy (exterior shunt). .the procedure was done without ANY anesthesia. The procedure was botched in a horrific way, causing her to have yet another brain bleed. At about that time, the CBS Evening News ran a segment about a courageous mother named Jill Lawson, whose premature son died after a PDA - also done without anesthesia. The belief at that time, was that preemies' brains were too underdeveloped to feel significant pain, and that general anesthesia was potentially too harmful. So surgeons and neonatologists were just going about inserting chest tubes, doing heart and brain surgery without properly medicating these infants. Of course, parents were not being told that their babies were being operated on without any anesthesia. . At about the time my twins turned a year old, I got medical records, and sure enough, our daughter too, was one of those unanesthetized babes. I just about came apart mentally thinking of the horrific pain she endured. Thankfully, this belief has begun to change. .
When I decided to become a RN, one of the things I vowed, was never to allow a patient to suffer if it were in my power as a nurse, to prevent it. I've had to step in and intervene when my mother was dying of colon cancer this year - meds were being held because they didn't think she was in all that much pain - my mother was in no cognitive shape to use a verbal pain scale effectively, but her body language sure told a different story. Hospice, thankfully, agreed with me and ordered scheduled pain meds rather than PRN, as my mother could not effectively advocate for herself in assisted living. So. .as a RN, and more importantly, a mom and daughter who has seen family members who have been adversely affected by poor pain management, you darn right I'm going to be an advocate for people who need pain relief.
- Sep 18, '10 by rn/writerThank you, thank you, thank you, tralalaRN!
I, too, remember the days of docs saying that newborns couldn't feel pain the way older people did. It was horrifying then and it's horrifying now.
I also cringe when I hear about narcs being withheld from people who are terminally ill because, "they might get addicted." First, as I mentioned earlier in this thread, people who are really having pain metabolize and react differently to opioids than those who do not. And second, who gives a flying flip if someone with three months to live becomes dependent on narcotics to have any quality of life in the time remaining.
Many people, docs and nurses included, misunderstand the difference between a legitimate dependence (meds allow the patient to function better even though the doses seem scary) and addiction (meds lead to dysfunction and degeneration).
At any rate, withholding needed medication is looked upon as a violation of patient rights by JCAHO and by enlightened facilities and caregivers. It just shouldn't be done.
- Sep 18, '10 by tencatVery misinformed and ignorant. NO ONE should have to suffer, and NO nurse is able to accurately assess someone else's pain. Period. Do we have those who abuse the system? Yup. But we cannot allow those people to hinder good care for those who really need it.
- Sep 18, '10 by matchsticktgtI'm sure had different types of nursing textbooks in school than the writer did! "And how do you like this statement from nursing textbooks, “Patient’s pain level is not what you think, it is what they report”. All people are different and react to pain differently. Patient can smile and still has pain 10/10. Give him narcotic to control his pain" My textbooks never advocated "give him narcotic to control his pain", but rather try non-pharmacologic methods first, and meds only as necessary.....a rather meandering article that was slightly offensive to me....I don't understand the need to drag religion into an article supposedly about the evils of medicating pain??
- Sep 18, '10 by porridgeHow dare you alter a patient's reported pain level to suit your own bizarre, paranoid beliefs. I would advise you to re-think your career path as instead of advocating for your patients, and thinking of their comfort and wellbeing, you are pushing your own misguided agenda. You should be ashamed.
- Sep 18, '10 by caliotter3This individual's often expressed beliefs elicit the same responses from other venues, such as the yahoo nursing groups he frequents.