Demerol, YUCK! - page 2
What is the love affair that PMD's and even some general surgeons have with demerol . On our ortho floor is we are not even giving our doctors the option to use it in the new pain management... Read More
Mar 4, '01Jill,
Thanks for your impression of your endoscopy sedation. Like I had said before, I have never acutally had any of the stuff, I got a PO Valium once when I was getting some stitches in the ER.
I have spoken with a couple folks who got Demerol only for Dental work, that is where I came up with the "aware of pain but unable to respond" impression. Yet in your post it seems maybe Demerol alone is good for something.
I do think some folks get both good sedation and good pain relief from Demerol and Versed, but I think from standing at the bedside lots lots more folks get good or excellent pain relief with Fentanyl.
Also, I think if a patient is experiencing pain the pain should be treated, whether the patient is going to remember the pain or not does not matter to me. In my procedure room, if you are in pain, or appear to be, and have a reasonable blood pressure and are breathing OK I _will_ give you more.
Mar 4, '01I just got done discussing this with my husband who has no medical and/or nursing background and his take on this is interesting.
he states that regarding the conscious sedation issue, we should control the persons pain regardless of whether they will remember it or not. He feels that knowingly not controlling pain is inhumane and cruel. He also feels that it would be prudent of us to assume that the amnesiac properties of versed may not be complete, and we should control the pain r/t this.
He stated that no health care professional should ever withold pain medications because we may suspect that someone is "seeking" because that is not our determination to make. He see's addiction as a much bigger problem than giving someone a shot of demerol in the ER.
Just thought it would be interesting getting the opinion of someone who would be a patient with no medical background.
Mar 5, '01I agree with KarenCCMA on the use of Demerol for migraine sufferers. I work as an RN in an urgent care facility and see many, many patients coming in for treatment of migraines, usually requesting Demerol. I also have migraines. What I can't figure out, is that when I have a migraine I am almost to the point of being debilitated; yet, somehow, these sufferers manage to walk in to the clinic, don't appear to be photophobic as they are NOT wearing anything to shade their eyes (all I want to do is lie still in a very dark room when I have one) and don't even appear to be grimacing from pain. Last weekend, one of our regulars came in, 3rd day in a row and again rec'd Demerol 100mg with 50mg of Phenergan. After she rec'd her injection, she asked me "Is that the max I can have?"! I just looked at her and replied yes. She also left with a script for Fioricet #3; all this after I pointed out that she had been in the last 3 days to the doc and rec'd the same treatment. Yet, another migraine sufferer receives Benadryl and Compazine for her migraines. I'm not saying that these people are not in pain, but do we have to give them Demerol every time they come in? There are other remedies for migraines besides this and I do think it encourages them to come in more frequently when they know the med they are going to receive. Any other opinions?
Mar 5, '01We all seem to have such strong opinions on things we have never experienced. Years before I was a nurse, I worked for a neurologist who had a headache clinic. (I did billing). I would see all these women coming in with these "so called migraines" and getting shots and meds and I thought, something is wrong with these people, they have too much stress, or they are not doing something right." A few years later, I started to have horrible migraines. I did everything I knew what to do. Food diary, avoiding susceptible foods, reducing stress, etc., and nothing worked. I was miserable for a couple of years, sometimes I was able to function and sometimes I had to call in sick. Finally I went to an MD and I had borderline HTN and he started me on beta blockers. That has worked for me. But I have talked to numerous family and friends, and they all have different remedies, some need the opiates, some need Imitrex, some need less stress, etc. All I know is that I can't and don't judge people anymore when it comes to ailments. Mental or physical. My newest ailment that I never had before are fever blisters on lip. (I know it's because I used to think, "what's with these people with these ugly sores on their lips?".
Mar 5, '01I'm going to jump in here again because pain is one of my soapboxes. For starters, I have a problem with the concept that if we don't remember pain, it's okay. That's bull. At some level we do remember and suffer and if it's traumatic enough, it can cause problems down the road. My mother suffered horribly from bone cancer because her dork of a doctor assumed she just "wanted attention" and so refused to give her even a one-time pain shot while she was transported to a real hospital 200 miles away. Pain is subjective. If a patient tells me they have pain, I take them at their word. The percentage of people who exaggerate their pain level is small, and everyone else should not have to suffer because of those few. That would be like requiring that everyone be on a diabetic diet because some people have diabetes and others may acquire it. Addiction is a disease and should not be treated punitively. Several psychiatrists and counselors with whom I've consulted agree that the rampant depression of the elderly is often related to chronic pain. Addiction shouldn't even be a consideration when there are effective medications that allow greater freedom of movement and quality of life. Pain is being addressed more adequately in the hospitals where I've worked recently. Some of the newer docs are finally getting it, and to be fair, since it has become mandated, and they are not getting into so much trouble with the Board of Medical Examiners, all MD's are much more relaxed about treating pain. Jill, your husband sounds like a wise and compassionate person.
Mar 5, '01Amen, mustangsheba. Sadly, the South, I think is still far behind on certain medical issues.
Mar 6, '01Nursejanedough, do you now have some disease that makes us afraid to treat you? It's great to read about other nurses that recognize that it is almost impossible to objectively judge someone else's pain. As far as the addicts go that come into clinics, er's, etc. I am glad some of you nurses give them something for "pain". Then I don't have to worry about them robbing me or my children or burglarizing my home so they can steal money to buy some illict drugs off the street.
Mar 6, '01opie, you are right. Better to give a potential drug seeker his "fix" in the ER, than to let him go and do "God knows what, stealing, or getting harder illegal drugs". I don't have all the answers. At this point, I am still against legalizing drugs, I have seen too much heartache out there.
Mar 6, '01There is an article in a recent AJN that describes all the awfull effects of demerol.(very informative). We rarely ever use it on our intermediate ICU.
Mar 6, '01Another thought on pain management...
Think about infants that have surgical procedures done without the use of pain meds (i.e. circumcision, etc.). This is a perfect example of experiencing pain but not remembering it; however, we do know that infants respond to pain through crying, increased heart rates, respiratory rates, etc. With that said, what psychological effects does this type of pain cause? I'm not sure that anyone knows the answer to that question; therefore, we really should hesitate before saying that having pain but not remembering it is suffient for pain relief.
Just a thought from someone without a medical background!
[This message has been edited by Born 2 B In OB (edited March 06, 2001).]
Mar 7, '01In my experience and in the literature, demerol is a crappy pain control drug. Lots of side effects, poor pain control and only IV or IM routes have any effectiveness at all.
On pain control all the literature agrees that patient report is the gold standard. Period. Pain is subjective. There is absolutely no objective test that can determine pain with any reliability at all. So when someone tells you they're hurting, whether they're laughing or crying, smiling or grimacing, they're having pain. Different people express pain differently.
Just my two cents.
May 24, '04I have been given demerol post appendectomy with a ten inch scar due to a grapefruit sized abcess surrounding my appendix. (whole different story there.) It made me more than dingy... Talk about hallucinations. I had a drug reaction to something after a 6 day stay in the hospital. Not sure whether it was the Levaquin or Demerol.