I guess I'm having a little problem with the "placebo" thing. Can such an order exist? Is it even ethical for an doctor to order a "placebo"?
With regards to pain management during the night shift, I also tell the patient the frequency the prn pain meds can be given. I also make a point on how important it is to tell the nurse when the pain is above the certain number (0 to 5) and to ask for the pain medication no matter what time of night or day they may experience pain.
Many patients seem to be more than reluctant to tell the nurse that they are in pain. They are afraid of addiction or of being over medicated; they don't want to bother the nurse. . . . or they just sometimes believe that experiencing pain is normal and "should" be tolerated. Somepeople even believe that experiencing pain is their "lot in life" . . . and they're sometimes the hardest to teach about effective pain management.
Well, pain may be normal after an operation or when experiencing metastatic bone cancer, but it doesn't have to be tolerated. My experience with effective pain management is that patients generally have a more positive outlook towards their situation and can do more things to help prevent complications (cough and deep-breathing breathing exercises, ambulating, etc. . .) Pain management education is the key, of course!
Interestingly, people can sleep through their pain as well. . . although usually fitfully. It's a shame because with effective pain management, they may experience a needed good night's sleep.
I've learned my lessons through working with dozens of cancer patients. I guess I'm rather agressive with pain management. I will advocate for PCA's. Did so last night when one of my ICU/CCU patients (who is a DNR/DNI) was receiving MSO4 q 1/2 to 1 hour with minimal results. The doctor actually took my advice and ordered a PCA!!!!! Here's the clincher, though. . . the f***ing hospital didn't have any spare PCA pumps to spare!!! ARGHHHH!
Oh well. . . I just gave the MSO4 all night long as stated above. . . and it seemed to help him sleep. . . at times.