The 5th vital sign - page 2

I recall reading that if you or a loved one has surgery or cancer that causes moderate to severe intensity, a 50% chance exists that you or your loved one will unnecessarily suffer this pain about... Read More

  1. by   ohbet
    Has anyone had a physician tell them not to give an opioid to relieve a patients pain cause it might mask the diagosis?
    Thats crap!
  2. by   K O'Malley
    Ohbet, that is the exact reason they wouldn't give me pain meds in the ER for my ruptured appendix. They didn't want to mask my pain response when they mashed on my abdomen, jerked my leg around, did a rectal exam. And since every resident in the place had to examine me it took forever for me to get any meds.
  3. by   CMERN
    Neuro checks..can be altered or allmost impossible to complete if a patient is snowed...I think too much pain med in a NEURO situation could mask symptoms..
  4. by   NRSKarenRN
    Originally posted by fergus51
    Undertreated because of our overexaggerated fear of addiction.
    Agree 100%.

    I'll never forget pt with Lung CA on our Hospice Program that was in excruciting pain from Tumor. Pulmonoligist wouldn't increase IV MSO4 drip above 10 mg hr at home---promptly shipped her to hospital via ambulance where she was titrated to 25mg/hr in 12 hrs.

    When confronted, he feared being reported to DEA as his colleageues INACCURATELY informed him if you provided higher doese they would monitor his prescribing. Gave him quite an education and reported him to medical director.

    I left hospice to resume home care; ran into him a year later and he thanked me for educating him re pain management... had a patient that need IV Morphine 100mg/hr for pain management and he didn't blink prescribing it.
  5. by   Ted
    . . . . . undercontrolled!

    What's sad is that (when I worked on a hematology/oncology/BMT floor) the physicians would prescribe MSO4 or Dilaudid to really high rates in hopes to control the pain, but they were not willing to consider supplimental ways of treating the cancer pain!!!! Like epidurals or that procedure where they cut peripheral nerve endings to the area where a tumor may be cause excrusiationg (sp?) pain (damn, I don't remember the name of that procedure. . . and I can't spell the word "excruisiating"!) The heme/onc docs, for some reason, were reluctant to consult Pain Management. . . politics, I guess. But that was a few years ago. Maybe things have changed for the better since then.

    Ted
  6. by   ohbet
    I wonder if this undertreatment of pain carries over to people who are dying and not receiving adequate pain relief. Under treatment of pain for the terminally ill is a strong argument for active euthanasia
  7. by   KaroSnowQueen
    Pain is undertreated in probably ninety percent of the cases in my opinion. And doctors are not too worried about causing pain and are rather "oh well" about it when confronted afterward by family or nurses. Had a doc remove staples in an abd. wound that was grossly infected, and then swab around in the wound with qtips and 4/4's with NO pre medication, and then came out and said the family was "pissed off" and to give her something.
    My son in law had a broken hand with the knuckle joint broken and displaced, he yanked on it hard, sil says, hey that hurts, stop it and the doc actually said to him that "All you Americans are just P--sies when it comes to pain!" And this was at a highly respected hand surgeon practice!!!!!! And he still didn't get any pain med.
  8. by   deespoohbear
    Originally posted by KaroSnowQueen
    My son in law had a broken hand with the knuckle joint broken and displaced, he yanked on it hard, sil says, hey that hurts, stop it and the doc actually said to him that "All you Americans are just P--sies when it comes to pain!" And this was at a highly respected hand surgeon practice!!!!!! And he still didn't get any pain med.
    And I would have immediately told that highly respected surgeon where to get off at and request another surgeon, STAT!! What a load of crap!! I would have also told that surgeon who commented that us Americans who are p--ssies, that he could jump right back on the airplane that brought him to our country and return to his homeland where he probably wouldn't be living such a good life. The only reason he probably came to this country was to make a million bucks off of us p--ssy Americans. (Stepping off my soap box now.)

    (And no, I am not against foreign physicians. I am against any physician who treats a patient like crap!!)
  9. by   deespoohbear
    In response to the original question, yes I think pain is highly undertreated in this country... Fortunately, my family physician is great about treating pain. My husband has a really bad back and our family doctor has been great about prescribing pain medications and muscle relaxers for him....

    A lot of nurses I work with are also scared to give prn's, especially to dying cancer patients. My philosophy is give them the whole d*mn narcotic cabinet if that is what is required to keep the pain at bay...I just love it when a doctor is afraid of prescribing more opiates because they are afraid the terminal cancer patient will get addicted. My response is "probably the best thing that will have happened to them in a long time." Geesh!!

    I had a patient one time who was 4 days post-partum. She developed a thrombosed hemorrhoid and was in excruciating pain. I was trying to convince the older, Oriental doctor who is set in his ways that 30 of Demerol IVP was way inadequate for this lady. His response was, "I not believe she have that much pain" in which my reply was "let me pull a 9 pound baby out your butt and then stick a piece of hot coal up there to really aggravate things." Got more pain meds for her real quick.
  10. by   Vsummer1
    i have an exam coming up and one section is on "pain".

    the literature states ""knowledge and resources exist to give pain relief to approximately 90% of all people who suffer pain. the actual number who get relief is closer to 50%" it goes on to say, "experts estimate that 25% of all cancer patients die without adequate pain relief"

    so, in answer to your question... according to what i am being taught, patients suffer pain which has been inadequately controlled. they are teaching us all of this so we will change it when we become nurses, and are really drilling it into us.
  11. by   ohbet
    Karo,Id sure the pri--!
    K O-this concern that analgesia will mask diagnostic information caused you to suffer needlessly,arent mds supposed to relieve suffering?
    If we know the severity and location of pain how would pain relief interfere with the diagnostic process?
    Which diagnostic tests indicated will require that the patient be fully conscious and in pain?
    Another point is that analgesics dont render the patient comatose.Usually pain is still present to some degree or the dose can be adjusted.
    If a fracture is being investigated a definitive diagnosis will depend on x-ray findings ,not on the continuing presence of pain.
    I just dont get it.

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