Need for New Pain Guidelines

[betts]

The American Geriatrics Society's Panel on Persistent Pain in Older Persons in new guidelines called on clinicians to evaluate and treat pain symptoms in older patients, without regard to age or condition. The Management of Persistent Pain in Older Persons guidelines state that simplifying a patient's regimen is an important part of prescribing for pain management. The guidelines also suggest use of the term persistent rather than chronic pain, because chronic connotes negative images associated with malingering, futility in treatment or drug-seeking behavior. The panel notes that economic barriers, including lack of Medicare reimbursement for outpatient oral medications, limited formularies and delays related to managed care pharmacy programs, could contribute to a patient's inability to get the drugs needed to relieve pain. The panel recommends beginning drug use at lower dosages, then adjusting as dictated by the patient's response. For more, visit http://www.americangeriatrics.org.

[Fgr8Out]

I applaud the American Geriatrics Society for their study. Persistent pain, especially in the Geriatric category, is undoubtedly an issue whose time for evaluation is long overdue. Thank you for this information, Betts. :)

[cargal]

How can I introduce this to a MD who refuses to prescribe anything stronger than tylenol for a nonverbal tube feed resident who cries out and yells when even touched. She looks so sad and we have repeatedly requested something else for pain. He is arrogant and likes to hear himself talk. "You have to ask yourself if her pain is worse than this time last year. You just need to get earplugs for the 15 minutes it takes to do her am care." The administrator has even talked to him with no avail. How can an MD be so cruel? My strategy is to fax him whenever I am on (PT) and re-request.

[boobaby42]

That is one of my "pet peeves". How dare they deny that poor patient pain meds. I would report that so and so to the medical board or something. That is pure neglect in my book. He took an oath, didn't he? Narcotic Pain meds are cheaper than most pretend to help pain meds.( well, loratab is cheaper than most) I can't understand why they are so stingy with em. Well, like another post of mine explained, even my dad, almost dead with cancer, couldn't get anything until the day he died. They prescribed morphine the day he died. Then hospice wanted to take it back! I paid 98 dollars for that med! I flushed it instead of giving it to hospice. I was pissed. Why did they want it anyway. They didn't help me get it for daddy.

[cargal]

We have to flush narcs at our facility rather than send them back for refund, even if they are unopened! This is money paid by Medicare! Something about possibility of being diverted during transport. Well they had to get to us by transport! Makes me sick! As far as being a patient advocate, I will keep up the fight! I tell them pain is the fifth vital sign. I have seen nurses say "She just had it at 7a. " Well , it is 8:15a and it is ordered Q hr prn. I will give it."

[km rn]

RE: physician who refuses to adequately treat a resident's pain

I would get the medical director involved. If he/she refuses, I would get the ethics committee involved (hopefully your faciityhas one).

If that doesn't work, I would wait until dressing change and have him come into the room with me.

[betts]

I myself,also whom has taken an Oath, and as the Advocate for my clients/patients/residents,would ask him pointly; "What if it was your Mother in Pain?" I know that she's someone's Mother and deserves to be comfortable or have you some test that states she's faking the pain? If you wish,we could both report our findings/observations to the administrator or ethics board. You can state how you've treated her for years and spend ____ minutes _____ weekly with her and I'll mention how I spend ____ hours listening to her everyday.