Senate Investigates JACHO Big Pharma Pain Link - page 3
Read article below first. I always thought something was fishy the way hospitals were mandated by JACHO to make pain a priority. My Admission assessment have an entire tedious section devoted to pain. It asks whether the pt... Read More
- 11May 13, '12 by CapeCodMermaid, RNIf I am ever hospitalized again with cellulitis from have no lymph nodes, I certainly hope my nurse takes my complaints and rating of pain seriously. People who are in pain shouldn't be judged and denied pain meds because there are people who abuse medication.
- 3May 13, '12 by nerdtonurse?We're talking apples and oranges, I think. Nobody's going to hold a pain med on a burn victim, major surgery patient, ortho repair or someone with trauma. But when you see the same teenagers and twenty year olds every single week in the ER for earpain...back pain...belly pain...foot pain...headache...back to ears, and they've been MRI'd, CT'd, and there's never anything wrong, they can't remember if the pain's on the left or the right on this visit, and they're always positive for illegal drugs? We are not making them better. We are making them want to do anything to us, our kids, or any other complete stranger to stay high.
I had major ovarian cysts -- I went to the ER because I thought I'd had a ruptured appendix or gallbladder going bad. They wanted to give me methadone when they saw I had masses in my abdomen. I actually asked the doc, "are you nuts? I may have masses in my abdomen, but you're not turning me into a junkie on top of things." Hurt like crazy, but I got by on Advil.
Had to have a BSO/TAH, stage IV endometriosis where they scrapped the tissue off of my intestines and cut loose adhesions. I took 8mg of Dilaudid, total, most via a PCA pump I had them pull the morning after surgery. By my second day home, back to Advil. It was another month before I could turn over in bed without belly pain. But a year later, I'm not hooked on vicodin, either.
I also have chronic back pain -- compressed disks, my pinky and 4th finger will go numb, and my back feels like it's on fire. That few days was the only time my neck/back hasn't hurt since I was a teenager. I've had docs offer all kinds of narcotics, and to put me on disability. I hurt. All the time. There are days where I look like a broken scarecrow trying to get up out of bed and start moving. But I'm not going to do a swan dive into a bowl of Vicodin just because I could get a script, either.
There's no way or legit reason we take 99% of the pain medicine in the WORLD unless it's being overprescribed. We're not the only people with back pain, arthritis, and chronic pain, but other countries and their citizens get thru life just fine. In other countries, physicians are only allowed to prescribe narcotics per week (not 300 at a time like I routinely see), unless the patient is on hospice. Practices have their script analyzed for "appropriate for specialty" and if you have a dermatologist where 70% of the scripts are for narcotics, they get fined and investigated. We're turning out a who generation of unproductive prescription junkies, and if you don't think so, go spend a weekend in the ER. You'll see them in droves.
- 2May 13, '12 by gonzo1It's a huge moral and ethical dilemna. How do you balance treating the people who truly need the pain meds against the people who criminally steal and/or misuse them. Unfortunately in the end it is going to come down to people will have to just learn to live with the pain because the drugs are most likely going to go away.
They will be regulated right into a pill prohibition and then we will have a worse situation on our hands.
I don't know the answer. I was disabled in an accident many years ago. Chose to rehab to the best of my ability and now work full time. I live with almost constant pain, but learned to ignore it for the most part. Motrin is as strong as I go. But I see how dibilitating chronic pain can be. I quess I could say Pride and Vanity rehabbed me cause w/c don't go with any of my outfits.
I've been an ER nurse for 8 years and I have seen drug junkies who come in every other day with back pain, and get loaded up with meds. And I have seen kids who have broken bones set with almost no pain meds because the doc/nurse doesn't believe in them.
I see the number of "self medicating" alcohol users going way up.
- 7May 13, '12 by GrnTea, BSN, MSN, RNi hear all this about pain, and i am completely with you and have always advocated for adequate relief no matter what it takes. i know-- and preach often-- the difference between addiction, habituation and tolerance. so forgive me if i don't want to follow you guys down that path in this thread. that's not what it's all about.
the idea that big pharma "doesn't make much money on opioids" so they don't have any incentive to push a lot of them makes no sense. one, have you priced the most recent additions to the pharmacopaeia lately? the fentanyl products, the oral and transmucosal morphines, the transdermal stuff, not to mention the non-opioids for neuropathic and other pains. not cheap. not cheap at all. two, even if that were true and all we had were the old traditional opioids, basic economics says that if you make only a small profit on a unit of product, what you need to do is sell a lot of it.
doesn't anybody feel as shocked as i was to read that article? that joint commission and big pharma have made it possible for more and more people to have opioids pressed on them, with a financial relationship with the apf? i found that astonishing. here's the link again....
american pain foundation shuts down as senators launch investigation of prescription narcotics - propublica
- 5May 13, '12 by CapeCodMermaid, RNEveryone has a different tolerance for pain. Mine is quite high but I don't use it as a gauge of anyone else's pain. I've worked in facilities where there were many drug seeking residents. I've worked in facilities with people who are in chronic pain and refuse to take pain medicine because they fear they will become addicted. If drugs that are legal are goi g to be taken off the market because some people abuse them, I suggest we start with nicotine which has no positive benefit to anyone and kills more people than drugs do.
- 7May 13, '12 by woohI'd rather give someone without pain a narcotic than withhold it from someone that is in pain.
But I think it's super amazing that JC is getting "investigated." Perhaps they should start having to fill out a bunch of forms to comply with a bunch of policies to assure the public they aren't corrupt.
- 1May 13, '12 by SHGR, BSN, RNQuote from CapeCodMermaidThat's why this is such a conundrum. Nobody wants people to hurt. Yet, because of these legal medications, there are people who are so addicted out there that they would kill to get high.If I am ever hospitalized again with cellulitis from have no lymph nodes, I certainly hope my nurse takes my complaints and rating of pain seriously. People who are in pain shouldn't be judged and denied pain meds because there are people who abuse medication.
I had a significant surgery in 2005 and was prescribed oxycontin and percocets. Then it was vicodin. I needed these for some time. Then the pain was less, but I was physically dependent on them. It took immense will power to stop using them.
Now I work in a clinic with patients who are manipulative, who expend vast energy and brain power trying to get narcotic prescriptions. I have worked in med-surg, oncology and hospice. I feel like I have the ability to see the issue broadly, but have no solution. In this day and age, why are we still using so many of these opioid meds that have been used since at least a thousand years BC? Seems like we should have something with less addictive potential by now.
- 7May 13, '12 by apocatastasisPain is not pain is not pain - there are different kinds of pain that need to be approached differently depending on the situation. The current research, which is what we should all be looking at, is that chronic, daily use of opioids for non-terminal chronic pain is not only inappropriate but INEFFECTIVE for the majority of patients and creates significant detriment to daily functioning. These patients are more appropriately served with drugs such as NSAIDs, tricyclics, GABA analogues, physical therapy, and psychotherapy (particularly cognitive-behavioral therapy).
HOWEVER, under-treatment of ACUTE pain (e.g. by someone who isn't even a nurse yet but who has ALREADY(?!) decided that she has a vendetta against opioids across the board for the "benefit" of her patients) leads to establishment of pain pathways in the nervous system within the first several weeks after the initial injury. If unchecked, the establishment of these pathways leads to a patient who now has CHRONIC pain rather than ACUTE pain.
Acute pain should ALWAYS be treated swiftly and appropriately, and this includes use of narcotics if necessary and appropriate to the patient (e.g. no history of addiction), so that pain does not become a chronic issue, with attendant psychiatric comorbidities.