pain in the ed - page 14
by MAGIK GIRL
i am wondering if a percocet or an oxycontin drive thru right in the waiting room would be the answer. then perhaps, we would have the time to give quality care to our patients who are really sick. our er uses the pixis and... Read More
- 0Jan 13, '04 by ktwlpnOriginally posted by angelbear
You are correct noone here is debating the fact that there are true drug seekers out there that only want the stuff for a high I agree. What I am saying is that if that is the case then make a referral. Also please stop saying physically addicted when speaking of people in true pain they are not physically addicted they are tolerant or physically dependant. Furthermore those in LTC deserve and have a right to adequet pain management even if that means methadone or oxycontin. If security is your concern #1 dont make it known the drug is there and #2 GET SECURITY LTC has drugs and people know it be it darvocet, vicodin etc... all are narcs HELLO SECURITY!!! Our elderly and our incapacitated deserve pain care just like everyone else. As for the care in health care if it was there so many healthcare providers would not lack knowledge concerning pain management and EVERY patients right to it. Thank you
- 0Jan 13, '04 by hogan4736Originally posted by MD Terminator
One could also say we over write Norvasc, Atenlol, or Clonidine.
People have chronic conditions. People need medication long term. We agressive treat hypertension, so why not pain?
It is in NO WAY criminial to prescribe enough medication to ease someones suffering. Not in the least.
But it IS criminal to continue to provide these meds at #120/month for example, with NO accountability as far as education, precautions, or the POSSIBLITY of addiction...
If you get into a serious accident, and "need" 4-6 percocets/day during your recovery, there is a HUGE possibility you may need some help getting off them after your recovery, especially if you are an alcoholic/addict, or have the addict gene...No one talks about the research on the addiction gene. And yet the overprescribing continues. And if the patient that gets 120 percs/month has "breakthrough pain" after picking up his son, and runs out before month's end, guess who picks up the slack? THE ER!
- 0Jan 13, '04 by Dave ARNPI absolutely never do narcotic medication with education and accountability. When we treat patients with these medications, we use a very strict accountability program. I have a liscence to protect and we all know to well what kind of trouble people can get into for writing these drugs (be it legit, or otherwise).
I keep getting the feeling that everyone thinks I'm NP Feel Good. Nothing could be further from the truth. I don't just dole out the pills and send up packing.
When people come into our program, they are (99.9%) of the time at their rope. NOTHING and no one has helped. They have pain that keeps them from having ANY QOL. Not more than a hanful of of my "pain" patients can be managed on anything but a CII. Oxycontin, Methadone, Duragesic, Kadian, MS Contin. This is what keeps them alive. W/O it, they are in such pain that they really have no will to live. Those who agree to live by the rules of the program get a big return on their investment. We, in exchange, treat their pain to the best of our ability. We don't tell them "oh, we don't write for that". They get whatever treatment that they need.
Yes, we have kicked out people. Failed drug tests, repeated calls for lost medication, even had one threaten the pharmacist at RiteAid. Of the people whe have discharged from the practice, some have gotten help, but the majority have presented as a OD in the ED. To my knowledge, not one patient has been discharged only to have to find treatment somewhere else for a true pain condition. If they have, the new doc never asked for our records.
Nextly, we do not just emplore narcotics for the treatment of pain. Our non "pain" patients receive a variety of medications which take care of the pain. We've had great success with Tegretol and Effexor. So no, the heavy hitters, as l like to call them... are not my first choice.
I will 100% agree with you when talking about using the "heavy hitters" as a first line choice. If you told me of a doc that was doing that, I would gladly be the first to tell him he's making a wrong choice. (Mind you were not talking about cancer patients, some ortho cases and such).
I really admire you strong desire to do what you feel is best for your patient. We share that goal. I think if you were to change your views a little, we could really get along.
Dave, who is really going to have to NOT try to quit smoking and have a baby in the same week... and to those trying. ITS TOO DANG STRESSFUL!
- 0Jan 13, '04 by hogan4736Dave, our problem is that your (type of) practice is the exception (at least here in Phoenix), not the rule. I was nursing supervisor at an HMO. Our practice had 50,000 patients. 4 out of the 9 of the Family practice docs had notebooks w/ hundreds of patients on 80-180 Percs, Vikes, and Oxys per month. We received at least 15-20 calls/day for early refills...95% of those calling were given their refills, irrespective of their "excuses"
I am speaking of "real life"
Your defense sounds similar to the defense of the "system" of psychotropics for kids. The usual response is "well, the kid is supposed to get a counseling referral, eval by psych, and a laundry list of other interventions before Adderal is started." In reality, pediatricians are prescribing it in the office, usually in response to pushy parents.
I have seen pushy patients when it comes to pain med prescribing, and FAR TOO MANY DOCS JUST WRITE THE RX and turn the other way...
That is my issue. And from your description of your practice, you too would disagree with the management of chronic pain thru the ED...
- 0Jan 13, '04 by MAGIK GIRLOriginally posted by MD Terminator
...... Even more rare, is psycological addiction.
Dependence is common. It doesn't mean people are addicted. It means they need a little more medication to do the job.
let's face it. a person who doesn't normally take meds of any kind,who has pain from injury (or maybe even chronic), gets narcs and takes them for pain. now this person who normally does not take any meds is taking narcs. well, the pain gets better and maybe motrin would help. but the doctor said..... so now this person is taking the narcs for as long as they can justify it to them selves because the doctor said they need it right? we're all human. if a doc gave me permission to get high....
we are suposed to feel some pain. we are supposed to feel pain as a regulator so that we don't over extend ourselves. i am not saying that pain should not be treated. but i don't take oxycontin for cramps, i take motrin.
befor anybody jumps me, yes i have had my share of pain. i have chronic pain everyday but i don't live on narcs. i deal with it and move on. i don't obsess about it and blame alot of people for my problems. yes, pain sucks but so does addiction.
not all drug users are addicts. there are those who simply abuse the drug. they like the way they feel. yes, they can stop - but why should they when they can come into an er or see a pain doc and get all they want. some of these people even get out of work on disability. (i am not saying that all are bogus but i have done many many pre-litigation physicals in the er. you know the ones... "no, i don't have any complaints but my lawyer said i should come into get checked out.")
so, having said that, good night!
- 0Jan 13, '04 by angelbearI do not believe that anyone that claims to have chronic pain can possibely have very severe chronic pain and say the things you did. Most of the people I know myself included who suffer with severe chronic pain can not have any kind of QOL without the aid of strong analgesics. I personally find it offensive to be told to suck it up and move on. Walk a mile in my shoes then we will talk. Sorry thats as nice as I can be at this point.
- 0Jan 13, '04 by fab4fanNo...physiological tolerance does not mean that the pt is starting to "like" the effects of the med. It is something that happens over the course of long term use of opioids, but has absolutely nothing to do with addiction.
Using that theory, someone whose headaches used to respond to one Tylenol but now require two would be an "addict."
People with chronic pain do not get the "buzz" that someone who rarely gets a narcotic does. It takes all of the analgesia of the med to get rid of the pain...there isn't anything left over for a "high."
Daily, chronic pain is not normal, and to say that someone should live like that is cruel, IMO. Would you say the same thing about someone needing increased insulin to control his diabetes?
Living with daily pain may be your choice, but you shouldn't lay that trip on someone else. (Good grief, I can't believe I just fell back on that old saying.)Last edit by fab4fan on Jan 13, '04
- 0Jan 13, '04 by fab4fanForgot to add...I really wish the people making these comments would do some serious reading regarding new views on pain mgmt. I would be willing to bet that most have never read anything by Margo McCaffery, nor the AHCPR guidelines on pain mgmt. (That's your government saying your views are out of date, and lots of docs, nurses, other health professionals with the research to back it up. Where is the research to back up your statements?)
- 0Jan 13, '04 by angelbearWell said fab4fan. I have never gotten high on vicuprofen which is my maintenance drug nor have I ever gotten a buzz to percocet or demoral when in crisis. I will say how ever that dilaudid did give me this tunnel like feeling that I did not care for but it was IV so maybe that was it. At anyrate you are correct all the med is used to relieve the pain no high to be had. If I wanted to get high I would smoke the wacky weed or drink myself silly. That is not the goal of someone who has chronic pain.