Uncontrolled pain- how to approach the Doc?

[Sam J.]

We've all seen patients with uncontrolled pain, and many have stated the physician failed to act. Any insider tips that have worked to alleviate this issue, to advocate for the patient, even if the physician is obstinate?

Assuming the physician knows the patient personally (I'm not talking about calling anyone on call to ask for pain meds), and really is aware the patient is still in pain, and still the problem continues, what are some ways to get past this road block, without alienating the physician, of course? Begging? Pleading? Fresh-baked cookies? Suggest the family contact the doc? It can probably be tricky with some physicians, for a variety of reasons (liability claims, being offended by a nurse assuming to know more than the physician, personality differences, etc.).

Any unusual (or even simple, tried and true) success stories?

[P B and J]

1.) Collaborate w/ a pharmacist and get a recommendation from him/her that we can then suggest to the MD.

This. In my facility asking pharmacy for a pain consult is a nursing judgment. We call pharmacy, talk to them about pain management (or lack of) and they come do a thorough assessment, including gleaning info from the chart as far as current pain meds, usage, home meds, effectiveness, etc. Pharmacy then makes suggestions directly to Doc, and follows through to assess effectiveness of the new regimen. Our pharmacists and doctors seem to get along very well, and work together. I had a patient recently that was not getting effective relief from his meds, pharmacy was consulted, and the solution (that worked fabulously!) was a BID Xanax added to the scheduled meds.

I will also talk to the patient about what they have used in the past, and ask for this directly. "Smith in 252-1 complaining of back pain 7/10 45 minutes after X was administered. States he takes Y at home q6. Can I get an order for this? Thanks!" I almost always get what I ask for, and if not Doc will usually call and explain rationale.

[ladyinwaiting4]

Great post phaniea69! I love every word! :) As an OR nurse who has responded to many pages for our surgeons, I have found that the nurses who get the best response are those who can effectively communicate the situation (your point #3) and suggest an option for an order. Often, the surgeon is familiar with a patient if I call them by name, but may not truly remember their history/situation until I elaborate from what you have told me. Now granted, this is an impression, but most seem to not like advising heavy duty pain meds without looking at the MAR or chart. If you can tell me what they are taking and what has worked for the pt in the past, that helps a lot and they are more comfortable with giving a phone order for more effective pain meds.

Just thought I'd throw in my 2 cents...

[starwood500]

As a R.N.with chronic pain it's great to know that there are nurses that actually care about pain relief and the value of compassion. Great posts. What works for one will not always work for another.

[toomuchbaloney]

One of the reasons that I do not like Home Care is because so many of the chronic pain patients, particularly the elderly, are not provided adequate pain relief by their providers who are afraid of the meds and of their own liability.

[azhiker96, BSN, RN]

With one particular doctor I found the most effective method was calling from the bedside so he could hear his pt moaning in the background.