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Are We Letting Our Patients Suffer?

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traumaRUs has 27 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

14 Followers; 130 Articles; 185,717 Visitors; 20,643 Posts

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The title says it all - has the pendulum swung the opposite way? Are we providing adequate pain relief for our patients or holding back for fear of addiction? You are reading page 2 of Are We Letting Our Patients Suffer?. If you want to start from the beginning Go to First Page.

traumaRUs has 27 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

14 Followers; 130 Articles; 185,717 Visitors; 20,643 Posts

With respect, my first thought was: "only Norco 5/325 one tablet orally every 8 hours as needed." My knowledge/experience (including personal experience) is that dental abscesses cause severe unremitting pain. I have been literally shaking and diaphoretic with 10/10 unbearable pain every time I have had an abscessed tooth (which has happened several times), with the dentist on call the last time telling me to take large amounts of Ibuprofen at regular intervals until I could get an appointment with my own dentist, who when I saw him/her apologized that they weren't allowed to prescribe anything stronger. I'm pretty sure Norco 5/325 one tablet orally every 8 hours (which I have taken before at 6 hourly intervals for another problem) wouldn't have touched the severe pain from my abscessed tooth. What was your assessment of your patient's pain?

I should have clarified: this is a hemodialysis patient who weighs 50kg. This is the appropriate dose for this pt. I also added ibuprofen (the pt is anuric) 400mg twice per day.

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traumaRUs has 27 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

14 Followers; 130 Articles; 185,717 Visitors; 20,643 Posts

@Mudpinesredneck: What are talking about, the paxil comment and heart exploding? Please explain what you meant. I've been on 40mg paxil for YEARS and now you have me worried. Does Paxil affect the heart??

"Go to:

Other Uncommon Side Effects

Concerns with use of paroxetine include not only increased thoughts of aggression or suicide but also hypomanic/manic mood, abnormal dreams, rash, muscle pain, muscle weakness, electric shooting sensations, heart palpitations, feeling flushed, tingling sensations, and fasciculations. Again, the 2004 FDA black box warning eventually placed on all antidepressants indicated a two-fold increase in suicidal ideation and aggression in patients under the age of 24, especially in adolescents and children.5"

Paroxetine—The Antidepressant from Hell? Probably Not, But Caution Required

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vampiregirl has 10 years experience as a BSN, RN and works as a Hospice Nurse / EMT / Firefighter.

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I agree that at times the pendulum has swung too far the other way. As a hospice nurse, I've cared for patients who have not had pain adequately addressed until hospice admission. And then they've had a significant improvement in quality of life once the pain (and other symptoms) are managed.

At times it seems like assessment of symptoms and appropriate interventions are taking a back seat. Different types of pain require different interventions - for example if a patient reports leg pain, bone metastasis and pain caused by tumor pressing on a nerve are effectively addressed by different approaches. A pulled muscle or cellulitis are two other causes of leg pain and treatments are different.

Another consideration of pain control is monitoring opioid use. If a patient is requesting refills too soon, is it because the patient is taking more meds than prescribed? Even then, is it because the prescribed dose is ineffective or is the patient forgetting they took a dose and taking another too soon? Or are the meds unaccounted for due to another reason, such as diversion? If meds and pain control are being closely monitored from the start then any concerns can be addressed early. Sometimes this means changing the med route or quantity dispensed. Or it may mean involving other resources. But the bottom line is, that patients are receiving appropriate assessment and pain control interventions instead of just "blaming" the opioid issues for a provider being "unable" to effectively address the pain.

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It takes a special kind of depraved stupidity to withhold whatever it takes an ESRD Hoyer lift broken patient to have pain relief that is within their own health/life goals.

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Here is my own horror story.

6 years ago I was diagnosed with recurrent diverticulitis and it was suggested after the third attack that I was an ideal candidate for a laparoscopic colon resection removing 18" of my colon with the highest number of diverticula.

1. Following surgery I was placed in a PACU with a PCA pump but with no supervision or help, so I went from total general anesthesia to screaming in pain. Nurses claim I was fully conscious when they explained the PCA to me, obviously I wasnt.

2. Upon being moved to a room I learned they had me on a dilaudid pump. Dilaudid gives me severe nausea, not something you want after colon surgery, and asked the nurses to request my surgeon switch me to morphine. Two days go by, Im not recovering well, surgeon is worried the sutures didnt hold and that Im leaking into my abdominal cavity. Following an abdominal exploration to see, surgeon says the sutures are holding, there appears to be adequate perfusion so he isnt sure why I am responding so poorly.

I tell him I asked the nurses to have me switched from dilaudid to morphine. He gets furious and says they never passed on the request.

I am returned to my room, nursing team comes into switch my PCA and says right in front of me:

Nurse 1: "They are giving him morphine?"

Nurse 2: "Well you know these doctors, they give them whatever they want."

At which time I loudly confront them about the fact they never passed on my request to the surgeon and my concerns about being on dilaudid.

They flee the room. My wife calls the nurse manager and has them fired from my care.

Obviously I only wanted that morphine rather than dilaudid due to be a drug seeker....

3. I am finally discharged and sent home. Recovery is NOT going well. I am in severe pain every night, at 2am almost like clock work, Im prescribed 5/325 norco and its doing nothing to help. I have been hit by roadside bombs in Iraq and this was so much worse.

My surgeon's partner is on call, wife is trying to get ahold of him to get me something stronger. Tells my wife he thinks Ive simply become addicted and Im making up the pain for more pills.

Luckily neither my wife nor my PCP believe that and have me sent to another gastroenterologist for a 2nd opinion. He does a colonoscopy. He discovers the pain is necrotic tissue in my colon. My body is being attacked by some nosocomial infection, which was slowly eating its way through my colon.

I end up in isolation in ICU for two weeks on IV drip antibiotics and almost die.

They send the bacteria off to have it DNA sequenced because they had no idea what it was.

But obviously I was faking the pain for more pills.....

On the flipside I went to the ER one night for severe acid reflux, and the resident hands me a bottle of 30 oxy for the pain.... Like what the heck?!

There appears to be no middle ground. Its either nurses and providers scared to death to treat pain and accusing everyone of being drug seekers, or providers handing out an addiction starter pack for the smallest of complaints.

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Trauma, I can tell you about my dental experience. I had an infected tooth 3 years ago. My dentist performed a root canal. I left still having the effects of the novocaine and took some ibuprofen on my way home. I lived 90 minutes from this dentist as I still had not moved to this area. My house was bought, just not closed upon yet. The dentist was a family dentist and was trusted. I'm actually scared of dental work.

The anesthesia wore off and my mouth throbbed. More ibuprofen taken. Was also on augmentin for the infection. I couldn't eat and I started vomiting most likely from the augmentin. At the time, for my pain, I took a low dose of morphine extended release. Meant for long term Chronic pain. Not the acute pain I was having.

By the next day, I was in bad shape. We called the dentist who was very concerned about me and wanted me to go to my local ER while he went about getting me into an oral surgeon to get the tooth pulled. It was a Friday afternoon and he wasn't sure they could get me in on short notice and he was afraid I was dehydrated.

I went to my local ER. The PA accused me if drug seeking because 4 weeks earlier I had suffered a miscarriage. Because somehow, losing a baby at 8 weeks and an infected tooth was drug seeking behavior?? I cried but what about the vomiting? I had puked 3 times since being there. He told me to leave. This was a small, ER.

My husband drove me to the city. The office of the oral surgeon stayed open for me until 7 after my dentist called, begging them to get my tooth out. He X-rayed me and the infection was into my sinus cavities. He was dumbfounded at how I was treated. He actually called a lodged a complaint to that ER director. I didn't have to pay for that visit.

I then went to the ER in the city where my electrolytes were replaced and I left feeling so much better with that tooth out, and proper fluid balance.

That whole thing left a huge impact on me, even 3 years later.

Bottom line. Even drug addicts can have pain. We now undertreat people. Especially the elderly. I work in Trauma. I feel like these days, we are trying to make ICUs detox facilities. You can't do that when someone has a trauma, and compromised immune systems. If someone has 6 broken ribs, a broken c-spine, head injury, it's not the time to detox them.

We need to follow up as practitioners and get them the help once their acute problem resolves. And just because someone has chronic pain, that does make them a drug addict!!! I hate the hospital for myself. I hate taking any pills at all.

I wish with every ounce of my being that I was normal.

As you can see, I'm very passionate about this. I'm off my soapbox now!! Lol.

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traumaRUs has 27 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

14 Followers; 130 Articles; 185,717 Visitors; 20,643 Posts

It takes a special kind of depraved stupidity to withhold whatever it takes an ESRD Hoyer lift broken patient to have pain relief that is within their own health/life goals.

I totally agree

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traumaRUs has 27 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

14 Followers; 130 Articles; 185,717 Visitors; 20,643 Posts

These are some true horror stories. I'm sorry for all of you that your pain wasn't managed.

Edited by traumaRUs

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It's just insane to me that the rules are so strict here in the US. I get occasional migraines and when I lived in the UK I'd just go to my pharmacy and buy some codeine tablets OTC and take those with acetaminophen and ibuprofen. Worked a treat. Why are Brits trusted to be able to take mild opiates but Americans are somehow unable to be trusted to act responsibly? It's a huge insult to you all.

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traumaRUs has 27 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

14 Followers; 130 Articles; 185,717 Visitors; 20,643 Posts

It's just insane to me that the rules are so strict here in the US. I get occasional migraines and when I lived in the UK I'd just go to my pharmacy and buy some codeine tablets OTC and take those with acetaminophen and ibuprofen. Worked a treat. Why are Brits trusted to be able to take mild opiates but Americans are somehow unable to be trusted to act responsibly? It's a huge insult to you all.

Perhaps our government is more controlling?

I remember when we lived in Spain I went to a pharmacy when we were out of town and wow...lots of controlled drugs.

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brandy1017 works as a RN.

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It's just insane to me that the rules are so strict here in the US. I get occasional migraines and when I lived in the UK I'd just go to my pharmacy and buy some codeine tablets OTC and take those with acetaminophen and ibuprofen. Worked a treat. Why are Brits trusted to be able to take mild opiates but Americans are somehow unable to be trusted to act responsibly? It's a huge insult to you all.

You are so lucky. It is crazy here no national health care and so many things OTC in Europe and Canada that you need a Dr visit and script for here. I have migraines and am lucky to have a Dr willing to prescribe pain meds in addition to preventative meds and triptans, many are not. He is under pressure both from the govt and his health system not to prescribe narcotics at all. There are so many people now left to live with untreated chronic pain some turn to street drugs, alcohol and even suicide. Even the pain Dr's don't want to give out narcotics these days. What is really sad is the judgment heaped on people with pain, oh your just a drug seeker. Unless you've experienced real pain you have no idea what it is like to go thru! I've dealt with pain in my life but thankfully it was episodic, not constant. I feel for those that live with constant daily pain and hope we can find better treatments for them.

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Rock star's daughter overdoses. Rock star goes to governor of the state. Law passed to limit the number of pills and the times a prescription can be filled by a patient "not considered under the doctors care."

I went to a symposium on this on the opioid epidemic. County prosecutor says people now break into houses to steal prescription narcotics and sell oxy for $30/each on the street. Fentanyl now coming in in bricks from China to be mixed with heroine. There were also a string of doctors who were arrested for writing narcotic prescriptions and charging $200 each. It came to light after someone died. One doctor had over $500K in his house and a very large bank account. Pharmacies were refusing to fill prescriptions they found excessive.

Because of the bad actions of a few, people who legitimately need medication are sometimes made to jump through hoops or suffer. A lot of OTC medication is locked up and you need to provide identification and can't buy more than one since the stuff is used in the manufacture of illegal substances. We're not trusted with allergy medication so a codeine would definitely be out of the question.

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