Nursing2002 Study Reveals Nurses Know Pain But Not Narcotics

springhouse, pa, october 1, 2002 - a major research study* published in the october issue of nursing2002 reveals that nurses know how to assess their patients' pain but are less knowledgeable about the proper use of morphine and other narcotics in managing severe or chronic pain. for example, they tend to have unrealistic fears about the risk of addiction. this may lead them to undertreat pain in patients who need narcotic painkillers the most.

based on survey responses from over 3,200 nurses, the research findings were compiled by margo mccaffery, rn, ms, faan, a nationally recognized leader in the nursing care of patients with pain. she designed the survey to determine whether nurses' knowledge and attitudes about pain control have advanced in recent years. her findings include the following:

almost all nurses (99%) know that pain intensity should be rated by the patient, not a nurse or doctor. since the 1960s, research has consistently proven that the patient's self-report of pain is the single most reliable indicator of the existence and intensity of pain. nothing else, including disease pathology, vital signs, or behavior, has proven more effective.

over 98% of nurses correctly answered that patients should not be encouraged to endure as much pain as possible before resorting to a pain relief measure. delaying pain relief until pain is severe has no benefits, causes unnecessary suffering, and may ultimately result in the need for even higher drug doses to bring the pain under control.

but only slightly more than half of nurses (57%) know that morphine and similar narcotic drugs have no "ceiling" on their ability to relieve pain. in other words, raising the morphine dosage by 25% to 50% will provide additional pain relief indefinitely--only side effects (such as oversedation) limit how much can safely be given.

nurses overestimate the danger that patients using narcotics for pain control will become addicted. research over the last 20 years has shown that fewer than 1% of patients who use a strong narcotic to control pain become addicted, even when they use the drug for 6 months or more.

this study indicates that nurses still don't clearly understand the difference between addiction (a pattern of compulsive drug use characterized by a craving for a drug for reasons other than pain relief) and physical tolerance. when a patient uses a narcotic to control chronic pain, he develops a tolerance to the drug's effects and needs a larger dose to achieve the drug's original pain-relieving effect. however, he also develops a tolerance to the drug's side effects, such as sedation, so the larger dose is safe for him. tolerance is an expected physiologic response to narcotic drugs and is not the same as addiction.

mccaffery emphasizes that misconceptions about pain control aren't limited to nurses, but cut across the health care profession. in written comments sent in with survey answers, many nurses expressed frustration with doctors and other colleagues who prescribe inadequate doses of pain medications. although most nurses can't prescribe drugs, they're responsible for assessing their patients' need for medication and communicating these needs to prescribing colleagues.

according to mccaffery, the study shows that nurses still need education about pain medication and addiction. comparing these findings to the results of a similar survey conducted in 1995, mccaffery says that nurses' understanding of addiction risks hasn't improved in recent years, even though this information has been widely available in mainstream nursing journals such as nursing.

the joint commission on accreditation of healthcare organizations, the accrediting organization for american hospitals, issued pain management standards in 2001. these standards require that hospital staff be educated about pain management, but in many facilities, this may not have happened yet. hospitals responsible for improving pain management need to be aware that many of their staff may be poorly educated about pain, says mccaffery.....

*mccaffery, m., and robinson, e.: "your patient is in pain--here's how you respond," nursing2002. 32(10): 36-47, october 2002.

your patient is in pain--here's how you respond update 6/2013