People In Pain

  1. When people need treatment for pain chronically or for perhaps a terribly destructive accident (lots of fractures, serious burns, and the like), do their pain meds automatically stop after 60 or 90 days - or some other specified time, no matter how much they might still need pain treatment. For example, they have physical therapy but can hardly bear the agonizing pain it causes and the doctor won't order adequate pain meds for a long enough time.
    I know there are other approaches to pain management - TENS, intra-spinal stimulators, water therapy, manipulation under anesthesia, chiropractic, etc., but a lot of "Rehab" places offer nothing like these latter modes of care. Patients are told to grit their teeth and focus on the starts, the rainbow, whatever.
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    About Kooky Korky

    Joined: Feb '10; Posts: 3,982; Likes: 5,519

    8 Comments

  3. by   hherrn
    Short answer: No.

    What field of nursing are you in?
  4. by   fibroblast
    Quote from Kooky Korky
    When people need treatment for pain chronically or for perhaps a terribly destructive accident (lots of fractures, serious burns, and the like), do their pain meds automatically stop after 60 or 90 days - or some other specified time, no matter how much they might still need pain treatment. For example, they have physical therapy but can hardly bear the agonizing pain it causes and the doctor won't order adequate pain meds for a long enough time.
    I know there are other approaches to pain management - TENS, intra-spinal stimulators, water therapy, manipulation under anesthesia, chiropractic, etc., but a lot of "Rehab" places offer nothing like these latter modes of care. Patients are told to grit their teeth and focus on the starts, the rainbow, whatever.
    The pain meds that you are speaking of such as controlled drugs schedule II, Norco, Fentanyl, Morphine Dilaudid, I believe the prescription is only good for 30 days (no refills) or a short amount time, then there must be a new prescription. Other drugs such as Tylenol #3, there may be refills. Physical therapy seems contraindicated when there's severe pain. That seems a bit much for an MD not to address severe pain, most of the docs that I deal with do address this issue.
  5. by   hppygr8ful
    As a chronic pain sufferer I can tell you that after it became clear that the general practice doctor could not "Cure" my pain I was referred to a Pain Management Specialist or PMS. I do ton's of holistic things and have a ten's unit at home. I also see an acupuncturist who is also an herbalist. I do not take any herb without first talking to my PMS as some herbs can be just as dangerous as Tylenol for the liver. I do take opiods responsibly and by prescription. I am required to actually check in with my pain management specialist every 90 days. I must say Summer is the best time of year because I am more active. But I will be having some surgery this Summer so we'll see how that goes.


    Hppy
  6. by   KatieMI
    Who or what prevents every rehab RN to do a med check on her patients every week or so and then call the provider BEFORE scripts expire? I thought it is one of their job responsibilities - at least, I did it when I was there. They definitely do not hesitate to call at any time of day and night for "something for (insert any symptom you can think of)", so I do not see any problem except lack of organization and time (yes, this order, not opposite).

    I started to tell patients that those maddening 30 days limit scripts were created by some guys up there on Capitol Hill who never in their lives hold up anything heavier than a silver spoon, so if they want to change this and any other laws, it is their homework to meet their reps and let them know that there's job to be done or there'll be time to pack bags and go home rather soon.
  7. by   Here.I.Stand
    Quote from KatieMI
    Who or what prevents every rehab RN to do a med check on her patients every week or so and then call the provider BEFORE scripts expire? I thought it is one of their job responsibilities - at least, I did it when I was there.
    Working in rehab, few things were as irritating as coming in Saturday a.m., and having no meds. I had so much more to do with my time than 1) convincing an on-call NP who has no idea who the pt is to write a new Rx, 2) wait for the off-site pharmacy to deliver it, and 3) explain to the pt that they will have to wait hours for pain relief.

    ...when all the Friday day RN had to do was remind the pt's primary MD/NP that the Rx was running out over the upcoming weekend. (who, to be clear, was in the building rounding on Friday.)
  8. by   Kooky Korky
    Quote from hherrn
    Short answer: No.

    What field of nursing are you in?
    LTC now and am partly retired.

    Have done several different areas over the last 40+ years.

    My current concern is because of a neighbor who had a horrible car accident, was severely injured (multiple fractures, ORIF bilat ankles, pre-existing arthritis, multiple deep lacerations that are still not healed after several months). The doc at the "rehab" center was giving only Percocet 10 mg. pre-PT and 5 mg q 8 hours for breakthrough.

    Neighbor is home now, her Pain Mgmt doc has her on MSO4 10 mg po q 12. She has much better pain relief now. Amazing what more appropriate prescribing can do for a person, isn't it?
  9. by   Kooky Korky
    Quote from Here.I.Stand
    Working in rehab, few things were as irritating as coming in Saturday a.m., and having no meds. I had so much more to do with my time than 1) convincing an on-call NP who has no idea who the pt is to write a new Rx, 2) wait for the off-site pharmacy to deliver it, and 3) explain to the pt that they will have to wait hours for pain relief.

    ...when all the Friday day RN had to do was remind the pt's primary MD/NP that the Rx was running out over the upcoming weekend. (who, to be clear, was in the building rounding on Friday.)
    Bless you for taking care of it. That is a sign of really sub-par care (letting pts run out of necessary meds). I think CMS and JCAHO should be notified. Anonymously, if you prefer.

    Have you considered reporting the situation to Management and talking to the docs, who should keep some track of when refills are needed, seems to me.

    It really should all be reordered on Wednesday so it will actually arrive before the weekend. It should just be a routine part of the job.
  10. by   Kooky Korky
    Quote from KatieMI
    Who or what prevents every rehab RN to do a med check on her patients every week or so and then call the provider BEFORE scripts expire? I thought it is one of their job responsibilities - at least, I did it when I was there. They definitely do not hesitate to call at any time of day and night for "something for (insert any symptom you can think of)", so I do not see any problem except lack of organization and time (yes, this order, not opposite).

    I started to tell patients that those maddening 30 days limit scripts were created by some guys up there on Capitol Hill who never in their lives hold up anything heavier than a silver spoon, so if they want to change this and any other laws, it is their homework to meet their reps and let them know that there's job to be done or there'll be time to pack bags and go home rather soon.
    I understand your frustration, but do not believe legislators never experience hard work or pain. They just have excellent access to the best care.

    I agree that we all need to be in contact with our lawmakers to let them know the experiences of the common people.

    And I learned long ago why some nurses always got their breaks and went home on time. They never picked up a phone to get orders for things like a cough, constipation, pain, diet changes, and the like. Smart doctors order these things rather routinely and regularly, some just don't seem to bother.

    They had time to make themselves beloved of their patients and their patients' visitors, accept tips and gifts, exchange phone numbers, attend their weddings and bar mitzvahs, because they were only half doing their actual work, while fools like me were calling doctors for needed orders, reporting various pressing issues, etc.

    Oh, yeah.

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