Do comatose patients need pain medicine

[sophie2]

As a patient's level of conciousness decreases as they approach death,does their perception of discomfort also decrease? What data is there that tells us whether they still need their pain medication, or as much? If there is no response to noxious stimuli, would you stop routine pain meds?

[river1951]

At our agency we use two different scales for non-verbal patients, the PainAD for dementia patients and the FLACC for non verbal, non demented patients. They are easy to use and would answer your question with the magnificent... ta da! it depends- smiles

[CANRN, MSN, RN]

As a patient's level of conciousness decreases as they approach death,does their perception of discomfort also decrease? What data is there that tells us whether they still need their pain medication, or as much? If there is no response to noxious stimuli, would you stop routine pain meds?

If the patient had pain prior to becoming comatose, then yes, medicate as you did before, since patient is unable to swallow, Roxanol is used.

[augigi, CNS]

Depends why they are comatose. Do they have injuries that would cause pain? If so, provide relief, regardless of consciousness level (as prescribed). If they don't have conditions which would cause pain, don't. I have not seen any data about this - how would anyone assess it?

[caroladybelle, BSN, RN]

As a patient's level of conciousness decreases as they approach death,does their perception of discomfort also decrease? What data is there that tells us whether they still need their pain medication, or as much? If there is no response to noxious stimuli, would you stop routine pain meds?

As consciousness is usually on a scale, it would be difficult to ascertain exactly when sensation of noxious stimula and ability to respond it vs whether the patient is in pain starts or stops.

As such, if a patient is terminal care, with a painful disorder and has documentation that they have received pain med for a while, we try to continue it after conciousness fades. Especially if it will not harm them.

Think of it this way. If you were on pain med for along time, and your conciousness were fading, would you prefer the HCP not medicate you as you are not "showing" pain or medicate you as you had been before.

[Tweety, BSN, RN]

Good advice so far. We also use a non-verbal scale, that takes into account their vital signs and respirations.

As above, I'd not want to hold medications on a patient that has been receiving them for a long time, just because they are non-verbal.

[CoffeeRTC, BSN, RN]

Yes....look at the non verbals.

[river1951]

Depends why they are comatose. Do they have injuries that would cause pain? If so, provide relief, regardless of consciousness level (as prescribed). If they don't have conditions which would cause pain, don't. I have not seen any data about this - how would anyone assess it?

??????????????????

Please educate yourself about pain before you respond to anything like this, but most especially before you take care of patients who are non-verbal. Many good pain scales are available for patients who can't speak, I mentioned them in my earlier post. Pain IS the 5th vital sign and every proffessional nurse MUST assess it.

[Gompers, BSN, RN]

If they were on narcotic pain meds for a long time prior to becoming comatose, they definitely need those meds to continue because their bodies are addicted to them at that point. You don't want their bodies to have to deal with withdrawl on top of whatever else is going on. I also agree that there are many nonverbal cues as well to see if someone is experiencing pain while they are unconscious. Just because they can't respond to us doesn't mean that they aren't in pain. They don't have to have actual traumatic injuries either - just being immobile and sick is enough to cause discomfort.

[sophie2]

Thanks for all the great input. Do you think there is any truth in the statement, " as a patient's level of conciousness decreases, so does their awareness of discomfort"? If they do not react to a painful or noxious stimulus, would you assume they are feeling no discomfort?

[Gompers, BSN, RN]

Thanks for all the great input. Do you think there is any truth in the statement, " as a patient's level of conciousness decreases, so does their awareness of discomfort"? If they do not react to a painful or noxious stimulus, would you assume they are feeling no discomfort?

I would err on the side of caution and provide pain medication in the same amounts that the patient required before the coma. And again, if the patient was on narcotics before, you can't just stop them or their body will be in silent agony from withdrawl.

[subee, MSN, CRNA]

Thanks for all the great input. Do you think there is any truth in the statement, " as a patient's level of conciousness decreases, so does their awareness of discomfort"? If they do not react to a painful or noxious stimulus, would you assume they are feeling no discomfort?

Patients in surgery are certainly unconscious but they certainly react to noxious stimuli quickly if they haven't received enough analgesic drug. Tearing and heavy sweating will occur with lots of patients who are too "light".