How to medicate chronic pain

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Specializes in SNF, 2 year s hospital.

This experience happen yesterday and at the end of my shift I still wasn't sure if all had been done! Has anyone exhausted a pt's PRN medication including tylenol? All shift the pain level was a 10, the wife complained of not enough pain relief and here Iam doing all I can to the point of having nothing left to give! How do you deal with this? Any ideas would help! :uhoh3:

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Specializes in Med/Surg/Onc, LTAC.

If a patient has used all of their PRN medications and still has pain rated 10/10, that would be a time to talk to the MD and see about something long acting, or increasing it... assuming you know it's chronic pain and not a symptom of something else.

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Specializes in SNF, 2 year s hospital.

I called the supervisor twice ( this is hospital policy) the MD increased the frequency of dilaudid to Q3hr instead of Q4hr and increased the neurontin and the patient and wife were still unhappy. I just felt as if nothing I did for 12hrs helped him?

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Specializes in Med/Surg/Onc, LTAC.

What kind of pain is this for?? What are all his pain medications? Any alternative ways to decrease pain being used? Has the family or pt mentioned any type of med/dose that has worked for them in the past. Sometimes orders can get way off from what they were used to while they were sick in the hospital and it takes a long time to get the pieces back together. With switching the order, have you seen any signs of relief? Is the patient sleeping now, laughing etc?

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Specializes in SNF, 2 year s hospital.

He states " electric shocking pain" in the lumbar. Dilaudid 4mg q3h, zanaflex 4mg tid, valium 5mg tid, neurontin 300mg tid. Hx of past gastric bypass and unable to take "long acting" pain meds? Nothing ever seems to help his level of 10. However he does laugh and move without any s/s of pain when meds have been giving? wife reported having to take the bottle of dilaudid and count the pills because he would take 2every hour? He states 48mg a day?

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Specializes in Med/Surg/Onc, LTAC.

Hmmm... sounds like he needs a pain consult! Maybe a fentanyl patch would be appropriate for him, if he can't have long acting PO meds.

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Specializes in Gerontology, Med surg, Home Health.
He states " electric shocking pain" in the lumbar. Dilaudid 4mg q3h, zanaflex 4mg tid, valium 5mg tid, neurontin 300mg tid. Hx of past gastric bypass and unable to take "long acting" pain meds? Nothing ever seems to help his level of 10. However he does laugh and move without any s/s of pain when meds have been giving? wife reported having to take the bottle of dilaudid and count the pills because he would take 2every hour? He states 48mg a day?

I have a patient who takes dilaudid 24mg every 3 hours around the clock. She says the best her pain ever gets is a 4. She is a tiny woman but remains alert and able to do her adls. So 48 mg a day doesn't sound like a huge amount.

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Specializes in Critical Care, Progressive Care.

Indeed, a pain consult seems needed.

Sounds like the pain is neuropathic (electric shocking"). Nuerontin is a good choice but they prolly need to increases the dose substantially.

if he was on 48 dilaudid qd then no wonder 4 mg q3 (which is 32mg daily) was not helping him. And dilaudid reaches a peak plasma concentration in about 20min- so if he does not have relief by then then he wont have it an hour later...

It is not unusual for people with chronic pain to laugh and move without signs of pain. If he says it is 10/10, then it is.

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