What is the Issue with Pain Control in the ICU?

athena55, BSN, RN · Jan 8, 2006

Dear Leslie:

Gosh, it just rots my socks to see that in this day and age there are still health care professionals who are afraid of making their

1) patients/clients more comfortable

2) having their patients become (gasp!) physiologically dependent on pain relief

I mean, good golly, your mum had her airway protected (intubated) and she was on a vent, so what is their rationale for withholding pain meds? Oh,that's right, giving her some extra Dilaudid or MS04 might depress her ventilations {shaking my head in disbelief}

I was saddened to read that you were attempting to make your mum more comfortable and you could see that she was not experiencing adequate pain management.

Not all critical care units are afraid of making the patient comfortable enough, whether it is for first time ambulation post op, or nearing end of life....

There is an excellent website devoted to pain management from Beth Israel Medical Center (NYC) Pain and Palliative Care Unit. If you check it out you might be able to have sites at the ready when you attempt to make yourself - and your mum - heard and more comfortable: www.stoppain.org

How is you mum doing? How is she handling the chemo? I had worked for 15 years at Memorial Sloan-Kettering Cancer Center in NYC plus I went through the same thing (kind of) with my father-in-law.

I will keep you and your family in my thoughts,

Blessed Be,

mary

suzanne4, RN · Jan 8, 2006

Doesn't make sense to me either and shame on them. Especially if she was already vented, and not that it should make a difference. Pain is pain, and when a patient is experiencing it and you can fix it, and don't, then shame on that staff.

How inhumane!!!

steelcityrn, RN · Jan 8, 2006

What ever happened to pain the 5th vital sign? Oh great, not only do I have to bring my lysol and clorox with me, but also pack my bag with some pain killers if I should be so unlucky as to end up in a hospital. Pain mng is very difficult also in home health to tx. Last physician I spoke with friday afternoon wanted a post hip fx recovering at home to keep a "pain diary" first before he dolls out a few darvocet or percocet.

leslie :-D · Jan 8, 2006

oh......so this isn't the norm?

i'm a hospice nurse and am proficient in assessing pain.

even after she went into vasculature collapse (blown up like a balloon) and albumin infusions weren't working, i further and more adamantly pursued the pain issue. ALL the nurses maintained that her pain was well-controlled. once i decided to stop all txs and they started the mso4 drip, she died 55 minutes later. yet an hour before, i had met with 2 of the head oncs and 1 of them had said that her prognosis remained very poor and IF she did wake up within a couple of wks., she would die shortly thereafter. yet they both still pressured me into continuing treatments until i finally lost my temper and read them the riot act. that is when they begrudgingly agreed to stop tx.

i'm relieved to know that not all icu's operate this way.

i thought my questions about increasing vent settings and upping pressor dosages were reasonable, just so she could achieve proper pain control.

i will say however, she did die very, very peacefully. and this hospital was supposed to be so reputable.

thank you for putting this experience in perspective for me.

gratefully,

leslie

suzanne4, RN · Jan 8, 2006

Leslie,

So sorry that both of you got treated this way. It definitely would not have happened under my watch, that I can promise you.

dorimar, BSN, RN · Feb 16, 2006

i wish I could tellyou that was an uncommon occurrance, but it is not. For the life of me, I cannot figure out why nurses are so stingy with pain meds. Sometimes I get paranoid and think they are looking at ME as being too liberal with them. In ICU we sedate often, but many forget to give the analgesics as well. I will point out that analgesics MANY times decrease the amount of sedation dosage needed. We should always look at pain control first in sedation issues. Interesting that you mention the furrowed brow. I document the grimace regularrly on my pain interventions. I always try to take care of my patients the way i would want myself or my family cared for.

DidiRN · Feb 16, 2006

I take she was still a full code at the time? Not saying this is right to withhold the pain meds in this case, but I'm guessing they might have been afraid of having a code situation if they did do this (ie going ahead and giving the pain medication). That's kind of the mentality in the ICU. The fear of that happening.

I personally would not have had a problem with giving her something if she looked uncomfortable, and then upping the pressors, unless she was totally maxed out on them. But I probably would have started with a low dose and then worked it up if she tolerated it but still looked uncomfortable; if she was very unstable with her pressures even with the pressors maxed out, I'll be honest, I would be very nervous about it though with the full code status. If she was on three pressors, she sounds like she was highly unstable. But that's when I would have probably addressed exactly this issue to you. A reversal of the code status. But I know of alot of coworkers who would have said to you exactly what you experienced.

i didn't want to hijack another thread but do have a question that has been bothering me for a year now.
when my mom was dx'd w/aml, she opted for chemo in spite of a poor prognosis.
she developed colitis in her lg and sm bowel which led to sepsis.
in the icu, they were very frugal in dispensing pain meds.
when i would bathe her, give her mouth care, she would knit her brows together w/very soft moaning. all the while she was unconscious but not so deep that she didn't feel pain.
as she slept, she had a semi-grimace on her face.
i repeatedly told the nurses and the doctors, that i felt her pain was poorly controlled. their response was that they didn't want to depress her respirations or her bp.
she was on 3 different pressors and vented.
why couldn't they just increase the dosage(s) of the pressor(s) or the settings of the vent? when i asked that, i still don't remember the answer but it made no sense.
when it was decided to stop all txs, they started a mso4 drip and i saw immediate relief....immediate.
so why the hesitation in dispensing narcs in the icu, in my mom's case anyway?
thanks in advance,
leslie

leslie :-D · Feb 19, 2006

yes, she was a full code up until we decided to dc all txs.

the more i think about it the more i understand that her pain wasn't fully controlled.

then when we opted to stop all txs, the mso4 drip began with very notable relief. i suppose i should be grateful that they let her die that way.....w/o pain.

i just noticed various nsg. actions that made me rethink the way i care for my pts. as they die. thankfully, there's very little i would change.

leslie

geekgolightly, BSN, RN · Feb 21, 2006

it sounds like their fight against the disease process and seeing if they could "win" was more important than caring for your mom. i am glad that you were there to advocate for her and that she was able to die peacefully.