Need suggestions for pt uncontrolled pain

allnurses Guide · Feb 27, 2008

I have need for any suggestions - I have a pt in chronic pain who it has been an issue to get her pain meds increased. I was able to get her 3mg Dilaudid q3, but her pain is never under control and she asks for her next dose at least an hour before she is due. (Pinched nerve pain and possible beginning of CA pain).
She is allergic to morphine, ASA, percocet and I think NSAIDs also. Can anyone think of some alternative pain therapy that might help? I can't think of anything to suggest to the MDs - I feel like I only harass the MDs about her uncontrolled pain.

My first question would be what are her reactions to all these meds she is "allergic" to? To many times patients list allergies to meds that they aren't actually allergic to, but only have had mild side effects to those medicines.

Anyways adjunct treatments for chronic pain: topicals like capascin, peripheral/central blocks, gabapentin, tricyclic antidepressants, pregablin, anticonvulsants (carbamazepine, dilantin, divalproex sodium etc.), sodium channel blockers (mexilitine, lidocaine), GABA agonists (baclofen, clonazepam), Alpha agonists/antagonists (clonidine, tizanidine), long lasting opiates, skeletal muscle relaxants, Ultram, Benzos, sleep aids etc.

We just had a chronic pain lecture and these are straight off of my notes.

Also, if she has is having that much pain it might be time for referal to pain specialist.

Hope that helps.

Josh L.Ac. · Feb 28, 2008

Try to get the patient assessed by a pain doc since she might be a candidate for an epidural steroid injection (or perhaps something more).

classicdame, MSN, EdD · Feb 28, 2008

It is not really feasible to consider that pain is on a schedule and that in 3 hr. 55 min you are not hurting but 5 minutes later you need narcotics. I would report EVERY time the patient needs additional meds. The MD is getting paid to decide whether or not to increase the dose or change meds or get a referral. Your job is really to advocate for the patient. There are many other avenues, as suggested above. Surely they teach that in med school! (one hopes)