Pain assessments - gabapentin?????

[martymoose, BSN, RN]

Now we are being told we have to reassess pain within an hour for gabapentin. When did this happen?? Gabapentin is for chronic nerve problems , like numbness and tingling. I should know- I am on it myself.If I am having pain ( like from my torn meniscus) neurontin does absolutely nothing for that pain. It just stops the burning sensation from my neuropathy. Knee still hurts!I have heard similar situations from other patients.

This is not a prn med like tylenol or narcs for post surgery.I don't get why this is being included in the pain reassessment.It will probably always show as a "pain not relieved score"

Does this mean we should reassess for lyrica, all antidepressants incl. cymbalta, anti seizure meds, muscle relaxers, etc?

This is out of hand.

[morte, LPN, LVN]

probably some nonmedical person saw "pain" and decided it would be a good idea. makes no sense.

[BlueDevil, DNP]

It makes a lot of sense. Gabapentin has a very important place in the management of complex regional pain syndromes, and is not limited to neuropathic pain and fibromyalgia. I manage quite a few long term chronic pain patients, and gabapentin is a mainstay in their treatment plans. There is a growing body of research demonstrating that it is as efficacious and safer than opioids for acute post operative pain as well. In some research institutions, they are using gabapentin preoperatively and demonstrating much decreased reports of post-operative pain. It is a fascinating drug with a great deal of potential, and far preferable to opioids for most conditions. I suspect you will be seeing much more of it.

[Here.I.Stand, BSN, RN]

^^^Interesting! Thanks for the info

[iluvivt, BSN, RN]

I can see just doing it as part of an overall pain assessment but Gabapentin's ability to control pain depends on a certain level of the medication being present over time. It is not prescribed as a prn med. So if there pain is not relieved they may need to increase the dosage if the pateint is not already on their maximum and is taking it as prescribed. Sure it may be a good drug but I thinks its odd that they are making you check for relief after a dose considering the nature of the drug.

[VANurse2010]

I can see just doing it as part of an overall pain assessment but Gabapentin's ability to control pain depends on a certain level of the medication being present over time. It is not prescribed as a prn med. So if there pain is not relieved they may need to increase the dosage if the pateint is not already on their maximum and is taking it as prescribed. Sure it may be a good drug but I thinks its odd that they are making you check for relief after a dose considering the nature of the drug.

Agreed. Obviously the effectiveness needs to be assessed, but the idea of a one hour after assessment for Neurontin is silly.

[wooh, BSN, RN]

Agree with iluvivt. Sure, it's GREAT for some types of pain. But it's not a "Take this and you'll feel better in one hour!" kind of med.

[Ruas61, BSN, RN]

It makes a lot of sense. Gabapentin has a very important place in the management of complex regional pain syndromes, and is not limited to neuropathic pain and fibromyalgia. I manage quite a few long term chronic pain patients, and gabapentin is a mainstay in their treatment plans. There is a growing body of research demonstrating that it is as efficacious and safer than opioids for acute post operative pain as well. In some research institutions, they are using gabapentin preoperatively and demonstrating much decreased reports of post-operative pain. It is a fascinating drug with a great deal of potential, and far preferable to opioids for most conditions. I suspect you will be seeing much more of it.

Really good to know this.

[martymoose, BSN, RN]

Mind you, this is more crap being added to the hcahps evaluation and TJC.More paper work already added to the bs we allready have.Let's face , we will never have good scores unless we prescribe dilaudid ATC for 1/2 the population.

I understand if I was a nurse in a pain clinic, but this is for a general medical floor, and usually the pt is not here for that reason. Why should a hospitalist be messing around with their pain management regime if that is not why the pt is admitted?

For those pts looking for dilaudid, they are going to refuse gabapentin, or lyrica, or cymbalta, anyways. Guess what - big fat zero on the hcahps "was your pain controlled. "

Don't get me wrong- I know dilaudid is appropriate in some cases, and the md is aware of that and orders it. But with this trend, all we are going to have is more pts taking it out on us nurses when the docs won't prescribe anything else but neurontin.

That's ok. Another "tick" in the "get out of this silly profession" box

[brandy1017, ASN, RN]

Mind you, this is more crap being added to the hcahps evaluation and TJC.More paper work already added to the bs we allready have.Let's face , we will never have good scores unless we prescribe dilaudid ATC for 1/2 the population.

I understand if I was a nurse in a pain clinic, but this is for a general medical floor, and usually the pt is not here for that reason. Why should a hospitalist be messing around with their pain management regime if that is not why the pt is admitted?

For those pts looking for dilaudid, they are going to refuse gabapentin, or lyrica, or cymbalta, anyways. Guess what - big fat zero on the hcahps "was your pain controlled. "

Don't get me wrong- I know dilaudid is appropriate in some cases, and the md is aware of that and orders it. But with this trend, all we are going to have is more pts taking it out on us nurses when the docs won't prescribe anything else but neurontin.

That's ok. Another "tick" in the "get out of this silly profession" box

I can't like your post enough. Doing a pain score for neurontin is ridiculous and lets not give them any ideas about the other meds cymbalta, lyrica, etc! They want us to ask the patient's their pain score every time we see them. If they have chronic pain I don't think every time I'm in the room asking them their pain level is going to help them, it will only remind them of their pain, esp if it's too soon for their pain meds.

[amzyRN]

Yeah, kind of weird to have to reassess for gabapentin. As far as I understand, it's the kind of drug that requires a certain plasma concentration over time to have an effect. It's not like an oxycodone tablet that has effect in 20 minutes, in my understanding. I do think it's good to be aware of a patients pain level and know if the regime is working or not so that the doc can be make aware if the patient needs something else.

[martymoose, BSN, RN]

I do think it's good to be aware of a patients pain level and know if the regime is working or not so that the doc can be make aware if the patient needs something else.

ahhh but that's a slippery slope.Once the docs see that you go to pain mgmt ( after all, the general population doesn't usually get that med prescribed by their pcp) the docs don't want to touch you.I've seen it- they say "oh you are in a contract" or something like that, and are very unlikely to prescribe anything beyond tylenol. Had a doc recently who would only write one time orders. We had to call everytime.

Sorry, I digress.I just think neurontin is not a pain med for the hospital patient.

If anyone was to read up on neurontin, it's not prescribed as a prn. and withdrawing suddenly from it can Cause seizures, etc.

Perfectly appropriate in the chronic pain management setting.Not acute hospital.