Pain control

Long Term Care Columnist / Guide · Sep 30, 2003

I think doctors are afraid to prescribe appropriately because our illustrious Attorney General John Ashcroft has stuck his long nose into our Death With Dignity Act here in Oregon. He's already threatened MDs with prosecution for prescribing potentially lethal doses of medications, and will undoubtedly try again to have the law overturned once he gets bored with selling the Patriot Act. JMHO.

sjoe · Sep 30, 2003

This problem predates Ashcroft, of course. Historically, docs get very little training in pain control (ditto for nutrition, dying, alternative remedies, etc.) while they are in school, and don't tend to focus on it.

The experts in pain these days seem to be in hospice and oncology.

And remember, whether as an employee or as a patient:

jansgalRN · Sep 30, 2003

Hospice nurse here. I agree. I get patients with extensive metastasis on Lortab 5mg. Of course, they reqire 2 (10mg) every 4 hours around the clock and still aren't controlled. Not to mention exceding the 24hr max dose of acetominaphen(which is 4gm) and with increased doses of these kinds of drugs, the pain relief is not neccessarily better; just more side effects. I feel certain (and I may be out of a job if this ever happens..LOL) that if docs were educated on proper pain control and differentiating between the different types of pain and treating appropriately thereafter, patients would reqire lower doses of narcotics. It's not a trick. Okay now, I'm hopping off of my soapbox.

nowplayingEDRN · Sep 30, 2003

It is a well documented fact that if pain control is not appropriately addressed, the pain becomes out of control and then almost impossible to control there after.

I have not found it a problem to get appropriate pain medication here in NY but I do know on the out side, Docs start to worry that the insurance company will come after them for over prescribing and then, you are right back to the original problem of pain and the poor attention that it gets. I truely believe that it is a combo of the law and the insurance company that creates the rouble and that is really a shame, especially when there are people out there that A) have a naturally high tolerance to medication B) have a serious medical condition that requires narcotics to control pain or C) have a terminal illness, in which incidence, they should be allowed to die with dignity and in comfort with out suffering. I am by no means advocating euthinasia or the Kevorcian(sp) methode but dammit! When will folks quit making our patients and our loved ones (and sometimes our selves) suffer??? When will pain be treated with the compassion and attention that it needs? Don't people realize that when we control pain, recoveries are faster and patients comply with doctors orders better than when they are left to suffer miserably? I will now step off my soap box, lest I get me self in trouble (which is not an unusual occurance)

Traveler · Oct 1, 2003

jansgal,

I read your post about hospice, mets and lortab. Our hh agency also does hospice and we use lots of oxycontin which works really well- too bad so many are abusing it and giving it a bad name. We also use Roxicet/Roxanol for breakthrough and very rarely for mets do we use lortab. We also work closely with a compounding pharmacist who whips things up for us.

Ann