Pain control

[Matt8700, RN, EMT-B]

So everyone at the prison I work was just recently taken off of their naproxen and Motrin because of all of the new literature that shows how dangerous they can be. Needless to say we have some very unhappy customers to say the least. We have been told to tell them to obtain non-aspirin and Motrin from the dorm officers for their pain (they can get 400mg of Motrin TID). However, they keep coming to the clinic and to sick call saying that these meds are not working and they are demanding something different. Has anyone else ever had this issue, and how did you handle it? For the most part these people arent in too bad of shape, mostly just age related things like DJD and OA. What pointers can you give me? The medical director isn't very keen on writing scripts for anything else either. How do you handle this with the patient? Do you have to have a stern talk with the patient and tell them it is what it is, or do you advocate to the MD?? Any ideas or input??

[TriciaJ, RN]

Do you have regular staff meetings? This is a situation that warrants further discussion with the powers-that-be. Up till now the inmates' pain has been treated as real but now they're just taken off their meds cold turkey with no alternatives. This does seem a bit drastic. I think I'd be advocating for some reconsideration and some alternatives to be made available. Muscle cream? Heat packs? Yoga classes? Risk vs benefits eval for each affected inmate to stay on the meds?

Good luck.

[Orca, ADN, ASN, RN]

Far too often, inmates who say that OTC pain meds are "not working" are hoping to get narcotics, which we don't use except for fresh post-ops in the infirmary. We also had a near rebellion when we found out that gabapentin (Neurontin) was being traded on the yard, and we discontinued its use for pain control. We had numerous kites and grievances insisting that it was "the only thing that works". All of these guys somehow survived not having it.

In your instance, I don't understand the discontinuation of OTC pain meds, especially naproxen, which has less risk than the others. In a correctional medical seminar I attended a couple of years ago, naproxen was cited as the only OTC pain reliever that doesn't potentially create cardiac issues with long term use.

We limit use of OTC pain relievers to 90 days, at which point the inmate has to be seen by a medical provider to determine the need for continuing therapy.

[Matt8700, RN, EMT-B]

We had people on naproxen and ibuprofen 600mg for 365 days a year. The problem is, they say, that there are risks associated with long term use of these meds, mainly kidney issues. They were not reassessed at 90 days and when they were reassessed, they still had the same chronic pain issues...... arthritis, chronic back pain etc. What do you do for these folks? How do you manage their pain? The other issue we are having right now is everyone, and I mean everyone insisting they need allergy meds and ppi, like protonix, both of which are also being extremely limited now. They say with the protonox that it was not meant to be a long term med and to use it as such is dangerous. But again, our previous doc was writing them 365 days worth of protonix. Now that they don't have it, they are putting in sick call after sick call to get it back. I just don't know what to say to them because even when you explain the risks, they still insist they need it!! It gets very frustrating sometimes.

[bryanleo9]

Gabapentin was one of the most abused drugs in prison. They snort it and shoot it. It should have been removed long ago. Many drug addict inmates will say and do anything for narcotics, even break their own fingers. There are far too many narcotics in the prison system and they result in a great amount of violence when drug debts aren't paid on time.

[Orca, ADN, ASN, RN]

We had people on naproxen and ibuprofen 600mg for 365 days a year. The problem is, they say, that there are risks associated with long term use of these meds, mainly kidney issues. They were not reassessed at 90 days and when they were reassessed, they still had the same chronic pain issues...... arthritis, chronic back pain etc. What do you do for these folks? How do you manage their pain?

According to a study cited at a correctional medical conference that I attended, long term ibuprofen and acetaminophen use can also carry the risk of cardiac issues (naproxen does not).

If an inmate continues to insist on a medication that is not supposed to be for long term use, often there is an evaluation by x-ray and sometimes other tests. If none of the testing reveals anything that would cause the symptoms that the inmate is claiming, he gets nothing.