First I'll define terms. When I say "addict" I'm including everybody who is physically dependent on opioids who isn't a terminal cancer patient. I don't see how physical dependence can exist independently of psychological dependence as one can't be physically dependent on opioids with also having a psychological need for them.
Pain management has become based on the absurd assumption that: "the patient's pain is always what the patient says it is".
In most cases that assumption is probably valid but we know, with certainty, that people will lie in order to obtain pain medications. Pretending that report of pain is an objective finding is absurd.
Much addiction has been caused by the current pain management theories. We've been overmedicating many people for years based on pain management theories. There is an underlying assumption in current pain management that treating complaints of pain with large amounts of medication doesn't really have a downside when the fact is that it has a huge downside......We've got a large population of addicts who didn't have to be addicts.
Let me be clear about how important it is to control pain. I'm not saying that nobody should get opioids. They are extremely beneficial if used properly. "
Without a doubt, Sir William Osler, renowned Canadian physician of the late 1800's, was justified by remarking that morphine was "God's own Medicine
That is really frustrating. I don't mind working really hard to control a given patient's pain. I don mind it when, despite heroic attempts at pain control, you've accomplished little due to the patient's pill popping.
Overprescription of opioids is a national tragedy and a national disgrace.
I too wish there was a better way than "what the patient says it is". But there isn't.
I think there is a better way........Unrealistic mandates on how we must deal with pain are, in my opinion, really bad. They require us to engage in nonsensical pain control practices and we know, with certainty, that these practices are harming patients.
Specializes in Critical Care; Cardiac; Professional Development.
But if we don't we are also harming patients. I think that is the material point. Which way to err? On the side of making sure pain gets treated even if it means addiction or tolerance issues.
Specializes in Critical Care; Cardiac; Professional Development.
I greatly agree with the anxiety component. I take care if a lot of post spinal surgery patients and frequently Valium is prescribed prn as a muscle relaxant. It gets underutilized. It works both on anxiety and spasms and has often been the key in getting my chronic back pain, chronic opioid patients comfortable and ready to get up with PT.
There are ways to control pain that aren't based on nonsensical assumptions.
What is your proposed alternative? I am interested in what you feel is a better way?
That's a good question and I hope you like my answer.
When dealing with complicated, difficult, and profoundly important problems (this applies to social problems such as rampant violence in inner cities and whatnot) it's vital to start with what is true and to throw out what is false.
The first step in proper pain management is to correctly identify that patent nonsense that is the basis pain control management. As long as patent nonsense is referred to as anything but "patent nonsense" it's not possible to have good pain control policies.
The next step would be to bring true experts together and to be sure and include those of us who have been dealing with pain control problems in 'the field'. (The theoretical basis for current pain policies has almost nothing to do with reality).
The next step is to describe the problems of pain control accurately. The next step is to acknowledge that pain control needs to be individualized.
After that the best ideas would be considered.....What sort of patients are likely to have anxiety driven pain problems and whatnot.
Tough problems tend not to have simple solutions.
I greatly agree with the anxiety component.
Thanks.....It's extremely obvious to those of us who treat pain in PACU on a daily basis but the "experts" are, in many cases, completely oblivious.....Because of the idiocy of pain "experts" on this matter there are patients suffering because of the policies dictated by clueless "experts".
My point isn't that I'm angry at the "experts" I speak of....That has nothing to do with it. My point is that those who are insisting on completely idiotic pain control policies need to be replaced if pain management is to improve.
I have to agree with the OP. There is a serious problem in this country with the over prescribing of narcotics from pain management groups. There was a time that you would never see prescriptions for dilaudid or fentanyl outside the hospital setting. Now, just go down to your local pain clinic and keep telling them you're having pain . You'll get the dilaudid eventually. What happened to trying to get to the root cause and alternative methods? Ask your chronic pain patient about physical therapy, I can guarantee you will hear a story about how PT made them worse. Cortisone injections? Made them worse. The only thing that works is narcs. Most of these patients will also tell you they are allergic to tylenol, toradol, tramadol and all NSAIDs.
I am talking about chronic pain and pain clinics. The treatment of acute post op pain is another story altogether. People who present with acute pain, need to have their pain managed so they can heal. Proper pain management in these patients leads to better outcomes. The majority of these people use their pain meds appropriately and stop using them once they are healed. Acute pain is the pain that needs morphine, dilaudid and fentanyl.
Quantifying pain is difficult, if not damn near impossible. I work in an ED and too many times I see chronic pain patients talking on the phone, sleeping or laughing and joking all while telling me their pain is a 10 out 10 when asked. Really??? it seems to me that if you can function with this kind of pain, you really don't need any meds. The truth is....people lie. They over exaggerate their pain to score more narcs. It has become entirely too easy to obtain narcotics in this society. There are actual websites that tell drug seekers what to say and how to act so they can get scripts for narcs.
There needs to be better guidelines and maybe research done on pain management to help prevent all this abuse from happening. One good step is the computer program that lets doctors pull up a patients name and see how many narcotic scripts they have have filled, how many different docs are prescribing them and what pharmacies they are being filled at.
I have read this entire thread before responding. I have a few conclusions about the initial premises of your thread. The obvious suggestions for obtaining better information upon which to base judgment are, well, obvious.
1) Jonathan, probably best not to use your real name and hometown/state in your profile. What is that bachelor's degree (not in nursing) in, anyway?
2) Do not conflate some pieces of factual information, e.g., that some people get inappropriate prescriptions for medications, that some people are addicted to opioids, and oxycodone is widely abused, into massive overgeneralization, e.g., that everyone who seeks pain relief is faking, overstating, or addicted. Well, except people with cancer. Maybe. Gee, thanks for that.
3) Despite your protestations to the contrary, it is clear that you really do not understand (or believe) the difference between addiction, tolerance, and habituation. By definition, addicts use for the psych effects, to get high. Habituation and it cousin tolerance are physiological results of prolonged use of substances. These are not the same thing as addiction, even though both will show withdrawal symptoms if the opioid is withdrawn. This physiological (not psychological) result is because addicts also become habituated and tolerant to higher doses, but people with tolerance and habituation born of long use are not necessarily addicts.
4) You also do not understand that merely requiring increased doses of medication for pain does not constitute psychological addiction, although you apparently approve of it in limited cases, e.g., malignancy.
5) You also clearly, from your reported position in a PACU, do not understand the difficulty many people with chronic pain have in getting their condition taken seriously -- often by people like you, who wear the clothes of a caregiving profession but who have an inadequate understanding of the complexity of pain as clarified by modern neurological research, which I commend to your attention. You conflate "care seeking" with "drug seeking" and conclude "addiction" where it may well not be present at all.
6) You are ignorant, or don't appear to fear looking ignorant, of how many people who are inappropriately prescribed opioids for neuropathic pain experience pain relief when properly diagnosed and given different medications or a combination of medications (anti-inflammatory, opioid, and neuro) and technology (e.g., nerve blocks and ablation, Calmare). You clearly have no first-hand experience, as many of the other posters here do, of the process involved and in how very grateful those people are to be heard and treated appropriately. Patients are not responsible for their physicians' ignorance in inappropriate prescribing and often need expert nursing assistance to obtain better care.
There are actual websites that tell drug seekers what to say and how to act so they can get scripts for narcs.
That's really horrible. I once floated to the pain clinic and had a patient who was a "trifecta"....Complained of back pain, migraine, and asked for Dilaudid (I think she was allergic to Toradol too.)
What is that bachelor's degree (not in nursing) in, anyway?
My degree is in Biology. I now study Philosophy, History, and Theology (other stuff too)
Do not conflate some pieces of factual information, e.g., that some people get inappropriate prescriptions for medications, that some people are addicted to opioids, and oxycodone is widely abused, into massive overgeneralization, e.g., that everyone who seeks pain relief is faking, overstating, or addicted. Well, except people with cancer. Maybe. Gee, thanks for that.
I never do that and I find it odd that you are accusing me of it. I've stated several times that most patients don't have problems with opioids.
Despite your protestations to the contrary, it is clear that you really do not understand (or believe) the difference between addiction, tolerance, and habituation.
After reading "The Pharmacological Basis of Therapeutics" twice and reading the Opioid section a few more times I'm quite conversant in the use of those words.
In reality the situation is muddy.......Pain Clinics have to have contracts with pain patients that state that they won't request refills early and whatnot. Many pain patients, in fact, exhibit severe drug seeking behavior.
You also do not understand that merely requiring increased doses of medication for pain does not constitute psychological addiction, although you apparently approve of it in limited cases, e.g., malignancy.
I understand that perfectly well and I request that you stop falsely accusing me of that sort of thing.
You also clearly, from your reported position in a PACU, do not understand the difficulty many people with chronic pain have in getting their condition taken seriously -- often by people like you, who wear the clothes of a caregiving profession but who have an inadequate understanding of the complexity of pain as clarified by modern neurological research,
Once again I request that you stop making false accusations against me. What is your problem?
You are ignorant, or don't appear to fear looking ignorant, of how many people who are inappropriately prescribed opioids for neuropathic pain experience pain relief when properly diagnosed and given different medications or a combination of medications (anti-inflammatory, opioid, and neuro) and technology (e.g., nerve blocks and ablation, Calmare).
Can you not do that? What is it with you? You seem obsessed with making false accusations here.
Can we start over?.......I mean start over without you typing a lot of crap about me?
I wouldn't bother GrnTea. The individual is clearly not interested in dialog or learning anything, just pontificating. Move along folks, nothig to see here.
The individual is clearly not interested in dialog or learning anything, just pontificating.
Why are you lying about me? I'm very interested in dialogue and learning. Why just this morning I was discussing whether Natural Rights exist and reading about the history of the Ancient Near East. I'm reading up on Continental Philosophy too. (I have a fondness for Analytic Philosophy as well but I don't embrace it as much as I do Continental Philosophy)
Anyhow.......I'm interested in why you have taken the trouble to lie about me.....My interest is genuine.
I might as well discuss the poetic/philosophical aspects of dependence on opioids.
I've met many patients (not most patients by any stretch) who think about taking opioids to the exclusion of, what I consider to be, life. I fully understand that in some cases this is unavoidable and I'm limiting this post to people who have easily preventable problems with opioids. There are a whole lot of people in that category.
When I get up in the morning I almost always hurt somewhere. Sometimes more sometimes less. At my age I expect to hurt a bit.
I almost never think about my pains for very long though. I think about living fully. Most mornings involve a stroll in the woods in my backyard with a Philosophy book in my hand. I like to start out the day in a wooded setting contemplating whether the universe has a purpose......Whether evil would exist in the universe if humans didn't exist......Whether the number 5 can be said to exist....Stuff like that.
After being around drug seekers I've come to understand that they are enslaved by their habits. They don't have free will.
In short the drug seeker doesn't seek joy because they are not free to do that.
When advising young people to stay away from opioids (opioid use in young people is rampant) that' the approach I take.......Grab life I tell them.....Pills won't let you do that.
For what it's worth that is the strongest argument against pill dependence I've come up with.
SocratesJohnson
93 Posts
That is really frustrating. I don't mind working really hard to control a given patient's pain. I don mind it when, despite heroic attempts at pain control, you've accomplished little due to the patient's pill popping.
Overprescription of opioids is a national tragedy and a national disgrace.
I think there is a better way........Unrealistic mandates on how we must deal with pain are, in my opinion, really bad. They require us to engage in nonsensical pain control practices and we know, with certainty, that these practices are harming patients.