Pain Management ideas

[tincan]

For pain management there is pharmacological management and non-pharmacological management. What do you think are the "best" managements? When a fresh post-op patient with pain 7/10 refuses narcotics, such as hydromorphone and oxycodone, for their pain management due to the side effects (ex. N&V, drowsiness), what would you do? I could only come up with the following...

1. Give the minimal dose ordered, and if it's already the min. dose, ask the physician to write a new order for decreased dose.

2. Try a different narcotic (ask physician to consider a different one if there are no alternatives ordered). Try a different administration route.

3. Try relaxation technique (but I think its effect is low when a patient has 10/10 pain and still refuses narcotics)

4. Give Tylenol... only if the patient isn't already on regular acetaminophen that's close to the 4g/24hrs mark.

What else have you found helpful? Any input would be appreciated. :)

[turnforthenurse, MSN, NP]

EDUCATE.

*Sometimes patients prefer not to take narcotics because they are afraid they will become addicted to them. When taken/administered as directed, the chance of addiction is very low.

*Tolerance, which is not the same as addiction.

*Educate patients that adequate pain management helps with healing

*Common side effects with narcotics. Again, not indicating that the patient may become addicted.

Tylenol is going to have a minimal effect unless it is combo with a narcotic (like Percocet which already contains Tylenol in it) because those two medications have a synergistic effect. Tylenol is not anti-inflammatory and post-op patients will have inflammation. You could try relaxation techniques in addition to pain management with medications.

[turnforthenurse, MSN, NP]

Oh and regarding N&V side effects...talk to the doctor about getting some phenergan or Zofran on board to combat those side effects. For constipation (another common side effect), consider getting an order for a stool softener.

[nurseprnRN, BSN, RN]

it totally depends on the cause of the pain. morphine and other opiates/opioids are not effective for every kind of pain.

orthopedic pain responds well to acetaminophen and nsaids, though there is some research to indicate that nsaids delay bone healing.

neuropathic pain needs meds specific for that-- often classified as antiseizure meds, these act on the neurological generation, transmission, and processing of painful stimuli.

suggest you look up the excellent nursing resources joy ufema and margot mccaffery for ideas to answer your question. you'll be glad you did.

[SnMrsSmiley]

If for example your patient is a post op hysterectomy, direct her to place a pillow over her stomach to splint it, especially when she coughs or is trying to change poition. a warm semi dark relaxing environment, music, something to read to take the mind away... these are all things you can do to facilitate comfort.

I had a post op pt lat week that refused even a tylenol... she wanted to bare it out with NO meds at all. We made it 6 hours using these techniques until she finally decided to take a lortab so she could relax enough to sleep. It helps with the pain and if you continue to educate and explain the positive aspects of pain relief (without sounding like a pusher) then your pt will understand you.