Pain Medications

Nurses Professionalism

Published

I am happy to notice that doctors prescribe much less pain medications now then they did even five years ago. Some nurses say that new approach makes some patients to suffer unnecessary. Well, lets compare pain medications with antibiotics. Antibiotics save tens of thousands lives but at the same time some patients die due to adverse reaction to antibiotics such as anaphylactic shock. Should we stop using antibiotics just because one out of million patients may die due to anaphylactic shock? Of course not. A lot of Americans became addicted to pain medications, hundreds of thousands already died of overdose of pain medications. Should 60 thousands Americans die every year d/t overdose just because few patients have "ligimite" pain and suffer unnecessary d/t new strict prescription guideline? My answer is "No".

...In some cases even 1 tab of Percocet is enough to become addicted...

Do you have a source for this?

Up Vote Up Vote ×

Yes. I read in New York Times several years ago that someone became addicted after taking few pill of Percocet after tooth extraction. If you want to know more barrow from library books "American Pain" by John Templer and "Drug Dealer, MD" written by addiction doctor Anna Lemke

Up Vote Up Vote ×
Specializes in Emergency, Telemetry, Transplant.
What I can say... the less opioids the better. if your friend's mother develops opioid induced constipation (it is not fun at all) neither your friend nor your friend's mother should complain...

Oh you're right! It is way more important to prevent constipation that to regain independence after an injury from which recovery is possible with therapy. :sarcastic:

Up Vote Up Vote ×
Specializes in Emergency, Telemetry, Transplant.
Yes. I read in New York Times several years ago that someone became addicted after taking few pill of Percocet after tooth extraction.

Because that is a scholarly source that is completely free of an agenda.

Up Vote Up Vote ×
Specializes in Transitional Nursing.
What I can say... the less opioids the better. if your friend's mother develops opioid induced constipation (it is not fun at all) neither your friend nor your friend's mother should complain... One of my patient died of opioid induced constipation. Couldn't move bowel for 2 weeks, then developed massive GI bleed...

All my patients get senna S and anyone who hasn't had a BM in 3 days gets MOM followed by a sup with a finale of a saline enema (although usually step one is enough). This is no reason to deny needed pain relief.

Up Vote Up Vote ×
Specializes in Transitional Nursing.
Yes. I read in New York Times several years ago that someone became addicted after taking few pill of Percocet after tooth extraction. If you want to know more barrow from library books "American Pain" by John Templer and "Drug Dealer, MD" written by addiction doctor Anna Lemke

Again, there is a difference between addiction and dependence. We should be trying alternative methods but if/when those fail we shouldn't expect folks to participate in therapy or even ADLs with 7/10 pain levels. It's just not humane.

Some of my patients take only apap, some take Motrin (those who it's not contraindicated in) some take tramadol and some take oxycodone. Some of them are "clock watchers" and some of them won't ask for pain relief unless I assess them and ask them if they need it. There needs to be a balance, it's not a one size fits all situation.

Yes, there is an epidemic. No, people with sprained elbows or knees don't need to go home with 20 Vicodin, but folks with post op pain are not in the same situation, not at all.

Up Vote Up Vote ×
Specializes in Transitional Nursing.
I was with a friend, and we visited his mother who was recovering in the hospital from a surgically repaired hip fx. On this particular day, she was being transferred to a SNF for rehab. She asked the nurse for pain meds not to long before the ambulance was due to arrive and she would have to be transferred onto the medic stretcher. The nurses reply "oh, it's still 45 minutes before you can have another dose of oxycodone" (OK, fair enough....probably should have called the MD for a one time dose, but I can live with this). Then the nurse said, "and besides, you should not be taking this much pain medications." FWIW, it was nothing crazy, just the standard post op ortho regimen. The nurse added, "if you keep taking this, then I will just see you right back in here with stomach problems."

I was speechless. Here was an ortho nurse telling a pt to take fewer doses of the opioid right before the pt was going to start therapy for a broken hip. I understand that everyone needs to be more careful considering the opioid epidemic, but to tell a 70-something year old with a broken hip to take fewer oxys...right before the start of rehab? Society has made some believe that all pain meds are the devil, but some serious education is in order if ortho nurses are telling this to pts.

And truly, shame on her because it was at least 4 hours if not more before that pt was able to get another dose. SNFs don't have an in-house pharmacy and many have to wait for the pharmacy to deliver the meds in order to administer it, and we have to wait for the patient to arrive before initiating the process.

We do have "emergency" kits, but due to the hoops to jump through in order to open the narcotic ekit, it's rarely done. (Every state is different, but thats how it is in New England).

It's so frustrating. Sometimes I feel like I've done such a good job educating my patients (about a variety of things) and sometimes it seems like other nurses come behind me and undo all my hard work.

I wish we could all get on the same page and not just repeat things we've heard in passing or that evidence based practice has shown otherwise. I wish we could put our own biases aside and just focus on whats good for the patient.

Sometimes it seems like some nurses would rather be the "police" and determine whether or not the pt is truly exhibiting symptoms that require a requested PRN before giving it. I've seen nurses who wouldn't give PRN valium because the pt. wasn't displaying "anxiety". I just don't have that mainframe. If it is ordered and they request it by name I will generally give it, within reason and if its safe.

blah, off my soap box.

Up Vote Up Vote ×

. I've seen nurses who wouldn't give PRN valium because the pt. wasn't displaying "anxiety". I just don't have that mainframe. If it is ordered and they request it by name I will generally give it, within reason and if its safe.

By other words, you are feeding addiction because they taught you in nursing school to do so.

Up Vote Up Vote ×
Specializes in Transitional Nursing.
. I've seen nurses who wouldn't give PRN valium because the pt. wasn't displaying "anxiety". I just don't have that mainframe. If it is ordered and they request it by name I will generally give it, within reason and if its safe.

By other words, you are feeding addiction because they taught you in nursing school to do so.

No, I was taught to use objective data when possible and subjective data when indicated. I can't tell if someone is truly feeling anxious just by looking at them. If they say they are anxious and they have an order who am I to hold the med because I decided they aren't intact, anxious. Seriously?

It would be one thing if the order read "give 2.5mg valium for restlessness, pacing etc." but thats not the case in the type of situation I am describing. Also, I am NOT going to fix any type of "addiction" by being a med nazi. The best I can do is offer compassion, education and gain the patients trust. At least that way I have a prayer of offering them help if thats what they choose.

Not to mention, Addicts do not get better until they want to get better and I have no right to determine someone even IS an addict based on requests of PRNs. Good grief.

Up Vote Up Vote ×
Specializes in Emergency, Telemetry, Transplant.
Not to mention, Addicts do not get better until they want to get better and I have no right to determine someone even IS an addict based on requests of PRNs. Good grief.

Also, if they are addicted, we are not going to cure them just be withholding a dose here and there.

In addition, what's to say they ask for their PRN anxiolytic when the first start feeling anxiety, and they ask for a dose to prevent a full blown attack. Yes, the pt probably should get professional help to work on a better POC for this, but, again, this is not something that we are going to change during a short, acute hospital stay.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Gonna just say it again:

WAY too much ignorance in the nursing profession about dependence, addiction and associated concerns.

EVERY single nurse should have to take ongoing continuing education on this timely and misunderstood subject. It should be required in all nursing school curricula.

I just hope the OP never has to suffer at the hands of someone with her lack of knowledge and poor research to back it up, and judgmental attitude. Suffering pain, she may come to feel the backlash of attitudes just like hers.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Oh and here's a little something: ADDICTS are ENTITLED to pain relief just like anyone else.

Let that sink in.

Up Vote Up Vote ×
+ Add a Comment