Pendulum Swinging too Far on Pain Meds?

Nurses General Nursing

Published

A good friend of mine's hubby is waiting for a hip replacement surgery. He's the farthest thing from a drug seeker I can think of. He's in a lot of pain, bone on bone. He's a karate instructor as a sideline, probably that repetitive motion contributed to this problem, he's in his mid 60s.

He didn't like the oxycodones which made him itch, but Tramadol helped. The doctor wouldn't let him have 1-2 every 6 hrs like he had before. They wrote the script for 1 every 6 hrs. They told him he needed to wean down before surgery, that it would make pain control afterwards easier.

If they checked the controlled drug database, they'd see that this fellow hasn't needed pain medication until now. Are the doctors under so much pressure to meet goals to satisfy the overseers that they are under medicating?

Previously I always thought that the policies on opiates were too liberal and contributing to addiction. But now I sense an almost puritanical attitude on the part of some.

Isn't there a middle ground?

Specializes in Adult Internal Medicine.
Just wanted to pipe in on this regarding your original question regard MDs and pain meds and the environment becoming puritanical with an example of the insanity. I have a pt who was pegged as drug seeking several years ago...but now we are s/p L AKA, and they wont give pt anything for pain. Keeps going back to the ER complaining of pain they wont give anything...dehiscence of the stump everything getting necrotic, pt in pain, wont give anything. Finally has a blow out moment where home health wound care goes to see pt and finds maggots in the wound. So back to the ER pt goes. They finally go in with an angiogram and end up having to do a mechanical thrombectomy and revascularize the illiac with a stent....so stump has been ischemic this whole time. I imagine that's probably pretty painful.

The problem here is that because someone is labeled as drug seeking they get NO PAIN needs met! Its really frustrating and impossibly hard to advocate in this environment.

I feel for the suffering the patient went through, however, I could also see an argument that pain meds are not the appropriate treatment plan for an ischemic limb and by not getting narcotics he ended up finding a provider that figured out the actual problem in time to save the rest of the limb.

Specializes in Medical-Surgical/Float Pool/Stepdown.
I feel for the suffering the patient went through, however, I could also see an argument that pain meds are not the appropriate treatment plan for an ischemic limb and by not getting narcotics he ended up finding a provider that figured out the actual problem in time to save the rest of the limb.

But why is this happening in an era where we are so medically and technologically advanced, with also having so many different resources that could have lessened the pain, were they not being treated appropriately with simultaneously finding out the underlying source?

What is that saying about multi-tasking? One can only half ass when doing more than one task at any time but can be at their best when focused on only one task at a time. Something like that. I just don't buy it that we couldn't pull off both and it's going to just be one or the other. I don't know, maybe that's just me...I'm an odd one anyways :cheeky:

No, I don't think this is a case of under-medicating. It is reasonable to start at the low end of the dosing range, and it's true that he should be thinking ahead to his post-operative pain management situation.

Yes. Most orthopedic surgeons require weaning or tapering off pain medication prior to surgery.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I have very strong opinion about this topic. The pendulum has swung too far the other way. All of this "opioid crisis" and the increased overdoses have little to do with the real patient that is in pain. Weaning a patient off pain meds to make it easier for pain control post op is torture of a patient that cannot get relief. Frankly in my opinion it is delay of treatment and malpractice.

I am on some powerful pain meds right now and frankly, I am sick to death of being treated as if I am endangering the general public with my narcotic pain use or I am secretly behind the pharmacy shooting heroin. I have been sick for a year now and a 9 month hospital stay and still have another surgery to try to fix me. I am sick to death of being treated like a terrorist just to get pain relief. These new "laws" will NOT stop the heroin crisis or the use of IV Fentanyl by rock stars. Their drug addiction has absolutely NOTHING to do with my pain.

I do not take my pain Rx to get high. I take my meds as prescribed for the relief of pain. I do NOT expect complete relief but I do expect to have enough relief so I may function I wish (I had enough strength and was well enough to confront the lawmakers and the family members of those who died of overdose and tell them of my nightmare of relentless debilitating pain that I have to beg to get someone to believe me.

While I understand the need for awareness the pendulum has swung too far in the opposite direction and patient who really need relief....can't get any meds

Specializes in ER.

(((((Esme)))))

I'm sorry for all the suffering you're going through :(

It's VERY GOOD to see you!

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Yes. Most orthopedic surgeons require weaning or tapering off pain medication prior to surgery.

I have never ever heard of this and would be interested in hearing more about this statement from the OP. I did ask my husband, who is a general orthopaedist and also Fellowship trained in both joints and hands, if he had ever heard of this. He said no. He said that most often by the time he sees a patient for possible joint surgery, the patient may or may not already be taking medication for pain control. Post-op care has to be individualized to each patient, but, in his opinion, the statement above does not make sense. Quoting him here: "Patient is already experiencing significant pain, and there is time enough later to taper pain medications after the initial post-operative recovery."

I would say it is. The VA I recently left instituted policies where it would almost take a letter from congress to get an opiate and if you were on an opiate, you were likely going to be switched to tramadol whether it worked or not. We had a pain mgmt. clinic but it was pathetic when it came to medicating. If someone tested positive for a benzo or barb or amphet they would automatically dc the opiate and refer them to substance use; never mind that they were on Zoloft or ibu or Wellbutrin; they didn't want to take the time to further investigate. And the opiate ban like the 3 strike criminal laws--permanent--althought you only got one strike in this case. Typical fed govt idiocy. I of course would have to deal with these individuals when they came to the crisis clinic and reported they were going to commit suicide rather than deal with the pain. I get that. Pain is debilitating.

From an anectdotal POV, I severely sprained my foot a year ago. I was out of town and went to an urgent care clinic thinking something very well could have been fractured given the pain/swelling and discoloration. The doc/staff were quite surprised nothing came up on x-ray, but then again the swelling may have covered up a crack. So while I was there they gave me a lor-something. This was a Saturday. I asked for a Rx for 3-4 days. He said that if I wanted something beyond the 1 he gave me I'd have to go to my MD. So most PCPs don't do weekend hours and even if they did at least Saturdays, I wouldn't have been able to get home before their office closed. Also, it's not always a guarantee that you'll be able to get an appt. same day, so no guarantee I would be seen on Monday. So I had to live with ibu. I like ibu fine for most issues (fortunately I don't have any chronic pain issues), but yeah that was quite a miserable weekend and by the time I got in to see the doc the pain was manageable by ibu.

When I was earning my MSN I did a paper on the misuse of prescribed opiates. I ran across a source (which I could never find again) which said the US uses like the upper 90% of all opiates in the world (and I wanna say it was 99%). I'd be curious to see more recent statistics to see how much the pendulum has swung, if at all.

Specializes in PDN; Burn; Phone triage.

This is probably a stupid question but I have always wondered why "cancer pain" gets a pass. Is there something specific to cancer pain that makes opiates a better choice? Or is it just because it's cancer? What about chronic cancers?

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
The point of my post was not to argue my friend's individual case actually. That was merely an example of what sounds like fear or hesitancy to prescribe controlled substances. I suspect this might be due to increased scrutiny of prescribers.

The reason given sounded rather bogus. And, Tramadol is hardly the drug seekers preference in the first place. My friend, who is a nurse, said she felt they were being treated like drug seekers.

There has been a drastic shift from what I was taught in school, to cater to people in pain. That philosophy led to the problem we see today, mass prescription opiate dependence and abuse. Are we now swinging too far the other way?

As always seems to be the case, the pendulum is swinging too far . . . witness the "Customer Service" reimbursement model. And HIPAA -- both cases of over-reacting to problems that could probably have been dealt with less drastically. An orthopedic patient who has scheduled surgery to fix his problem relying on pain medication to get him through his daily life until after the surgery is not the problem. The person who "lost" all of her pain meds or has had them stolen three times this month might be.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I have very strong opinion about this topic. The pendulum has swung too far the other way. All of this "opioid crisis" and the increased overdoses have little to do with the real patient that is in pain. Weaning a patient off pain meds to make it easier for pain control post op is torture of a patient that cannot get relief. Frankly in my opinion it is delay of treatment and malpractice.

I am on some powerful pain meds right now and frankly, I am sick to death of being treated as if I am endangering the general public with my narcotic pain use or I am secretly behind the pharmacy shooting heroin. I have been sick for a year now and a 9 month hospital stay and still have another surgery to try to fix me. I am sick to death of being treated like a terrorist just to get pain relief. These new "laws" will NOT stop the heroin crisis or the use of IV Fentanyl by rock stars. Their drug addiction has absolutely NOTHING to do with my pain.

I do not take my pain Rx to get high. I take my meds as prescribed for the relief of pain. I do NOT expect complete relief but I do expect to have enough relief so I may function I wish (I had enough strength and was well enough to confront the lawmakers and the family members of those who died of overdose and tell them of my nightmare of relentless debilitating pain that I have to beg to get someone to believe me.

While I understand the need for awareness the pendulum has swung too far in the opposite direction and patient who really need relief....can't get any meds

I'm sorry for your troubles, Esme.

I understand the need for awareness as well -- but like you, I think the pendulum has swung too far in the wrong direction.

I have degenerative joint disease in my right hand from the meds I've been taking for breast cancer. I can get my cancer meds changed -- again and again, with survivability rate changes -- but can't get anything for the pain in my hands. I finally took half of a Dilaudid tab left over from post-op and requested a PT consult. The PT has done wonders to decrease the pain and increase strength, mobility and flexibility of the hand -- I'm a fan of PT. I've still got the leftover Dilaudid as a back up plan, but PT worked.

While I was sitting in the PT office, another patient had an episode of "Status Dramaticus," screaming, flinging herself on the floor and kicking the PTs who were trying to help her. It seems her issue is that she wants her Oxy 30 mg. prescription renewed for her "Turrible back pain." No injury, but she can't work. She can't even get out of bed most days because the pain is so bad, and she needs her prescription increased, not decreased. Her doctor died and the new one made her go to PT when anyone could see she needs medicine. She won't do the exercises because she knows they won't work, and how in the world is she gonna get to the office three times a week when she can only get out of bed three times a month to collect her benefits and pick up her pain medicine? Might I note that the nurse in me observed the patient was moving quite normally when she walked into the office and when she was having her tantrum, although she walked with a notable limp and obvious wincing when she thought anyone was looking.

Denying medication to folks in legitimate pain isn't going to do a thing to fix that woman's problems.

Specializes in Pediatrics, Emergency, Trauma.
But why is this happening in an era where we are so medically and technologically advanced, with also having so many different resources that could have lessened the pain, were they not being treated appropriately with simultaneously finding out the underlying source?

What is that saying about multi-tasking? One can only half ass when doing more than one task at any time but can be at their best when focused on only one task at a time. Something like that. I just don't buy it that we couldn't pull off both and it's going to just be one or the other. I don't know, maybe that's just me...I'm an odd one anyways :cheeky:

I agree.

It took SEVEN years for me to find a doctor who has well versed and specialized in pain management for my CRPS and my migraines; my neurologist is great in arranging the meds and have me on a regimen that works best; before then, I would go to the ED when I had an exacerbation; the only saving grace was they treated he symptoms and never made me feel like I was "crazy" for having pain.

I was sick and tired of going to ED for it; I had to change primary docs and my neurologist (who thought my pain was "psychosomatic" when it wasn't; it was a combination of many complications with having a major medical event; it even involved me having several specialists-including GI-to help with regulating bowel movements, which not going enough changed the pressure in stomach, which produced pain secondary to my exploratory laparotomy and removal of portions of my small bowel, and it would effect other part that were injured.

I'm also relieved how people treat migraines; IN the 90s, I remember they used to throw Percocet at me for the migraines; which would work once; now, they have a migraine protocol which involves NO narcotics and has a better response with the combination of medications to help relieve the symptoms and the headache itself. I used this combination of ibuprofen with my sumatriptan and take beastly and ranitidine and hydrate myself and save myself a trip to the ED.

If the advance cans be made for migraine suffers, and un-sexy it is to focus and research and develop and for chronic pain, it would be more effective to take a multidisciplinary approach instead of the 1950s freak-out approach to a "crisis" that has been LONG ignored.:no:

+ Add a Comment