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Pendulum Swinging too Far on Pain Meds?

Nurses   (28,332 Views 53 Comments)
by Emergent Emergent (Member)

Emergent has 25 years experience and works as a Emergency Room RN.

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Kittypower123 has 6 years experience and works as a RN.

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I and my coworkers wonder a lot lately...

Granted, I work in end-of-life care and there is a lot of symptom management related to terminal illness. There has always been the group of providers who are very hesitant to prescribe narcotics for symptom management pain and would not prescribe liquid morphine to deal with SOB unless the patient decided to be CMO.

Pain management is not that easy to begin with if a person has more than the standard pain issues or prior substance use. When we see patients who have a prior narcotic history or are already on high doses they may do better with methadone but many prescribers do not have the experience and do not like to deal with it for example. I had a patient basically screaming out in severe pain because of cancer and the patient had a prior tolerance history with taking up to 200 mg of morphine a day. What can I say? methadone fixed the problem but it was an act to get there....

I do think that providers need to be more educated about prescribing narcotics and also utilize other medications and methods.

So well said! So much more education on pain control and narcotics is needed, specially in regards to end of life. I run into the Morphine kills, once you start taking Morphine you'll be dead in 2 weeks, type comments. Thankfully, I work with a doctor who is comfortable with Methadone - works wonders for bone and cancer pain too.

As a side note, I do my own conversion calculations before I talk to the doctor. That way I can say "if we switch to x drug, the equivalent dose would be y." It helps that I work with great doctors.

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58 Likes; 14,159 Visitors; 880 Posts

Let us know when he has his surgery. I've heard patients say, " I wish I had done it sooner."

That's exactly what my mother said after she got her hips replaced. She's had severe RA for 40 years now and had her hips done when I was in college and what a difference it made for her! On another note, my mom takes tramadol prn for pain and it has gotten harder/more complicated for her rheumatologist in the last couple of years to prescribe it. My mom finds the new regulations quite ridiculous as she has severe chronic pain and really doesn't take much pain medication, but she now has more hoops to jump through to get it. Tramadol and OTC ibuprofen is all that she takes for pain- she refuses any type of morphine, oxycodone, etc. She even had a wrist replacement surgery and was totally happy with just a couple of days of Vicodin- she refused anything stronger.

I think it has swung too far the other way. I'm sorry what you are going through Esme, my mom hates feeling like she's just a drug seeker too and that's exactly what these new regulations are doing. Her urine is now tested- if the level is too high well that's bad and you have a problem (which has never happened), but if the level is too low then the response is "what are you doing with your pain meds- are you selling them? You obviously don't need pain medication or that much". Some days she takes more than others, but she never takes more than allowed and more often than not she takes way less- but she has it for when she needs it.

Edited by AceOfHearts<3

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BeachsideRN has 2 years experience as a ASN and works as a RN.

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He's "lucky" he got it 1 q6h. Prior to my surgery I was given an Rx for 1 q12h. And quite frankly tramadol doesn't work that great for pain, at least not for me.

The situation of pain control and the fear of being investigated is out of control.

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Mommavik has 32 years experience and works as a Retired.

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I think we are; used to be you went to the Dr, described your pain and if he/she thought you were being truthful and you did need medication it was prescribed (narcotic or nsaid). Now it takes going to a pain clinic to even get a nsaid prescribed other than a standard dose; if the standard dose is needed either they'll tell the patient sorry can't increase this medication, then won't change it or say"sorry let me send you to the pain clinic"

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RNCCMMS has 40 years experience and works as a Clinical Quality Auditor.

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I'm confused about the push to use Tramadol. My pharmacist told me that it is usually only given postop if you have received a dose in the immediate postop setting-because the side effects are major-seizures, decreased respiratory status. And it is for moderate to severe pain and is short term. What happened to the pain steps- starting with the nsaids, and working up to the narcotics, unless it is immediate postop or injury related. If we start out with the opiates to treat pain from muscle pulls, osteoarthritis, etc, and they stop working, where are we going? The current heroin epidemic is being blamed on codeine addictions. When police officers have to carry Narcan, it's a sad day for us.

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NurseGirl525 works as a Registered Nurse.

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I agree 100% it has swung too far the other way. But isn't that how it usually goes?

God Forbid somebody ask for help with pain. It's considered a weakness to ask for help. The same nurses I see on here advocating to remove the stigma from mental illness, think the exact opposite when it comes to pain.

I'm very passionate on this subject. I asked for help with my chronic pain. I don't tell people that for fear of judgement. Whether it's acute or chronic, people need treatment for pain. It's not a weakness!!!

I challenge anybody on here to live is constant, daily pain, knowing that at a 5-6 that's all the more I can get it controlled, so I've adapted my body to it. Imagine live my every, waking hour at a 5. Most people would collapse under it. It has made me stronger.

People should be made to feel ok about saying, Yes, this hurts, please treat it. Not, oh my gosh, does asking for help mean I'm less of a person, or will the see me as a drug seeker? Will they think I'm a wuss? Will I be labeled a frequent flyer? It's ridiculous.

I've heard the few drug seekers in my pain clinic. They ruin it for all of us. It really sucks when they see you take a chronic pain med, and it helps, but doesn't touch acute pain. Doesn't touch. And now you seek help for the acute and they look at you like you have three heads.

I dont one get how people abuse tramadol. Where is the high? I've never once felt that with tramadol. It's a knee jerk reaction to this ridiculous nanny society we live in.

Off Soapbox.

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NurseGirl525 works as a Registered Nurse.

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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

Esme, it's so nice to see you!! I feel you on this subject and I'm so sorry you have to go through this.

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NutmeggeRN has 25 years experience and works as a HS Nurse.

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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

Esme, glad to "see" you, sorry it has been such a tough road for you.

The pendulum HAS swung to far. I think there has been been easier /looser prescriptive approaches in the past. But often the real issue is those who DO NOT take their meds as directed. If one feels good, two will be better. And when ETOH is added ....well, we all know how THAT goes. THOSE are the people who abuse and then blame the docs, and people like you get screwed....

Hang in there!

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Pixie.RN has 18 years experience as a MSN, RN, EMT-P and works as a Infection Preventionist/Nurse Epidemiologist.

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I think we all love Esme very much. *hugs*

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I was RN for 20 years before becoming FNP, worked much of that in home health/hospice. There's no easy answer and really until you are the one prescribing and responsible you don't have the complete picture.

This article is in response to the 2016 CDC pain guidelines. Granted, it's on chronic pain, but the gentleman in this story is chronic pain until he becomes postop given his history.

Medscape: Medscape Access

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My husband and I both suffer from back issues that flair up. I hate taking pain meds, but once in a while I need them in order to sleep. We asked our mutual doctor for a refill on the pain meds we last filled almost a year ago. At that time he gave us 30 tabs. It took us a year to use them. This time, he gave us 15. No big deal for us, but this is some kind of ridiculous. If someone needs pain meds, they need them.

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I think the pendulum has swung to the ridiculous. I have a friend who went to the ER in severe pain from a diner stone. They gave him IV Tylenol. Needless to say it didnt touch the pain. They made him suffer until the tests proved that he had a kidney stone. THEN they gave him IV Dilaudid.

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