POLL: Do you think cancer pain is properly managed?

[Dave ARNP]

This poll is to give all of us an idea on how cancer pain is being managed thoughout the world. Those of us who care for cancer patients in pain, know how rewarding the work can be. What I would like to know is how do you see pain being treated in your area? Are cancer patients given enough medication to rest and pass comfortably?

Please vote and feel free to post any thoughts, questions or suggestions you may have.

-Dave

[P_RN, ADN, RN]

I don't believe that it is well managed in most situations I am familiar with. My father had lung ca w/ mets to the brain. His doc didn't want to "overdose" him with pain meds. Within a day he was comatose and until he died 3 weeks later he kept a frown on his face. Death was a release for him. I will never forgive what that neurosurgeon did.

[Spidey's mom, ADN, BSN, RN]

The docs I work with do a very good job of managing pain. I'm grateful for their continuing education in pain management and for the nurses who stay open to the idea that patients deserve pain relief.

steph

[gwenith, BSN, RN]

It is better managed since we instituted pain management teams within our state hospitals. Some of the private hospitals have followed suit with the idea and now we refer all patients whom we think might have a pain issue problem to them. They will also look in on major surgery patients with epidurals etc.

[aimeee, BSN, RN]

It was difficult to chose the answer I wanted because of the wording. Pain management varies quite a bit from doc to doc. Some are excellent pain managers and some are awful. Some are very uncomfortable with prescribing schedule II drugs for anybody no matter how bad their pain is. But when you use the word "we" I take it to mean my own organization, and "we" take pain management very seriously and strive to keep our patient's pain at 3/10 or below, or at whatever level they believe is acceptable. We will get the medical director to take over pain management if the primary refuses to write the necessary orders to get the patient comfortable.

[angelbear]

In my facility we dont have alot of cancer but do deal with alot of other end of life stuff. I do think it is good but could be better.

[caroladybelle, BSN, RN]

As a general rule, my Oncologists do an awesome job.

However, frequently when other MDs are involved, the end of life care goes down the tubes. We all know the story, family in denial at the end of "the long trip home" asks MD the feared question, "Isn't there ANYTHING ELSE that you can do?" and MD gets the much loathed renal/neuro consult. Neuro "thinks patient is oversedated" and takes away pain meds. Renal sees patient as a bunch of screwed up electrolytes yearning to be corrected and the patient gets a restricted diet (that they need like a hole in the head), fluid restrictions (like they can tolerate anything but liquids), and huge Mag/K+/Neutro Phos/Calcium pills (that they vomit up ...if they can swallow at all) and NO SEDATIVES!!!!!

I think that the family issue (You are going addict Daddy to Demon Drugs!) is a more difficult one to surmount. And you can educate the family, till the cows come home....and it gets completely undone from a wellmeaning consultant with MD at the end of his name.

[Dave ARNP]

As a general rule, my Oncologists do an awesome job.

However, frequently when other MDs are involved, the end of life care goes down the tubes. We all know the story, family in denial at the end of "the long trip home" asks MD the feared question, "Isn't there ANYTHING ELSE that you can do?" and MD gets the much loathed renal/neuro consult. Neuro "thinks patient is oversedated" and takes away pain meds. Renal sees patient as a bunch of screwed up electrolytes yearning to be corrected and the patient gets a restricted diet (that they need like a hole in the head), fluid restrictions (like they can tolerate anything but liquids), and huge Mag/K+/Neutro Phos/Calcium pills (that they vomit up ...if they can swallow at all) and NO SEDATIVES!!!!!

I think that the family issue (You are going addict Daddy to Demon Drugs!) is a more difficult one to surmount. And you can educate the family, till the cows come home....and it gets completely undone from a wellmeaning consultant with MD at the end of his name.

They did this when I was in NP school.

I didn't practice it then, I don't practice it now.

And getting mommy and daddy addicted to demon drugs? Don't really hear that one as much as "will you give me some Lortab incase I catch the cancer before I can get in to see you again?"

Dave

[caroladybelle, BSN, RN]

And getting mommy and daddy addicted to demon drugs? Don't really hear that one as much as "will you give me some Lortab incase I catch the cancer before I can get in to see you again?"

Dave

What can I say Dave, but that I have worked in the boonies for a bunch of years?

Where women have to wear dresses and never cut their hair. Where Little old ladies get admitted for hypotension, 'cause "they done fell right out at the A&P". Where people believe that if you die with smoke or liquor or a pain drug in your system, you are going straight to Hades. Where people believe that you may have to suffer "like Jesus" when you die and it is a good thing.

It gets kinda scary out there at times, Dave.

[Dave ARNP]

Okay, I really hope you're joking... cause that is sick.

-Dave

[fab4fan]

I wasn't sure how to answer, because as a hospice nurse, our pts do get good pain mgmt.

Once in a while, you do get the bone-head doc. I had a pt that was SCREAMING in pain, and he wouldn't order anything because he didn't want to "depress her respirations." Dimwad. I said, "Well, since the pt is currently screaming her brains out, I don't think you need to worry too much about her ventilatory effort." What can I say...dimwad.

[Dave ARNP]

Great reply Fab! Don't ya just want to smack people like that?

Glad to see you around. I wondered where you were!

-Dave