READ THIS

Speedy1RN · Dec 26, 2000

Follow up:

This is the email I received from Jacho (notice the spelling)

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Jacho has some articles on their website about pain management if you do a search for pain. They are vague in nature in that studies are underway or have been done.

I agree that pain management is important. It is very subjective on our part and unless we are in the patient shoes, how do we know without asking. Speaking from an ER standpoint, most people come to us in pain and want relief.

HOWEVER

There is a portion of our population that abuse the system. Drug seekers in particular. I had a patient change the refill number on a prescription and tried to fill it. I now chart how many refills we wrote to cover my self and the doc. I could sit here and write all kinds of situations, but you too know of stories.

I would hope Jacho addresses this more. We should be allowed to keep a record of repeat offenders of narcotics and pain medicine. Hey, if sex offenders are posted on websites, let's post drug seekers on the website. May be a bit extreme...

Your thoughts.

fergus51 · Dec 26, 2000

Pain is quite an issue. I do believe that most doctors do tend to undertreat their patients for fear of addiction when the research doesn't support that. The number of people who get addicted to pain meds when in real pain (not fake pain drug seekers) is miniscule. Fear of addiction is robbing people of their quality of life. One nurse's father who was dying of cancer didn't want to take his pain medication because he didn't want to be a junky. He didn't want demerol, but would accept it when we called it meperedine.

Even when drug users are in real pain we tend to ignore it. I was on an orthopedic floor with a former addict who had multiple fractures to his face as well as a broken leg and the doctor ordered he be given a placebo instead of real pain meds. It made me sick that we would all let him scream in pain rather than give him a narcotic.

Also I think we do need to ask about pain SPECIFICALLY. A lot of people won't answer the question unless you ask it specifically. An example is my mom. She always puked like a dog after surgery, but everytime she was asked if she had ever had a reaction to anesthetics she would say no. She thought a reaction meant you stopped brething. It wasn't until she made a joke about it to a pre-op nurse that they changed the medication and she had her first puke free surgery. We laugh about it now.

pickledpepperRN · Dec 27, 2000

I also heard on the radio that each time vital signs are taked the patient should be asked to rate their pain on a 1:10 scale.

I agree with the purpose and much of the article, however I'm afraid it will become a problem like the forcing of the MD to assess the patient within an hour of applying restraints.(Can't an RN describe to an MD that the patient is pulling at the ET tube?)

I ask my patient, "How do you feel?" If there is any discomfort (including such discomforts as nausea that are NOT pain) the patient will tell. Then I ask the patient to describe their discomfort. Many MI and angina patients will say, "I don't have pain, just this pressure." What about the patient with numbness, weakness, or shortness of breath? What about asking the location of the pain? Is it worse when you move? WHAT ABOUT THE NURSING PROCESS?

I think I'll go to JCAHO.org and try to ask.

babs_rn · Dec 27, 2000

ok, I read it. I like the part about patients with "no history of psychological problems" not getting addicted to pain meds. How many patients coming to the ER DON'T exhibit signs of "psychological problems"? At least in the area where I live there are so many, SO many with what I guarantee are undiagnosed psychological problems - to include massive codependency, drug dependency, alcoholism, abusive behavior to self and/or others, etc,etc,etc....Who among us DOESN'T have some degree of "psychological problem"? Let's get real here...or at least more specific. We're all dysfunctional to some degree and thus we all have "psychological problems".