Do patients really need pain meds as much as prescribed?

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Pain is very difficult to assess and evaluate because for the most part we have nothing to go by except for what the person experiencing the pain tells us.

Regardless of what is the cause for pain there are many choices to treat different types of pain.

As healthcare professionals, when our clients complain of pain we tend to reach for that MAR and see what pain medication is ordered and how much we can give.

Our heart might be in the right place, but have we explored other options?

There are alternatives we can try to alleviate the discomfort that doesn’t have to include narcotics, but it’s so much easier and faster to give two Percocet than to try repositioning, heat, cold and/or distraction. It may not work but we won’t know if we don’t try!

Over the past few years I have noticed an increasing use of pain medication being prescribed.

Not only the amount, but in many cases different types of pain medications prescribed at the same time for the same pain.

I remember back in my initial days as a nurse when physicians actually had control on the type and amount of pain medication according to the situation causing the pain or discomfort.

Today with all the focus on lawsuits and the fear of violations of patient rights I have noticed a scary practice among physicians of increasingly adding more pain medications to patients.

Who’s to blame?

In part, the media is a major part of the problem.

The pharmaceutical companies advertise every five minutes their commercials about the newest medication to relieve this pain or that discomfort.

Then law firms hit us on the next commercial on how you can sue your physician/hospital if “not treated appropriately.”

I agree that people should be informed of their choices and what is new to help them with any illness or discomfort.

This knowledge can help us make better choices, but sometimes it can be overwhelming and misguiding.

I understand pain is very personal and varies from person to person even if they have the same situation causing the discomfort. Still, it’s frustrating when I’m consistently giving a patient around the clock a class three narcotic for “high” levels of pain while he or she seems comfortable watching TV, having a meal or conversing with family members.

It also frustrates me when I have a patient clinching with discomfort but for whatever reason denies having pain and refuses pain medication. Sometimes they tell me they don’t want to get “addicted” to the pain medication. I explain to them that it will not happen if they use it appropriately.

RX for pain

How many of us have seen this; Fentanyl patch 50mcg every 72hrs, Oxycontin 30 mg BID, Oxycodone 5- 10mg every 4 hours PRN, Gabapentin 600mg TID and Dialudid 2-4mg every 4 hours PRN?

This practice adds more problems than what it solves, creating not only the possibility of narcotic addiction but also an increasing dependency or tolerance on pain medications which can be just as bad.

It’s possible the patient that needed 4mg of Dilaudid for pain relief because they have used it so long – or in addition to other pain medication – might require 6-8mg for any new pain management.

In an article written by WebMD in collaboration with the Cleveland Clinic it states, “People who take a class of drugs called opioids for a long period of time may develop tolerance and even physical dependence”.

According to the National Institute on Drug Abuse (NIDA), the 2005 National Survey on Drug Use and Health, the incidence of new nonmedical users of pain relievers is now at 2.2 million Americans aged 12 and older.

This problem continues to escalate each day, but what can we do about it? When is it enough?

In my opinion this is one of those gray areas in nursing.

We are taught to do different assessments, act accordingly and evaluate the results from our actions.

Pain is one of those areas where we have very little to go by other than what our patients tell us and sometimes the story does not correlate with the picture. But what can we do?

“I don’t want my patients to be uncomfortable or in pain but I don’t want to make it worse either.”

I educate my patients about pain.

I tell them to ask for pain medication at the first sign of discomfort.

I explain to them that if they wait too long the medication might not be as effective.

I also educate them to other options according to what they tell me is the discomfort. I don’t want my patients to be uncomfortable or in pain but I don’t want to make it worse either.

Do we continue the polypharmacy use of narcotics or are there other answers?

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