Pain Medication from Common Sense Perspective.
by, 10-05-2010 at 12:50 PM (4443 Views)
Is pain scale an objective tool to measure pain level. I’ve never thought so. How often it happens when a nurse asks a patient:
Do you have pain?
A little bit.
How would you rate your pain level on scale from 0 to 10?
Eight or nine.
In this case the majority of nurses do exactly as we are brainwashed to do: document 9 and offer pain medication. The majority of patients do not refuse a pain shot even though they would not request one if a nurse does not push. Does it make sense? A little bit of pain rated as 9???
Several weeks ago I attended “Pain Control Class”. Both doctors and nurse educators talked about pain. I really loved listening doctors. And I learned that doctors did not like prescribe pain medication because of side effects. One doctor said that even though opiods can control pain well, a lot of patients still suffer of withdrawal symptoms a lot. But why patients are not informed about down the road complications? Instead we tell them, “Do not hesitate to request pain medication”. I feel that we, nurses, are pill pushes. We believe we are professionals but we do not know much about medications we give to our patients. It is even not our fault because nursing textbooks do not say anything about it. Probably because they do not want us to know the truth. They just want us to be pill pushers. I remember a 20 years old patient with stones in gallbladder. (He was a pre op) He told me he cannot sleep and requested sleeping aid. I forwarded his request to MD.
How old is he? - asked me MD.
Twenty, replied I.
Doctor did not tell me anything but looking at her face you could see she did not like that young pateint’s request at all. Anyway, she ordered Ambien. Why did she write that order against her conscious? Why not to go to talk to the patient to explain to him all risks and why she did not want to take that med? I think doctors are not free in this country. They are under Big Pharma and are not free to practice common sense.
As I said not only doctors, but nurse educators talked about that topic. And their message was opposite, you know, “Do not hesitate, give pain medication. Pain level is what patient says. But this approach makes a lot of harm. Let’s have a look at my patient who had “a little bit of pain” and rated it 8. I handle this situation according to common sense. I documented “4” and did not offer pain med. The next day I came to work and found out from the report that my patient was confused, pulled out JP drains, talking about conspiracy all the time a had a sitter.
She reported pain 8 out of 10, - told me a night nurse and I had to offer her Percocet. She took it and became confused.
How stupid you are, - thought I about that nurse but did not tell her anything. What can you tell someone who are brainwashed by nurse educators?
Not only doctors but also nurse educators talked about pain at that class. Their message was, “Do not hesitate, give you patient pain medication”. I definitely could see that doctors and nursing theorist are on different pages: nursing theory teaches you to push pain meds as doctors do not like it to do it. By the way, I was surprised. One doctor honestly admitted that some physicians increase dose of pain medication a little every time a patient on narcotics come to appointment to make sure that the patient will come back to him.
And how do you like this statement from nursing textbooks, “Patient’s pain level is not what you think, it is what they report”. All people are different and react to pain differently. Patient can smile and still has pain 10/10. Give him narcotic to control his pain. This statement is a brainwashing. Pain shock kills, so pain 10/10 kills. But our body has a protective mechanism. When you are in severe pain you may loose conscious. So if you lose conscious but still alive it means toy pain level is 9/10. Women in labor experience pain level 8/10 does not kill. By the way, have you ever seen a woman in labor, smiling and laughing? Of course not, because even though we are all different, our reaction to pain is the same. To make a story short, only few category of patients need narcotics to control pain. They are: cancer patients, patients with gun shot wounds, some (not all) post op patients.
Once my patient requested two Percocets. It does not matter how he rated his pain because so called pain scale is not a scientific tool but when I asked he said that his pain related to constipation. I had to give him narcotic. When I visited Europe this summer I told about this case to my friend who is an experienced anesthesiologist. He had a very hard time to believe me that in America patient can get narcotics for constipation pain. And that doctor told me that only a few categories of patients need narcotics. Again they are: cancer patients, patients with gun shot wounds, some (not all) post op patients.
Have a look at a chapter about pain in any nursing textbook. One short paragraph tells you that addiction is possible and 20 pages tell you how important to give your patient pain medication. But I tell you doctors are not so easy about down the road addiction. So why nursing theory ignores this problem??? And in the Internet you can find a lot of hard breaking stories written by people who became drug edicts in hospital. I tried to find official statistic of addictions r/t hospitalization but couldn’t. Probably they do not keep track of it or keep information in secret. I only found out that in Ohio 43,000 patients become addicted each year. I could not find information about other states. But it is a lot!!! And it is not a secret that nowadays the majority of drug addicts switched from street drugs to prescription drugs. And it looks like that Big Pharma when planning production of pain meds, considers not only hospitals needs but also drug addicts needs and it is scary.
Why is it so? I think that the answer is in the Bible and Jesus is only a solution. The Bible says, “For the love of money is a root of all kinds of evil.” (1 Tim 6:10). Big Pharma loves money and for this reason they brainwash customers to believe “the more medication the better”. But it is crime and overusing narcotics is even a bigger crime. Why doctors who claim they are Christians do not speak against this madness? Why Christian nurses are silent? We all are accountable to God for this crime. I remember an instructor in nursing school read a letter to our group written by terminally ill child. I remember only one moment from that latter: a terminally ill child refused pain medication because he realized he would not live long and wanted to enjoy communication with his family. Terminally ill people need to have clear mind as long as possible to reconcile with God. But too often they are over medicated and it is a crime/ I remember 89 years old patient. She was pain free but she had few days to live. Tube feed was discontinued and patient complained about abdominal cramping related indigestion/ (She got only about 50 ml of tube feed). She even did not requested pain medication but her family did it for her and convinced her she needs it. And doctor ordered Delauded 2 milligrams. In this case 0.2 milligrams would be more than enough. This dose made her sleepy and several of her final hours were lost. But for this huge dose, her family could have enjoy meaningful communication with her dying loved one. How does God look at all of this?