Purdue University
English Composition II – Eng 105
Fall 1988, Dr. Bolduc
Grade: (B+)
Pain Medicines
I occasionally give patients more pain medicine than ordered by their doctors; I do this when I think the dose is ridiculously small; I document giving the ordered amount. Only God and I know or will ever know the difference. As shocking as this sounds, my consciousness is always at ease; in fact, it actually relieves my consciousness to ease my patient’s pain. Experience with patients in pain has given me gut instincts about their need for pain medicine. Nurses spend most of their time at a patient’s bedside; doctors order doses according to drug manuals and then walk away. An example of a situation in which I would give more than the prescribed amount would be a man who just had his lung removed weighed 200 pounds, and was screaming, “Let me die!” The order said to give 8 mg of morphine; even a textbook would say I could give 15 mg; I gave him 10 mg.
I attended a seminar about pain relief. The nurse who gave it was a dolarologist (pain specialist). She had done enormous clinical research on pain relief. She also worked as a consultant to doctors and pharmacists all over the country; she guided them in relieving their patient’s pain. Her research documented what I knew through experience; patients need much more pain medicine than we are giving them and much more pain medicine can be given safely; pain is not good for your patient’s health.
To illustrate the vast disparity in what doctors order and what patients need I will use this example:
Doctors orders: Morphine 6-8mg every 3-4 hours
Patients need: Morphine 360mg in 1 hour.
I am talking about major discrepancies!
The seminar also dispelled myths about using narcotics to relieve pain:
MYTH: We must be stingy with pain medicine because patients might become addicts. People may lie about having pain just to get narcotics.
TRUTH: The number of patients that would lie about pain or become addicted when taking needed pain medicine is so small that it should not even be considered. Nurses are now taught to believe the patient about his pain. Surgical patients are not even remotely thinking about becoming addicts; cancer patients do not want to be taking narcotics.
MYTH: Narcotics depress respirations and may make the patient stop breathing.
TRUTH: The use of pain medicine must be individualized; it should be titrated to the patient’s relief, not by drug book usual doses. When patients have pain their pain receptors use up the narcotic and do not allow the drug to depress respirations.
MYTH: As long as the textbook doses of pain medicine are given the responsibility of the health care professional is ended.
TRUTH: Relieving pain is just as important as giving a diabetic his insulin. Unless you relieve pain in a surgical patient he will not cough well and may get pneumonia; without relief, he will not move around well and may develop blood clots. So, by relieving the pain you are preventing complications that could kill the patient.
MYTH: I should not take pain medicine, especially narcotics.
TRUTH: Most patients feel guilty about asking for pain medicine; they have been socialized not to take drugs; they associate narcotics with drug addicts. To relieve their guilt ask the patient, “If you did not have pain would you want to take this medicine?” Of course, they answer no. They are then greatly relieved.
Patients can sense the health professional’s attitude about relieving their pain. It is psychologically painful and frightening to think that your nurse or doctor does not believe you about your pain. Health professionals should make their patients feel “OK” about taking needed pain medicine; they should even point out the health benefits associated with being comfortable such as fewer complications with their illness.
By relieving patients of their chronic pain, we allow them to be intellectually involved in their own care; when you are in constant pain you cannot think. Chronic pain makes people feel that they have no control over their lives; with relief, they have control back. Dying patients are allowed to live in comfort until they die with adequate pain relief.
Even though research has given us new data about pain control, this data is not universally used in health care. Many seasoned doctors and nurses are not aware of this new knowledge; many have heard it but are unable to accept the new knowledge and attitudes about pain relief. It will take time for these new attitudes and knowledge to become accepted and trusted. Until then I feel compelled to use my new proven knowledge when faced with a patient in pain who has a doctor from the old school.
Consumers beware: the knowledge and attitude of your healthcare professional can literally hurt you!