Pain is more than just a number on a 1-to-10 scale. Treating pain at Henry Mayo Hospital means looking at the patient holistically and considering the risk of addiction to narcotics.
For Pam Geyer, pain management nurse specialist at Henry Mayo Newhall Memorial Hospital, the key to managing a patient’s pain is more than just an IV of morphine.
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It means looking at the patient and their condition holistically and determining how to best treat their symptoms while keeping in mind the growing epidemic of narcotic abuse across the nation.
Pain is More than a Number
Using research from the American Society for Pain Management Nursing and the World Health Organization, Geyer and her team of pain resource nurses evaluate the emotional, spiritual and psycho-social condition of their patients, she said, in addition to the intensity, location and duration of their pain, which is more complex than a simple 1-to-10 scale.
“You can’t just treat a number,” she said.
Geyer and her team work in all areas of the hospital, and there are two primary types of pain that doctors and nurses deal with on a daily basis: acute pain and chronic pain.
Acute pain is temporary and sometimes severe, such as “if I punched you in the nose and you said ouch,” Geyer said.
Chronic pain is long lasting and can actually causes changes to the nerves themselves.
Geyer was also quick to point out that managing pain does not mean relieving it completely; instead the goal is to control the pain while allowing functionality at each stage of the recovery, something that isn’t possible if the patient is constantly on opioids.
When a patient is receiving five or more doses of opioid drugs during a 24-hour period, it is a red flag to the pain management team that their condition is not being dealt with effectively.
When determining what level and combination of medication works best for a patient, Geyer uses the WHO “Pain Relief Ladder.”
Step one starts with a simple IV adjuvant, such as acetaminophen (commonly known as Tylenol).
Sometimes, this non-opioid drug can effectively manage pain on its own, Geyer said, but if it is not effective, doctors will bring the patient up to step two with a combination drug–often Norco, which adds hydrocodone to acetaminophen.
Step three utilizes a more powerful opioid, such as morphine or hydromorphone.
Facing the Addiction Epidemic
But this simple rubric is also informed by sobering statistics provided by the Drug Enforcement Administration.
California is the number one consumer of hydromorphone and the number two consumer of hydrocodone, Geyer said.
“Do people hurt worse here than they do anywhere else in the country?” she said.
Several factors affect the problem, and Geyer said that physicians have to take responsibility for the medication they prescribe.
The fear of litigation can influence some doctors, she said. They worry that patients will sue if pain isn’t treated to their satisfaction.
But prescribing an opioid can put the patient at risk for addiction or abuse, Geyer said.
Anytime a doctor prescribes a narcotic, it is put on the patient’s record, so that separate hospitals can determine if an addict is going from emergency room to emergency room looking for a prescription.
If someone comes to the hospital with a legitimate illness or injury they have a right to pain relief, whether or not they have an addictive disorder, Geyer said, but knowing that a patient has a problem allows the hospital to more aggressively wean them off of the opioid and minimize the risk of a relapse.
“We don’t want to contribute to that one more death,” she said. “…We don’t want to be the one pill that does kill them.”
A Different Approach to Pain Management
Sometimes, pain management means using low doses of medication meant for other conditions, or no medication at all.
Studies have shown that low doses of anti-seizure or antidepressant drugs can treat chronic pain.
Geyer said she tells patients that their chronic pain is like a piece of swiss cheese: different medications fit different holes, and opioids are not a one-size-fits-all solution.
In other situations, something as simple as opening the window blinds and getting people out of bed to take a shower can go a long way to making them feel better.
“When we start to feel like us, we become better able to management those other conditions,” Geyer said.
Ultimately, the goal is to treat pain with the patient’s best interest in mind.
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Source: Santa Clarita News