chronic pain management
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nursing pain management

Read and learn more about nursing pain management. For more, visit the Chronic Pain website ChronicPainFAQ.org

Q: What does a nurse practitioner do at pain management?
I have my monthly appt at my pain management doctor in a couple weeks and they had to change it with the nurse practitioner because the doctor won’t be there that day. Do they do the same thing your doctor does? Will they be able to prescribe more medicine if you need it? Will it be a wasted trip there?

A: An NP can write any prescription a Dr. can write, unlike what blondey wrote. They are under the “supervision” of the docs in the office which is what allows them to treat patients and write the scripts. If the NP determines that you need to have the narcotics, she will write them for you.

Q: Are there any nurse practitioners currently working in a chronic pain management unit/setting?
I am looking for any SOP’s (standard operating proceedures), clinical pathways, terms of reference, best practice guidelines or job descriptions for a nurse practitioner in a chronic pain management setting. We have recently established a new NP position at the PMU (chronic pain management unit) within our hospital and would like further guidance as to the role/job description etc. Appreciate input.

A: Hi, I found your question very interesting. I too am looking for SOP’s for np’s r/t chronic pain management. I work in a rural family practice and work with many clients with chronic pain, no insurance and not much within 30 miles to refer to. today alone I saw 3 chronic painers and spoke w/ 2 more via phone. Have you found any info? I am even interested in training for NP’s Thanks

Q: Once cancer patients have Mcmillan nurses attending for “pain management” does this mean it is terminal?
My sister-in law has adrenal cancer and I have been told by my brother that a mcmillan nurse and a registrar are going to see her at home for pain management.

I need to know as my brother will try to keep things from us so as not to worry us-but I want to know so I can give support.

A: I left hospital in tears as one of my new friends had just been diagnosed with cancer – went back for follow up a week later and she was being discharged, looked great as at last she knew what was wrong and was starting treatment…

MacMillan are fantastic and will give your Brother and Sister in Law much help and support.. You are right though as your support will be vital to him – supporting them will also help your own health problems.
Click on “getting involved” at the top of the web-page to see what you can do to help – if the worst happens I am sure that getting involved would also help your brother and you already being there will an incentive..

Your best way of starting would be to support MacMillan – speak to your brother and tell him that you want to support MacMillan to thank them for the support they are giving them.. Let him know also that you will always be there for him if he wants to speak – night or day – and that he must not bottle things up to spare you.

If you are worried about speaking to your brother without more knowledge of your Sister-in-Law’s condition then why not speak to McMillans yourself? Clearly they will not discuss individual patients but tell them that you want to support your brother and feel that a little advice from them would assist and I am sure that they will be helpful.

http://www.macmillan.org.uk/Get_Support/Macmillan_information_centres/Macmillan_information_centres.aspx

http://www.cancerhelp.org.uk/help/default.asp?

Good Luck, I hope that your Sister in Law gets her heath back and that all three of you can join in fundraising for MacMillan..

Love to all, Suzy xx

Q: Should I see a chiropractor or a pain management doctor?
A few weeks ago I was in a weird position lying in bed and something startled me causing me to jump, hurl myself forward, and leave my Left arm and shoulder behind! In other words, I dislocated it for a minute then it popped back into place. I cried out in pain. Ever since then, I cant sleep with my Left arm up under the pillow, and sleeping is pretty much a difficult task now. My boyfriend says there are many large “knots” in my neck so he rubs them out and that is the only way I can get relief. Hes not here now, its 6 am, and I cant sleep!

Plus…….

When I was younger I had a bike accident that gave me a concussion and whiplash. Should I see a chiropractor or do they really know what they are doing? Would a family doctor, pain management doctor, or nurse practitioner be better?

A: I would see a chiropractor (worked great for my partners whiplash) AND a pain management doctor. Chiropractor can relieve the preasure and pain by finding the direct source. Pain management would help because of what the Chirpractor cant treat.

Q: I have a problem with a pain management Nurse paractioner.?
Hello,

I have a 5 year history of chronic pain. I was found to have peripheral neuropathy with Allodynia, herniated cervical discs (C3- C5 that impinges upon the thecal sac) Inflammatory Arthritis in my knees, and Fibromyalgia. I have been going to a pain management clinic and have been Rx’d Oxycontin 60mg every 12 hours, Oxycodone 15mg 3 x day for BT pain and lidoderm 3 x day.

While this has not stopped all my pain it has reduced it from a 8-9 to a 4-5 on most days. I could not live a decent life without these meds.

Recently I was tested for Lyme disease and the tests came back positive, I am now on Antibiotics. I have been going to a pain clinic for a few months and I see a Nurse Practitioner there and she was the one who ordered the Lyme testing and told me to see a Lyme doctor.

She recently told me that narcotics do not work for Lyme pain and that they don’t work on me. I tried to tell her differently but she would not listen. She said that my meds need to be tapered and stopped. When I again mentioned my bad discs she said that Lyme is causing it. Everything I have is now due to Lyme disease at least according to her. If she stops these meds I do not want to think about how bad my life will become. I have tried just about everything under the sun from NSAIDS to Biofeedback and everything in between and nothing else has reduced this GOD Awful pain.

How can someone act like this and work for a pain clinic? Am I missing something here? The pain I have has not changed. I have been lead to believe that Lyme can be as painful as cancer pain, yet cancer pain is treated.

Does anyone have any suggestions? Would it be a wise idea to speak to the actual Doctor and tell him what is going on? I saw him before I saw the NP and he was very understanding.

A: I wonder why the NP is saying that your pain is caused by Lymes Disease. Lymes Disease is caused by a being bitten by infected blacklegged ticks and symptoms include fever, headache, fatigue, and skin rash. None of the symptoms should increase your pain, or really even give your body the type of pain you are talking about.

Did you have any of these symptoms for her to request a Lyme test? If not, then I would seriously consider going to see another doctor as well as talking to the head doctor at the pain clinic.

I do think pain clinics do a wonderful job. I attended a course about 5 years back now and learned different ways to adapt my life around my pain, meditation techniques and many other helpful things.

I’m not saying that a pain clinic is for everyone. It’s not.

I’m surprised that the NP can change your medications. I would have thought that would be entirely up to the MD.

Definately talk to the MD about your concerns and if you are not happy, then go to another MD.

Q: Question about Non-drug pain management?
I’m a nursing student and I have been searching about Non-drug pain management. What nurses can do for non-drug pain therapy. I would like to know detail and example of Hypnosis, Biofeedback, Guided Imagery, breathing techniques, progressive muscle relaxation, and magic glove or blanket. How I can use these intervention. My text book mention little about these. However, I cannot know how I can use these in hospital. Thus, could anyone tell me example of how nurses use these for patients please? Also, which non-drug pain management are used most and which one is most effective?

A: Also very important is nutrition. Often, if you look at the bloodwork of chronic pain patients, the C-reactive protein and sed rates are high, indicating inflammation. What does the medical community do? Prednisone or NSAIDS. Not the best answer (see Vioxx). However, if you do a quick history of the patient, you will probably find a diet laden in Omega-6 (Saturated and Trans fats, or the inflammatory fats, if you will) with little Omega-3 (Flax and fish oil, among others, or the anti-inflammatory fats) So, teach them to balance their Omega-6 to Omega-3 ratio to 1:1, taking plenty of antioxidants, and whammo, 50% of the pain can be reduced with this alone in those types of patients. Also, get rid of the neuro toxins in their diet, aspartame, MSG and the like. The rest, well, look to the nervous system. By allowing the nerve transmission to travel without interference from the brain to the body, the body will often take care of its pain on its own. How? Chiropractic has the answer to nervous system interference.

Q: I recently filed chapter 13 can my pain management doctor refuse to continue care because of this?
A few months ago I got into some legal issues over some problems I had with cymbalta my dr. took me off of this without weening me first it is antidepressent but used to help me with pain management and my dr. was subpoenaed to my hearing. Back when I had these issues I called the phone nurse and she refused to help me although I explained the horrible side effects the meds gave me. I think this is the real reason for my Dr’s Decision but not sure. Even in my follow up appt. he agreed the meds cause my problems. I’m 28 and had to file bankrupt due to my time off work. From age 22 till now i’ve had 3 surguries on my same disc in my lower back and it has cause my much grief i’ve never had a criminal history until I got charged with battery (for slapping someone) over my cymbalta withdraw and it sounds stupid but unless you’ve had horrible side effects from medication withdraw then you might understand, plus I was also prescribed 50 mcg of fentanyl pain patch which was also horrible.

A: I really sympathize with you, this past summer I had horrible side effects with medication and also need to file bankruptcy because of the affect it had on my ability to work. Unfortunately, unless you have insurance they may be able to refuse you. The Hippocratic oath is only for life/death emergencies or other catastrophic events. Best of luck in your rebuilding process.

Q: ethical issues in this document (hyperlink below) titled: “orthopaedic patients’ reporting of pain management’
http://64.233.183.104/search?q=cache:_wilyIyuqvQJ:www.nursing-standard.co.uk/archives/ns/vol12-46/vol12w46p4347.pdf+orthopaedic+patients+reporting+of+pain+management&hl=en&ct=clnk&cd=6&gl=uk

i’m actually so confused with what i have to do! please someone help me!!!!!!!!!!! :]

A: I’m not sure where you find ethical issues. The article seems to be a simple investigation into the patient’s report of perceived pain control using three forms of post operative pain management.

The results should have been expected. Both epidural and PCA analgesic methods provide a more constant release of medication at a low level, giving better pain control. IM injections give short acting medication which provides pain relief with significant peaks and valleys in the pain control levels.

There are no ethical issues, the issue is what is the best method for controlling post operative pain, and that is PCA or epidural analgesia. Of the two choices, I usually would prefer PCA analgesia in most cases as IV access is easier to obtain and maintain than epidural access. However, In lower body issues I find that epidural analgesia is quite effective.

Q: What countries in the world use methadone as a opiate pain killer for analgesic in pain management. Help!?
I have a friend who would be bedridden and unable to eat due to pain from cancer pain who had a colostomy, urostomy, prostima, kidney surgeries and now has liver pain that’s terminal and scar tissue from the multiple cancer surgeries she had. I am trying to find out what countries have methadone as a analgesic pain management opiate. Her pain management doctor has contact with u.s.a. pain management doctors but not forigen ones plus he does not know the laws in other countries.
I would like to find doctors or methadone clinics that will take foreigner pain management patient from the U.S.A. who’s going to retire or visit as medical tourist. Please tell me what countries use methadone for pain management analgesic drug. If your country uses methadone for cancer patients and others with chronic pain illnesses like multiple sclerosis, A.L.S. , major back problems ETC. Canada? United Kingdom? Ireland? Australia? New Zealand? Thailand? China? Hong Kong? India? France? Spain? Mexico? Philippines? Costa Rica? Aruba? and any unnamed countries that use Methadone as a Analgesic Pain Management.
Thank You So Much For Your Kindness
Hoping to hear from Doctors or Cancer Patients or other type of pain patients on Methadone. She would like to get out of U.S.A. with the high cost of care and avoid the Nursing Home Nightmare in U.S.A. which happens to the broke. She wants to get out before her money is gone
HELP! with doctors names, addresses,big hospitals names addresses and any landlords and addresses Again Thank You For Your Kindness.

A: I know methadone is available in Mexico. The care is also less expensive there. But here is the thing to consider. Health care is less expensive because there is little to no provision for those who are “broke.” If her money runs out first, it is doubtful that she would qualify for any care in a foreign country. It is also a very sad reality that a majority of medical expenses are incurred in the final six months of life unless there are provisions for a euthanasia option. To the best of my knowledge, only Washington state allows that option in the US. For all of the political rhetoric, the US still probably has the most compassionate and best end of life care in the world. Dignity is of utmost importance to the end. I don’t think that is the answer you were looking for, but it is the most honest one I can give based upon a great deal of work and study in the field of geriatrics. My thoughts and prayers are with you.

Q: 2 questions. 1.) What position is your baby in when they give him/her immunizations? 2.) Pain management use?
1.) I came across an article today on Bump.com (http://pregnant.thebump.com/new-mom-new-dad/baby-basics/articles/vaccinations-what-baby-will-need.aspx ) and the picture of the baby being injected is on his/her stomach. All of my daughter’s immunizations have been given while she was lying on her back on the exam table. I think it might have been easier on her if they had given me the opportunity to lay her on her stomach because she wouldn’t see what was happening. BTW, I tried to have her given the shots while my she was nursing but the nurse told me that the office policy was that the baby had to be on the exam table, for safety reasons. (That was just one more thing that really turned me off to that doctor.) My daughter is on an alternative immunization schedule so she only received the 4 main infant vaccines thus far. I chose to do only 2 at a time so maybe the nurse thought since it was only 2 it would be easiest to just have her laying on her back, I don’t know. My daughter is now 15 months old and I have since changed Peds (for numerous reasons) however she hasn’t had any more shots since we switched so I don’t know if this new office does it the same way and I haven’t thought to ask yet. So what position does your Ped/nurse put your baby in when they give the immunizations? On tummy? On back? Seated? Do they allow you to nurse during the shot or only afterward?

2.) Also, have you ever used any pain management techniques? I know there is a cream called EMLA (http://www.drugs.com/pro/emla.html ) which is basically Lidocaine and another topical that numbs the area where the shot will be given. I haven’t used it yet but I am considering it. Has anyone else used this or another method for pain management for their child? I know it can also be used before a circumcism so the newborn doesn’t feel the pain of the cutting.

Thanks in advance for your answers!
Yes, Avary’s a little toughie too. She screams when they first do the injection but I pick her right up and she’s fine. I just don’t want her associating the doctor’s office with all negative thoughts. I know even pets that get shots at the vet get so worked up and scared when they know they are going to the vet. My cat starts meowing so loud as soon as we get to the door. He knows what’s coming. EVen if it’s not a shot visit, he freaks out. I just don’t want Avary to have that anxiety whenever we have to go to the ped.

Thanks for all the great answers!

A: 1. Our children have all received their shots (as infants) laying on their backs on the exam table or being held in a cradling position by my husband or myself.

I understand that some doctors do permit the baby nursing while receiving the shots, but many do not as a safety precaution. They can request that the child not be fed atleast 1-2 hours prior to coming in to get the shots to reduce the chance of aspiration (A infant patient may aspirate for example by accidentally drawing material from the stomach into the lungs due to crying). Understandibly you want to have her as calm and comfortable as possible prior to the shot but aspiration is definitely something to avoid. Nursing her immediately after the shot to help her calm down is a safer approach. She will know that mommy is right there to help her & will probably forget about the shot as soon as she feeds.

2. As for pain meds we have always used either infants Tylenol and/or Ibuprofen, depending on age. Here in the states you have to get lidocaine with a prescription so we order ours from Canada where it is OTC. I have never used it for the vaccinations but may now that you mention it :)

Q: Pain management doc trying to take advantage of me? Need advice..?
I went to my pain management doc (Neurologist) about 30 days ago. He scheduled me to see his nurse today to pick up my Rx refills. I wouldn’t be seeing him, just an RN. In order to get certain meds that I have I have to be present and pick up a written Rx. I went back to get them from the nurse they said they want me to pay my 40 dollar co-pay. I told them that I was not seeing my Dr. today, just getting my Rx’s from the nurse and they said I’d have to pay it anyway. I refused and told them that i shouldn’t have to pay the same amount for a Neuro consult as I would to have an RN hand me my written prescriptions. I have a background in medical billing and insurance and I think this is shady. I called my insurance and they said that if I dont see the Dr. they don’t know why the charge would be the same. What should I do? I already emailed the superv. at the clinic, but should I just go ahead and pay it? I will go without my meds until I get a resolution. That means pain.
BUT don’t worry…. the doctor will be nice and comfy tonight in his warm bed and his million dollar home! Meanwhile on the side of town I’m DROWNING in medical debt and glued to a heating pad for a lifelong spinal disease. Grrr… I’m sure the 40 bucks will be a detriment to another patient that will be suckered into paying it….
Don’t see the doctor suffering too much.
The neuro visit where he examines me and sits and talks with me is 40 dollars.
They also wanted to charge 40 dollars for the nurse to sit me down and give me the written prescription. Then I’d take it to the pharmacy and pay. I did call my insurance and they said this is out of best practice. I knew from my work that this was wrong….I just needed that confirmation that I wasn’t over analyzing.

A: It is not uncommon for chronic pain patients to be seen monthly for their prescription refills. This is neccessary as they are usually Schedule II narcotics and cannot be written for a longer than 30 day supply and the prescription is only good for a short period of time. This normally means the physician writes the prescription while you are in the office.

In my practice, we see every patient every month. We assess the effectiveness of the medication, any side effects and other interventions which might help.

In most cases this is an established patient short or minimal appointment.

I actually don’t have a nurse, and my partner or myself see every patient. It is time consuming but the patients deserve it, and we often catch the need for changes in the plan, where we thought a simple refill might be in order.

Follow up and discuss this with the physician, if they won’t discuss it with you, take the refill (so you aren’t in pain, and start the process of finding a new physician.

Q: recommended pain management dr in virginia?
I have fibromyalgia and the pain has become so debilitating that I am on the verge of quitting my job as a nurse and selling my house for a smaller one story. My whole way of life has desinigrated into nothing but severe and exruciating pain. I am seeing a pain management dr but it takes an act of congress to get pain meds, and finally she did write me an rx, but it’s not enough. I didn’t get out of bed all weekend because of the pain. I have had trigger point injections, prolotherapy, accupuncture, phys therapy etc. Can anyone recommend a Dr who specializes in fibro/pain in the Va/Nc area?

A: email
kindness@fibrobetsy.com

she keeps a list of docs that are recommended by patients and takes off docs with bad reviews unlike otehr so called referral lists

Q: Suggestions for a good and compassionate Pain Management Physician in Phoenix, Arizona?
I have seen my sort-of current pain doctor for almost two years. He (or perhaps it was just his nurse practitioners) helped me so much with my Reflexive Sympathetic Dystrophy (RSD). I was unable to walk for more than ten minutes before these pain medicines were given to me, and now I can walk more than a mile, some days — sometimes for an hour and a half! (After a year and a half in a wheelchair, having taught myself to walk again… well, I am very proud of the accomplishment.)

Today he spoke to me — instead of his kinder nurse practitioners — and said he didn’t feel they were really helping me, because I have only had three of his spinal blocks and/or injections (the last one of which made me quite ill). He also kept remarking that I was too young to be taking “as much pain medicine as a cancer patient” (which I know to be false, at 15mg Oxycodone up to four times a day + one 50mg Fentanyl patch every third day). He gave me the number of “a doctor who just does pills” (sigh), but he is not taking new patients until after the new year.

Does anyone here know of a great Pain Management physician who does not consider a person in pain a drug-seeking addict? He would need to accept Mercy Care Health Plan from AHCCCS. I am very afraid; I cannot walk without the medicine, and am quite on my own — usually on foot!

I will be eternally grateful for any input.

A: Sorry to tell you, I live in the Phoenix area and have been in chronic pain for 6 years since an accident where a semi truck slammed through my vehicle, threw me from the car and almost ended my life. I have lived with chronic spinal pain ever since that day. You should feel very lucky that they will give you what you’re getting – sad isnt it how so many of us pain patients are denied a normal life. There are no compassionate doctors here. They ALL have treated me that way; granted I have only seen 3 total in these years so as not to be labeled a drug seeker, but I seem to get the same stories from everyone in my pain support group who are denied pain-free living. I went to one doctor and was given 10mg Percocets, which were helping somewhat, and was taken off medication after 6 months. That was after exhausting every other option, even trying quackery like acupuncture and chiropractors that made me have so much pain that I couldn’t walk the next day. The doctor was so rude, often made the same remarks that this 10mg Percocet is only supposed to be for cancer patients, and referred to me as “getting my candy” every month that I came to get my script. I gave up on pain management and doctors in general. There is a new rule with Ahccs that will no longer cover anything over 5mg Percocet without an approval process (taken up to 2 months for me with non-opiate medicine, don’t know if this will take longer for opiates or not) for any new pain medication you might be prescribed, unless you have been on the drug before. Many of us have resorted to getting our drugs on the street to avoid the hassle of doctors. I’m in my late 20’s, and it seems to me that many of us young people are viewed as addicts by doctors and they refuse to treat us. I am considering heading to Florida where the dodgy pain clinics are, just to live a normal life again. It’s a very sad situation. Sorry I couldn’t be of more help, but I thought I should share my story being that I live in the metro area as well.

Q: What do I do now about Pain Management?
I have been going to pain management for months. Today I had an epidural block for my low back pain, then I had my regular med check appt. I was given Vicodin to take 3 times a day, well I turned up like 6 pills short and they would not give me anymore. The nurse Practitioner was very rude about it too. Why do they make you feel like a drug seeker when you’re trying to go to a place for help with pain you have. This is all from a bad car accident I had almost a year ago. Should I try to go somewhere else or keep going there? Anyone have this experience with pain management? I mean, some days you need to take a little more if your pain is too bad. Why don’t they understand that?

A: because they want you to take whats exactly on the pill bottle..3 times a day,that means NO MORE then 3.now if you would of called your p m doctor and asked if you could take an extra one do to more pain he more then likely would of said yes,or adjusted your meds.doctors don’t like people who self medicate (take an extra)
i would switch to another pain management doctor,and be truthfull.i myself am in p m to,and my doctor watchs like a hawk on my meds. and i do understand what your saying,i’m just telling you like they told me.i’ve taken many extras before,then run low and have to suffer for a week or so..hope i’ve helped!

Q: Can anyone suggest alternative pain management other then medications? i am a chronic pain sugffereeer?
I am a 39yr old female, ex-nurse, I have spinal rods and screws, severe osteoporosis, been in pain going on 9 yrs,,had rods placed related to vertibras collapsed and i could not walk..they said i wouldnt never walk again but i do and i walk good,,but i live in constant pain and i am no longer able to work,,now i am lost,,i was always a workaholic,,the pain medication i am on is increased often and one day i know they will no longer work,,,so i am looking for alternatives,,,any help will be God sent ,,,,,,,thankyou for reading nurse in need

A: i totally sympathise! pain is a killer. i would recommend meditation or relaxation techniques. i wouldn’t get into the ‘religion’ part of it, but the breathing and relaxing technique are invaluable. if you are continually in pain you prolly don’t breathe well. it was so in my case. oxegen is one of the best things for your body! depending on how mobile you are, gentle yoga is also extremely good to do. above all, cheer up! “a merry heart doeth good like a medicine.” count your blessings. even your terrible cicumstances could be worse! be thankful for what you do have. and Carpe Diem. sieze the day. life is a gift, live it the best you know how. and know that you’re not alone in your pain. <3

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