Pain Management: The Tyranny Of Standardized Care

Standards of care are based on analysis of a huge amount of data which means, it describes everyone but applies to no one individual specifically.   That is the problem when you try to convince a medical professional  the specifics of your situation and get them to actually listen.

Pain management has become the elephant in the room because standards of care do not take into consideration an individual’s situation.   The fear is the person may be a drug seeker or selling the prescriptions on the street or worse become addicted and become a drug seeker.

I remember when I first moved to Massachusetts, my husband, who never gets sick, had severe abdominal pain.  I did everything I knew before driving him to the hospital.  My husband is an athlete, eats well, doesn’t drink and takes no medications.  So off to the hospital we went at 1AM.

The ER in the local hospital was empty.  By the time we got there, my husband was in so much pain, he was moaning and  in the fetal position.  It took about 20 minutes to get into a room and another 30 minutes for the doctor to come by.  There was only one other person in the ER.

I started to get agitated and went to find the nurse.  I requested he be given something for pain.  I was asked if he takes any medication, specifically pain medications and did he have a history of drug use.  I had to control my temper.  At that point, I insisted to speak with the doctor.  When he showed up, I said directly to him, I was a nurse practitioner and understood his concern my husband was drug seeking but this was not the case.  I explained as calmly as I could, his life and work in about 30 seconds and again requested he be given relief.

I could tell the doctor was debating if he should do a drug screen but relented.  Within minutes after getting an injection, my husband relaxed.

I was reminded of this experience, when an elderly client needed a second medication for breakthrough pain.  This client is eight years post tongue, salivary gland and neck cancer.  The surgery and radiation was extensive with permanent nerve damage, difficulty eating and constant pain.  It took years to find a pain medication protocol that worked.  Periodically, the pain flairs and a medication addition needs to be added short term.

It also took years to find a pain clinic that didn’t treat my client like a drug seeker and be forced to get drug tested at each visit.  My client uses a walker.  Did the staff worry my client was supplementing the prescribed medications with illegal substances?  At each visit,  a urine screen was mandated which meant a staff member had to be in the bathroom.  Finally, after changing to a pain management clinic with a doctor who specialized in post cancer throat, neck, head pain,  my client was no longer subjected or humiliated with the drug urine screen.

Every time my client needs medication for breakthrough pain, a common response from any doctor is,  I don’t feel comfortable writing for anything else since such and such drug is being taken. As an advocate, it is my job to explain which medications can be added as per the pain clinic doctor.  Not always an easy sell but I have a  list from the pharmacy of which medications were prescribed and when.

Part of the problem is many a medical professional has been burnt by a patient who turned out to be a drug seeker.  It happens.  It doesn’t justify the stonewalling of those who are in need or standards of care that turn a deaf ear to the suffering and needs of those in legitimate pain.