Pain Management- What is your take? Preference? Liberal / Conservative?

[fakingpatience]

I'm a new medic, but so far I've been fairly liberal with pain medication (morphine, its all we carry). Our protocols however are very conservative on what you can and cannot give morphine for (only standing orders for isolated extremity injury), so I end up making frequent calls to med control for pain medication outside of protocol. So far I haven't had anyone who is med seeking, but as said by others, who are we to judge whose in real pain and who just wants pain medication? I will also usually ask patients before anything if they want me to give them morphine for their pain. Some patients who are in significant pain might refuse, if they don't like narcotics, or have a history of addiction.

As far as pain medication for undiagnosed abdominal pain, I'll call and see if I can get orders, and it's usually a tossup which doc I get. From the doctors I've talked to, it's a fairly old rule to not give pain medication to undiagnosed abdominal pain, especially since now most patients will get an abdominal scan anyway and doctors are less reliant on their physical exam. The pain medication can also help to narrow down the source of their pain by dulling it, so the left over pain is more at the site of the pain, not where it radiates to, and making the patient more tolerant to a physical exam. (sorry, don't have any sources for this last bit, just what I've gathered from talking to various doctors).

[BushyFromOz]

Im so liberal with analgesia i could be considered a narcotic whore.

I have very litte limits as to what i can not give narcotics too, i am generaly free to administer 20mg of morph and/or 200mcg IV fentanyl and i can double those on cunsultation. I also have IN fent and the green whistle (which is handy, but i dont like it)

I can anlso consult toexceed those doses by as much again

Undiagnosed abdo pain is not a contra for me

Late second stage labor is a contra for me - apparently narcotised newborns is a no no

Sudden onset evere headache is a relative contra as they are worried about obtunding emerging CVA - but i can consult to get around this.

The IC guys can pretty much do whatever they want within sound clinical reasoning

[ERDoc]

It still just blows my mind that there are medical directors out there that beleive you cannot give narcs in undifferentiated abd pain. It's time to get out of the 1960s. Let's also keep in mind that not all pain requires narcotics. There are plenty of non-narcotic options that work just as well (though I realize you are limited to what you carry).

[rock_shoes]

It still just blows my mind that there are medical directors out there that beleive you cannot give narcs in undifferentiated abd pain. It's time to get out of the 1960s. Let's also keep in mind that not all pain requires narcotics. There are plenty of non-narcotic options that work just as well (though I realize you are limited to what you carry).

Still happens constantly unfortunately. I remember asking a nurse why my transfer (query appendicitis) patient was still doubled over with abdo pain. "Well he's already had buscopan and 5mg of morphine." That's nothing. How about 5mg q 5 min until its either under control or I hit 20mg. Then throw in some ketamine if that's still not cutting it.

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[BEorP]

As ERDoc says, it is amazing that some still hold the belief about witholding analgesia in abdo pain. It was just a couple of weeks ago that we had a lecture on abdominal and GI emergencies and the professor described this misconception that pain relief impedes diagnosis is “the biggest rubbish that ever escaped into medicine”.

[Quakefire]

Im pretty conservative with my narcotics, as we only have entonox and morphine for pain (we carry fentanyl but thats only for the MFI protocol) If the patient needs medication ill give it, but I don't jump straight to morphine if I dont have too.

[medicgirl05]

Morphine is the only thing we carry for pain management.

We have run into patients who are allergic and I have called medical control for permission to give enough Valium so they don't care as much about the pain.

[rock_shoes]

Morphine is the only thing we carry for pain management.

We have run into patients who are allergic and I have called medical control for permission to give enough Valium so they don't care as much about the pain.

You don't even carry Entonox? I'm assuming this is an ALS service since you carry diazepam.

Have you considered putting in a pain management protocol proposal with your service? Not to be harsh but a medic showing that kind of initiative might be all it takes.

Its like when you're a kid and your Mom comes in to find you've broken the cookie jar trying to sneak one. Now mom's upset and your ass is tanned. Sometimes all you have to do is ask and nothing gets broken.

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[medicgirl05]

You don't even carry Entonox? I'm assuming this is an ALS service since you carry diazepam.

Have you considered putting in a pain management protocol proposal with your service? Not to be harsh but a medic showing that kind of initiative might be all it takes.

Its like when you're a kid and your Mom comes in to find you've broken the cookie jar trying to sneak one. Now mom's upset and your ass is tanned. Sometimes all you have to do is ask and nothing gets broken.

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Believe me we have ALL tried. We have tried to get several different pain meds approved with no luck. We had Toradol in the protocols for a while but never actually carried it. When I started as a paramdic we carried a non-narcotic pain med that I can not remember the name of...but it was taken off because the ER docs didn't approve of it. IDK why I can't recall the name of it...having a very DUH moment.

[rock_shoes]

Believe me we have ALL tried. We have tried to get several different pain meds approved with no luck. We had Toradol in the protocols for a while but never actually carried it. When I started as a paramdic we carried a non-narcotic pain med that I can not remember the name of...but it was taken off because the ER docs didn't approve of it. IDK why I can't recall the name of it...having a very DUH moment.

I don't know what your family situation is or any of that but I would probably be seeking a different employer.

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