Postoperative Pain Management : Nausea Management

Opioid addiction is so prevalent in the healthcare system because of the countless number of hospital patients being treated for chronic pain. While opioid analgesics have beneficial painkilling properties, they also yield detrimental dependence and addiction. There is a legitimate need for the health care system to provide powerful medications because prolonged pain limits activities of daily living, work productivity, quality of life, etc. (Taylor, 2015). Patients need to receive appropriate pain treatment, however, opioids need to be prescribed after careful consideration of the benefits and risks.

Mike Alstott knows first-hand how opioids, when used correctly, can play an important role in managing pain and helping people to function, but he is also keenly aware of the growing crisis of opioid misuse and overdose. More American adults are dying from misusing prescription narcotics than ever before. An estimated 35 people die every day in the U.S. from accidental prescription painkiller overdoses resulting from things like not taking a medication as directed or not understanding how multiple

In fact, there was thought to be more of a need for them. Before the last two decades, opioids were used for cancer related or acute pain. However, in the 1990s chronic non cancer patients got attention because people nationally felt there was a shortage in patients receiving opioids, thus making them deprived of adequate pain management. Because of this, clinicians were encouraged to treat chronic non-cancer pain and patients in hospice care more often than they were used to. It was also encouraged to use high doses of opioids for long periods of time (Cheatle). The idea that providers seemed overly cautious about these medications caused a large increase in opioid prescriptions from health care providers. Threat of tort and litigation for some doctors that were deemed for not prescribing enough to alleviate pain of patients was also a concern for doctors This quickly turned a shortage of prescription opioids into a national prescription opioid abuse epidemic in under twenty years. From 1999 to 2010, the amount of prescription opioids sold to hospitals, pharmacies, and doctors offices quadrupled, and three times the number of people overdosed on painkillers in this time (Garcia). While some patients have benefitted from the increased sales and loose guidelines of prescription opioid analgesics, the increasing in opioid misuse, abuse, and overdose is truly daunting. As a nation, we need to back track, and

As better and more comprehensive education is provided both to the general public and practicing clinicians the hope is to reduce the negativity surrounding the users of opioids, and to eliminate demeaning language coupled to them as well. This could improve patient morale and help the needless continuation of physical suffering within patients, as they would be more comfortable approaching and using opioids for therapeutic purposes1. That being said there are those within our communities who do abuse these substances and pharmacists must recognize the signs of abusers, it is important for them to reach out, without comment, to help those suffering from opioid abuse once they have been

Vivek Murthy, a U.S. Surgeon General, said he wanted to change the way Doctors have been taught to handle pain management for the last twenty to thirty years (824). The reason Murthy wants to do this is because while he was reading a training document for nurses and doctors it claimed , "If your patient is concerned that they may develop dependence on opioids, you can safely reassure them that addiction to opioids is very rare in patients who have pain" (823). This document also reassured doctors they could prescribe opioids as a long-term treatment. The Center for Disease Control and Prevention advises doctors that pain-relieving effects may wear off for long-term users(824). This explains how opioids can be used to deal with pain management, but if used as a long-term treatment it can create an

Doctors and clinical prescribers have discovered their role in curtailing the increased opioid prescriptions in America. It is without a doubt that they play a role in facilitating the opioid misuse endemic in the past by being enablers of the situations. When patients ask for pain medications, they do not take time to analyze the pain complaints or suggest alternative medications other than opioids. Even in instances when one doctor declines to offer a patient an opioid prescription for their pain needs, the patient is likely to find another who will give the prescription. However, there has been wide recognition of the opioid misuse endemic such that clinical prescribers are practicing more vigilant prescribing and are advocating opioid-free

Although addiction and overdose of opioids was not declared an epidemic by the Center for Disease Control and Prevention (CDC) until 2011, the beginning of the epidemic can be traced back as early as the 1980’s when attention in medical care began to turn toward pain management. By the early 2000’s the Joint Commission on Accreditation of Healthcare Organizations named pain “the fifth vital sign,” implying that pain is as important clinically as pulse rate, temperature, respiration rate, and blood pressure (Wilson, 2016). At the same time, there has been an emphasis change from patient wellness to patient satisfaction metrics. Non-steroidal anti-inflammatory drugs such as Advil, Aleve, or aspirin have raised safety their own safety concerns, contributing to increased use of opioids. The lack of patient access to and insurance coverage for chronic pain management specialists or alternative healing therapies also contributes to the opioid epidemic (Hawk,

Roughly 100 million Americans suffer from chronic pain with an annual cost of $600 billion dollars in health care and a limited number of pain specialist physicians (Harle, et al., 2015). The conditions require the daily use of opioid medications which are being prescribed by primary care providers and providers in the ED. Along with multiple prescribers of opioid medications, the number of prescriptions for these medications has quadrupled from 1999-2013 in correlation with an increase in deaths related to opioid use (Greenwood-Ericksen, Poon, Nelson, Weiner, & Schuur, 2016). The significant increase of opioid related deaths and complications is commonly being referred to as the prescription opioid epidemic and to blame for the most unintentional deaths in the US (Smith, et al., 2015). Though responsible for administering and prescribing opioids to provide pain management, nurse practitioners in the ED have limited patient history and are placed under time constraints. Improved education regarding pain management, clinical practice guidelines and the use of resource tools like the Prescription Drug Monitoring Programs (PDMP) have been proven effective for reducing opioid related complications (Greenwood-Ericksen et al.,

Opioid abuse, misuse and overdose is a problem in The United States. You can’t turn on the TV or read a newspaper without some mention of the epidemic. This issue has caused the practice of prescribing or taking narcotic pain medication to be looked at under a microscope. Patients are fearful to use some necessary pain medication, because they may become addicted. Other patients who genuinely do have pain and need medication are having a tougher time obtaining the help they need. The problem of abuse and addiction is tough to solve since for some people the medications are the only way they can function and live a semi-normal life. A patient with pain may be hesitant to visit the doctor and

Prescribers play an important role in preventing the use and abuse of opioids. Physicians and regulators need more information about whether, and how, opioids should be used for treating chronic pain. Prescriber education about the best uses of opioids, including knowing when and for which patients they should be used is important in averting the drug abuse. FDA has recommended many educational training programs for clinician’s on the safest use of these

Talking to the doctor about all the choices available will ensure the method of pain management which suits the patient best to be chosen. Discussing any side effects of opioid use can determine whether or not prescription painkillers are the right option for the patient (CDC, 2017). Furthermore, pharmacists can help patients understand opioid use and how they should be taken (NIDA, 2017). Following the pharmacist’s instructions, a patient will understand when to take opioids, how much to take, proper storage, and proper disposal (CDC, 2017). The increase of communication amongst these people can allow patients to safely take opioids, minimizing the risk of

Opioids, otherwise known as prescription pain medication, are used to treat acute and chronic pain. They are the most powerful pain relievers known. When taken as directed they can be safe and effective at managing pain, however, opioids can be highly addictive. Ease of access helps people get pain medications through their physician or by having friends and family get the medication for them. With their ease of access and being highly addictive the use and misuse of opioids have become a growing epidemic. Patients should be well educated on the affects opioid use can have. More importantly instead of the use of opioids, physicians should look into alternative solutions for pain management. While pain medication is helpful with chronic pain, it is also highly addictive, doctors should be more stringent to whom and how often they prescribe pain medication.

Getting involved with opioids now days seem fairly easy, our young ones are becoming addicted to these medications because our doctors don’t care. Doctors are just signing off prescriptions left and right. But in reality physicians have responsibilities, such as obtaining physical examination, a medical history, develop a written treatment plan for their patients, and comply with controlled substances laws and regulations. In a lot of cases doctors don’t want to deal with their patients so they will just prescribed medications to get people in and out of the office, to keep up with their hectic schedule, and don’t want to find the root of the cause, or maybe they just don’t have the time. Other ways to get opioids include within relatives, visits out of the country, pharmacy and hospital theft, and “stealing from grandma’s cabinet” (Inciardi, Surratt, Kurtz, and Cicero 2007). Despite the overload of opioids in our country almost 80% of the world 's population today has no access to morphine. And an estimated 33 million people, need specialized medical care but have no access to even basic care and symptom control. This terrible lack of pain relief can be attributed to our governments need to control and regulation.

Chronic, acute, somatic and oncologic are all types pain - each with their own symptoms, reliefs, and evaluations. As pain has been explored, we have learned more about it; however, it remains an anomaly. In the postoperative setting, nurses are the first line of pain management. Their assessments of the patient’s pain, including questions and scaling is imperative when dosing medications and evaluating the patient. Studies continue to determine that healthcare providers undertreat and mismanage pain control and assessment. According, to the American Society of Interventional Pain Physicians, “80% to 90% of physicians have had no formal training in prescribing controlled substances, and only five out of one hundred thirty-three medical schools in the U.S. have required courses on pain management” (Glowacki, p. 37). The American Nurse Credentialing Center reported that “as of 2013, only one thousand six hundred seventy two registered nurses in the U.S. were certified in pain management” (Glowacki, p. 37). According to the CDC, about 50% of postoperative patients report unrelieved pain (Centers for Disease Control and Prevention, 2013). Effective postoperative pain control is necessary for successful care and treatment. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing (Francis &

described in the literature over the last decade have enabled prehospital clinicians to better understand and manage pre-hospital analgesic practice. In pre-hospital clinical trials, analgesic agents such as morphine and fentanyl, nalbuphine, and tramadol, and a range of nonpharmacologic interventions