Several years ago, we thought my father had lung cancer. He had a single nodule spotted during a routine X-ray. He has a history of heavy tobacco usage; therefore we were not shocked when the surgeon said, “I am 99% sure this is a cancer.” Many tears and tests later, he was scheduled for a procedure to remove the “tumor.”
My sister and I are both nurses and made sure we went with him and my mom for the surgery. When the surgeon appeared, he told us that it wasn’t cancer after all and that he thought it was a fungal infection. Are you kidding? We were all shocked and thrilled at the same time. However, my father had gone through major surgery and still needed to recover.
My father also has chronic pain from arthritis and chronic anxiety. He consumes large amounts of pain and anxiety reducing medications at home on a daily basis and has built up quite a tolerance. My sister and I knew that pain control would be his biggest issue. I can remember when they brought him into his room, the nurse asked him to rate his pain level on a scale of 1 – 10. “Ten!” he shouted. She replied, “I just gave you a 500mg Vicodan 30 minutes ago. Hasn’t it helped at all?” To which my father replied, “500mg? That’s like a Chicklet (chewing gum) to me.” We all knew it was not going to be easy for that nurse and the nurse coming onto the night shift.
The problem is that when a patient is admitted to the hospital and ordered pain medication, health care providers don’t always take into consideration the patient’s pre-hospital pain issues and tolerance. They are ordered pain medications based on the general population. For patients that have chronic pain like my dad and require higher doses, they often are left without adequate pain control.
What can you do if you find yourself or your loved one anticipating the need for higher pain control?
1. Be honest
Patients that suffer from chronic pain may require higher doses of pain medications. However, they often don’t admit the amount to others. Whether it’s from fear or embarrassment, they aren’t always honest about how much they actually take. Being honest allows the physician to estimate the gap between what is a typical dose and the dose that you will need to manage your pain. Tell the truth about your home dosage. It will make a big difference in the ability of your health care providers to manage your pain adequately.
2. Negotiate a plan
If you are scheduled for surgery, negotiate and plan how your pain is going to be managed before you get to the operating table. Have a conversation with your physician ahead of time to be sure he or she plans for higher doses of pain medication during your post-op care. This can prevent the unnecessary and sometimes ineffective phone calls by the nurse in the middle of the night asking for more.
3. Consider an advocate
If you need help to negotiate a plan for pain management with your health care provider, consider hiring an advocate. A clinical advocate can accompany you to your surgeon’s office and help make sure a pain management plan is coordinated prior to surgery.
My sister and I pulled the nurse aside and told her how much pain medication my father actually took. She was then able to call the physician and adjust his dosage. Although he wasn’t pain free, his pain was manageable. He had a restful night while the nurse didn’t have the added stress of trying to manage his pain in the middle of the night!
You deserve to have your pain managed. The key to making that happen is to prepare for it whenever you can!
I hope this helps
R. Thompson, MSN, RN
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