June 28, 2013
Reply by author to Ushakof on "Ethics: Ethics and Pain Management in Hospitalized Patients" by Esther Bernhofer, BSN, RN-BC (October 25, 2011)
I appreciate your interest in the important topic of ethically managing pain in the hospitalized patient. Indeed, many people come to the hospital emergency room/department with complaints of pain. I’m not sure that “20-25% of all Emergency Room visits are drug seekers,” but it would make an interesting study to confirm/deny that statistic and would involve defining drug-seekers. Currently, researchers have indicated that many who are characterized as drug-seekers (a demeaning term) are indeed relief-seekers and have slipped through the health-care system without adequate pain management or mental health care. They come to the emergency room/department because they do not know what else to do. Can you imagine how difficult it must be to come to a hospital where you know you will be judged, scrutinized, and forced to wait, only to receive a pill or two? Surely, there are better places for people with true addictions to go to get their fix. We must remember that many people who suffer have not been adequately treated for their pain or mental illness and we are ethically bound to treat these individuals with respect and knowledgeable care, making appropriate referrals when needed.
As you pointed out, the challenges of opioid misuse/abuse are truly of great concern in our communities. Opioids are prescribed because they work well to relieve pain. Unfortunately, their ill effects (such as dependence, somnolence, mind-alteration, and hyperalgesia) are their downfall. The problems that our society now faces with opioid misuse/abuse cannot be blamed on patients who “don’t tolerate even insignificant pain anymore,” large pharmaceutical companies, or physicians who in good faith sought to provide their patients with relief from pain. The problems we face are much more complex than that. Part of the solution is for all practitioners to become well-educated in pain management and treat patients who have pain ethically, competently, and utilizing a multi-modal approach. We would then have more people who trust their nurses and doctors to provide them with their pain care, and less who feel they need to rely on securing drugs in other ways or going to the emergency room/department because they feel they have no alternative.
Esther Bernhofer, BSN, RN-BC