[Dx E]

Saw a question about Pain,
And thought I’d Post an old post of mine from elsewhere-----
(PLEASE SKIP if not helpful)
---------------------------------
Pain Meds-

I was asked recently by a Pre-Op –
“What was the pain like?”
I was very quick to respond
That it wasn’t so bad really,
And the Drugs were Great!

This was awfully Flip and Glib of me,
And after giving it some more thought,
I had thought of a wealth of info
That I wished I had passed on.

So,
Some babble about Pain Meds while at the hospital-

Expect the best.
If you're in pain, ask for more drugs,
Or a change of Medication.
Tell the Dr. exactly how you feel.
If the Dr. won't be around for awhile,
Tell them to give him a call.
And They Will!
Successful Pain management should be just that!

Most important-
You will need to be able to describe your pain
On the universal rating of-

“On a scale of 1 to 10, 1 being no pain,
And 10 being absolutely unbearable,
How would you rate your pain?”
(Here's the "Scale" that is used most often)


Do not be deceived. If you speak in terms of
Extreme Discomfort, or “Very Un-comfortable,”
That has no place on the nurses’ or Dr.’s radar.
Speak in PAIN (1 to 10) Lingo,
And something will be done.
Also be able to specify the type of pain-
Is it- "Stabbing? Dull? Aching? Burning? Crushing? Pulsing? Throbbing? etc...

Specic types of pains indicate different causes.
The Pain Management team can serve you better with
Better info.

Do be Completely Honest,
But don’t lie there feeling terrible
Because it’s “Not time for your pain meds again yet.”
That just means that they are not adequate to do the job,
And should be adjusted.

"Pain is inevitable; suffering is optional."


The Nurse can not adjust the level, frequency or type
Of pain management.
Only your Dr. can do this,
So let him or her know ASAP while they are there.

If the Pain Medication you are receiving
Is making you nauseous
Tell the Nurse, and ask her to contact the Dr.
To ask for a Drug that does not make you nauseous.

For Example-
If you have a problem with the Morphine
Making you Nauseous,
Tell them to try something else. Demerol,
Or a Demerol/Phenagrin Mix.

It’s your care. They’re getting paid,
So they are working for your well being.
And keeping your pain at a “managed level”
Is part of that care.
Have someone with you who can
Be your advocate. (Most Important!)
You should be comfortable, calm and
Get the rest you need to heal.
We have the technology!

Your Nurse, if like most nurses,
Will be stretched very thin
Looking after more patients than
They should be asked to serve.
Hospital Administration is fighting to
Keep the overall “bottom-line” in the Black,
And it is the Nurses that are carrying
Most of that burden.

Be understanding, yet,
Don’t accept the-
“Do you want your pain medication or Not?
Because This is all I can Do!”

Your Key to Getting the attention of your
Health Care providers, when it comes to Pain
May be the simple Phrase-
“This Level of Pain is Unacceptable / Un-Bearable
And something must be done.
Would you please put a call into my Dr.?
Or get me a CONSULT?”

In the Very Litigious Society we live in
Every Hospital knows that failure to provide
“A Consult,”
In an area of expertise outside or beyond
The expertise of your Dr.,
Opens them to future Liability
Should something go wrong.
I’m not saying be a bully and a horrible patient,
But know that you will only get results if you
Know how to ask the right questions.

I’ve had 8 fairly Major Surgeries
In the last Two Years (this is old post) and have amassed
A good bit of Anecdotal information.

Some of this is just from comments from multiple Nurses,
Some is from a touch of web research.
Look it up for yourself and be informed
Before you head in to the Hospital.

So, if your pain is coming on up
And part of your discomfort is from
Gas and constipation,
The Dr. will explain to you that Pain Medications
Cause more constipation and Gas.
This is Very True of Morphine and Demerol.
However, Nubaine, which is just as effective
Does not typically have this side effect,
Nor do most of the Synthetic Opioids.

Morphine tends to cause a number of people to itch.
If this is the case with you and the itching is causing
You to lose rest, ask the Dr. if he could put
Benedryl on your list of medicines on an “As Needed Basis.”
Not only will it make the itching go away,
It increases the effect of the Morphine’s Sedation properties.

The Most used IV Pain Med, early on is Morphine.
It is the “Go To Drug” because it does its job well.
One of it’s draw backs, if you have to have it
For 5 days or more, is that it is Very Addictive.
One can also build up a tolerance to it
And it’s effectiveness decreases over time.

I have had Morphine on a self administering pump
And as an IV injection every 4 hours.
The IV injection was far more effective for me than the
More frequent lower doses.

Morphine also has side effects
When interacting with most Anti-Depressants.

It’s noticeable side effects for the average patient include-
Nausea, Itching, Increased Constipation.
It also aggravates Urine retention.
If this is the case with you,
Ask for a substitute.
Sustained use will also contribute greatly to Temporary Dementia.
In combination with the constantly interrupted sleeping schedule
The result is common “ICU Psychosis.”
Hallucinations that would leave Timothy Leary in the Dust!

Demerol is the second most popularly used IV Pain Medication.
It also is rather addictive, but not quite as bad as Morphine.
It tends to give many patients a feeling of “Floating” or “Bed-spins”
That lead quickly to nausea. For this reason it is often
Given with Phenagrin.

When paired with Phenagrin it is very sedative and
Will put the patient to sleep usually.
Demerol, like Morphine also can cause constipation,
Just not as bad as Morphine.
It doesn’t have the reputation for causing patients to itch,
However, that is listed as one of it’s side effects.
It also lists the same drug interaction problems as Morphine.

I have been given Demerol to slowly replace Morphine
When its effectiveness was reduced by my increased tolerance.
The Demerol / Phenagrin “cocktail” was very effective
In keeping pain to a minimum while not giving me nausea.
As with the Morphine, I found the direct IV injections to
Be the most effective.

Some hospitals use IV hydromorphone (Dilaudid)
as it’s a usual alternative to IV morphine.
It often does not cause the nausea that Morphine can for some
But as an opiate, it can still cause constipation.

I have also been given Valium IV a couple of times,
But this was during procedures in radiology were they
Were setting a drain.
It’s mostly an extreme sedative - anti-anxiety drug but
When used in conjuncture with pain killers and local anesthesia
It’s great.
So is SUBLIMAZE® (or Fentanyl Citrate)
It has an odd “out of body” sensation that’s very pleasant
And similar to AQUAVAN® (which is also very soothing)
(told ya I’d had my share of the Drugs!)

Nubaine would be my IV drug of choice.
The Pro’s and Cons of Nubaine are-
It is No Where Near as addictive as Morphine and Demoral,
But, it seems to have little to no effect on about 20% of people
And therefore is not a completely reliable Pain Management tool.
It also doesn’t increase incidence of constipation,
Therefore if your pain is predominantly
Being caused by extreme gas, it is very effective
In “breaking the loop” of more pain meds causing more pain.
So,
If you are having pain and the Dr. is not wanting to
Give you a higher dose of Morphine or Demerol due to
It’s ill effects on the digestive tract.
Ask about Nubain.
It has a much lower incidence of nausea, dizziness, vertigo, etc…
And is very effective when you are not in EXCRUSIATING PAIN.

Do know that if you ask for Nubain (nalbuphine) by name,
90% of the staff might ask- "What?"
and the other 10% will offer a urine drug screen
before supplying any pain med from them!
(anyone with that much Drug info is clearly an Addict-
Or they have had way too many surgeries!!!)

Nubain does have a reputation for causing inconsistent pain relief,
but it always worked well for me.
There was a factoid reported 10 years or so ago
by researchers at UCSF that nalbuphine
and its agonist/antagonist cousins
seem to relieve pain better in women than in men.
Just a thought.

Now all of this is not to suggest that you second-guess your Dr. at all,
BUT, do be very open and frank with him or her.
Pain management is however, just that.
Management.
They Cannot get rid of it completely.
And it is better to take something for it
Before it becomes intolerable.
But because pain is such a subjective aspect of surgery
And one that you are the authority on,
The system tends to err on the side of not “Over Doping” the patients
And will, if allowed, sometimes treat your complaints as
Less than objective, driven by the knowledge of the
Addictive powers of most drugs.
Full and open communication from you or from your
Advocate or loved one is the best way to insure that
You will have a fairly pain-free time of recovery.

There are many benefits of pain relief ....
You are much more likely to walk,
Cough and deep breathe effectively if you are not in pain.
You get no points or benefits for suffering....
As a matter of fact, it will slow your recovery considerably.
Another hint, if you are awake,
Try to change position in bed every two hours after surgery....
If you have had surgery you already know how difficult this can be,
Yet it is a very effective tool in speeding recovery
And preventing pneumonia and atelectasis
(lungs not breathing deep enough).

Expect the Best, and ask for it if you’re not getting it.

Once you have gotten past the first couple of days
Or even after the first day for many,
You may be moved onto oral pain management.
You certainly will before you are allowed to go home.

Lortab Elixir is very common for Gastric Bypass patients.
It is during this transition from the “Big Guns”
Of IV pain meds,
To the “Kinder, Gentler” oral pain meds,
That many people experience MOST of their pain.
It’s that transition from “too much,”
To- “not quite enough,” that is tricky.

Know that if you have moved off of the IV’s
You are on your way to merely discomfort
Rather than Pain, and it’s soon to pass.
The Lortab elixir and the 2nd most popular-
Vicodin, as well as Hydrocodone,
All increase your gassiness and constipation,
So use them sparingly.
Once you are home, Walking is one of the best
Long range pain management tools and
Since most of the pain will be from “trapped gas,”
The Walking targets the problem rather well.
Once home, also try a simple
Heating pad. Place it on your back and not on your
Actual incisional area.
The comfort from the heating pad comes from increasing your
Blood flow in the area where applied,
And increasing blood flow to your incisional area
Could increase your odds of having a Seroma.
(Blood or Fluid Trapped within tissue.)
Another great pain reliever is a loved one willing
To rub your hands or your scalp.
Any such stimulation releases endorphins and causes
You to just “feel better.”

This long of a post surely makes up for my Glib-
“Not so bad, and the Drugs are great!”

Any of you out there with pain med info-
Please add on to this post.

Best Wishes-
Dx

[jersey86]

I just had lap band surgery yesterday. Yesterday was miserable. I was given probably six or seven IV shots of various pain medication between waking up around noon and five thirty when i could leave. The gas pain was HORRIBLE. I was only given morphine when they couldnt get me out of the bed to go and check if there was a leak or not. Once I got the morphine things were a bit better, but still pretty shitty. The air that they pump into you is absolutely terrible and has caused me much regret about this surgery. Right now it is ten thirty pm on the next day...and I am still experiencing gas pains. I was prescribed 5mg oxycodone in place of oxycontin bc my mom is a pain med freak and thinks i will get addicted....there was no way of stopping her from talking the doctor out of prescribing effective and stronger pain medicine because she is insane...now i am suffering. please someone give me some advice on how to make this better, and how to feel better faster!!??

[DocSanae]

jersy, the first thing you need to do is move around--walk--that is the best way at this stage to get the gas moving.
Something else, the first couple of weeks will be pretty tough on you, so you need to be patient, and persevere. It will get better, but for now, take things one day at a time, and sip sip sip so as not to dehydrate.
(((((((HUGS)))))) May your journey go well.

[kimtindall]

Sorry that you are feeling so poorly. But Doc has it right when she said to get up and moving. It was the hardest thing to do, but it really did help.

[jersey86]

thanks so much for your help and postings...this support network has been a saving grace. i started experiencing severe nausea last night and called the dr. because i felt like i had to throw up and i know that that would be bad. he said to stay off the protien shakes for a few days because they can cause nausea. after about ten hours of severe nausea i said to myself, this cant get any worse and I chugged about a half a bottle of water....oddly enough that solved the problem!! I dont know whether i was having the nausea because of my stomach being so empty or because i was getting dehydrated...but either way who would have guessed that overdoing it by chugging a little water would have made me feel better??