• 💊 OTHER DRUGS 💊 Welcome Guest
    Posting Rules Bluelight Rules
    Notable Threads 1 Notable Threads 2
    Dangerous Combos Addiction Support
    Emergency Services Benzo Guide v.1
    Addiction Stories Scary Case Studies
    Biology, Pharmacology & Drugs 101
  • Select Your Topic Then Scroll Down
    Alcohol Bupe Benzos
    Cocaine Heroin Opioids
    RCs Stimulants Misc
    Harm Reduction All Topics Gabapentinoids
    Tired of your habit? Struggling to cope?
    Want to regain control or get sober?
    Visit our Recovery Support Forums

Nurses' knowledge about equianalgesia and opioid dosing

paradoxcycle

paradoxcycle

Bluelight Crew
Joined
May 5, 2004
Messages
5,568
Location
East coast, USA
City of Hope National Medical Center, Department of Nursing Research and Education, Duarte, CA 91010, USA.

Nurses are recognized as the cornerstone of palliative care. Yet, surveys of nurses' knowledge of cancer pain management reveal serious knowledge deficits that could adversely affect the care of patients with cancer pain. Previous research has explored basic pain management issues such as pain assessment and myths and misconceptions surrounding pain, and principles of analgesic use. Advances in recent years have increased the demand for continuing education that will extend scientific advances in pain to clinical practice. The purpose of this article is to share results from a study which evaluated nurses knowledge regarding three methods of analgesic delivery that have become common in clinical practice: intravenous morphine, extended release morphine, and transdermal fentanyl. Several resources are provided to assist clinicians in the appropriate use of these analgesic methods.



Source
 
^^ As a CCRN (CC= critical care= life-flight) and ER RN, I tend to agree for the most part, that most nurses don't know a lot about equianalgesic dosing of pain meds. Except, of course, those of us that are current/previous users of opiates...no patients under my care will ever have to worry about undue suffering.
I've even gone so far as to "suggest" an appropriate level of morphine in a critical care patient that was also on 125 mg of methadone for daily maintenance.
So, not all of us are ignorant, but I agree, that more education is necessary.
BTW, I have 1 more year to acquire my nurse practitioners license, FWIW...:\
 
Aha...

When I get back to the States, remind me to come visit you...ah, but you work crtical care. Oh well... I actually have doctors in my family but they are a lost cause. I am glad that I am going womewhere where there is no prescription system...

Anyway, you are indeed correct. Not all are ignorant. It still amazes me when I have to explain methadone pharmokinetickes to Rns at my clinic. One has been supervsinfg for well over a decade and still has not even bothered to educate herself. Stringe but true.
 
^i have a few family members in the field and based off my observations and conversations with them and their friends who are the same, i'd have to agree with this article..though my hat goes off to soundpharm and all the unacknowledged professionals in his boat. I wish there was more of you around. I blame most of this on the ignorance of the shameful politics in the medical field nowadays. Makes me sick at times. Leave the politics outside of the hospitals and clinics people. And god damn, what a shame it is that all the medical md's, practioners, nurses, etc have to worry about most of the insaine medical malpractice suites in today's day and age. Many dr's, practices, hospitals etc are loosing money, afraid of performing a needed procedure, are going out of business because of all the idiots and asshole lawyers that will start a lawsuite and sew over anything.....and i wanted to go into the medical field, ever since i was quite young...but not now...not after i've learned about all the bullshit going on. ..it's almost unbelievable. I can't believe this shit exists!
 
^^ I totally agree. Politics has no place in the medical system. And about all of the litigation- it truly amazes me...it's disheartening to say the least...but, unless we somehow acquire some form of socialized medical system (like Canada, for instance), lobbying groups (pharmaceutical industry, AMA, and the like), and therefore money will rule the system. It truly disgusts me that if you are ill/ in need of care, the longer they can keep you coming back (i.e. not "cured"), the more money they will make. So, IMO, not only politics, but also "money making manuvers" need to be removed from the system...it'll quite the battle...:\
Also, hats off to DexterMeth for having the clarity of vision to see a major part of the problem in the current U.S. health care system.

Rachamim18: I do eventually intend to start a family practice at some point, but since it will most likely be based in Washington state, it might be a little inconvenient for you, but you would be more than welcome...:)
 
^^ Oh, I will remember. Just tell the receptionist that "Rachamim" would like to speak to me. I only know one (Rachamim), and I'll always remember that name as one of the more knowledgeable people in the OD harm reduction movement...;)
 
soundphaRm said:
^^ As a CCRN (CC= critical care= life-flight) and ER RN, I tend to agree for the most part, that most nurses don't know a lot about equianalgesic dosing of pain meds. Except, of course, those of us that are current/previous users of opiates...no patients under my care will ever have to worry about undue suffering.
I've even gone so far as to "suggest" an appropriate level of morphine in a critical care patient that was also on 125 mg of methadone for daily maintenance.
So, not all of us are ignorant, but I agree, that more education is necessary.
BTW, I have 1 more year to acquire my nurse practitioners license, FWIW...:\
Click to expand...

Wow. Thank you for rising above the ignorance in your profession. I have always been terrified as to what might happen to me if I'm in a critical accident, or if I find myself in a hospital after an injury of some sort. If some woefully mediocre doctor believes that my buprenorphine maintenance is providing me any sort of analgesia whatsoever, I'm dead. I might as well just start blowing into my IV.

I need to get a letter from my buprenorphine doc that explains my tolerance to the dose, buprenorphine's incredibly high affinity for opioid receptors, the partial-agonist nature of buprenorphine, and the dose plateau. But I think some doctors would simply ignore it, thinking I was drug-seeking.

The attitudes towards opioids in this country is appalling.
 
diacetyldeath said:
Wow. Thank you for rising above the ignorance in your profession. I have always been terrified as to what might happen to me if I'm in a critical accident, or if I find myself in a hospital after an injury of some sort.

I need to get a letter from my buprenorphine doc that explains my tolerance to the dose, buprenorphine's incredibly high affinity for opioid receptors, the partial-agonist nature of buprenorphine, and the dose plateau. But I think some doctors would simply ignore it, thinking I was drug-seeking.

The attitudes towards opioids in this country is appalling.
Click to expand...

Getting that letter would be a good idea. Yes, you'd probably be "pegged" as "drug-seeking" by ignorant doctors once in awhile (since I'd just make a phone call to your doctor that maintains you on bupe, and just verify), but it's true. Many people in this profession are relatively ignorant of the psycho/pharmacological aspects of their specialty. I've had to inform numerous attending MDs of possible drug interactions that may occur from their orders (considering the state of the patient) before that has changed their mind(s) about their choice of meds to use...8)

And you don't have to thank me, I'm just doing my job...but, doing your job & knowing what you're doing are two different things sometimes... :\

The whole system is appalling, I agree... :\
 
Last edited:
LPN

LPN = Low Paid Nurse

I'm surprised all of this comes as a shock to anyone. As an MD I have 8 years more education than most nurses and often I've been forced to argue with them on how much narcotic a patient should get. At least in N.Y. it seems they always want to short the patient. Most often b/c they're afraid of overdosing and secondarily of it leading to drug abuse.
Occasionally you'll run into an MD who is the same way. Some of them have no clue what it's like to be in real pain and how urgent it is to get it under control. According to the DEA, physicians used to overprescribe pain medications /benzos. Then there was a backlash from patients claiming it was the doctor's fault they became addicted - as if the doctor shoved the pills down the patients' throats 8). Now that trend is starting to reverse because of all the cases of inadequate pain management.
Oh - and drug seeking is like a rape accusation. You're automatically guilty from the time you're accused of it on no matter how well you try to disprove it.

DrFlGd
 
Last edited:
I am glad that I am going womewhere where there is no prescription system...
Click to expand...

Now that does sound interesting. Care to share location/country?

I have to agree that in general most RN's have only rudimentary knowledge of opiates. That is because they are not taught a lot about it unless they specialize into palliative care or nurse practitioner.

Those of us that have used opioids most definitely have superior knowledge. But I am very interested in pharmacology in general so I have become the "go-to" guy at work for med questions. Yes, I am an RN too, in a very specialized area.

I wasn't going to comment on this thread but felt the profession needed some representation to show that it is only some. M.D.'s can be equally as ignorant. I have encountered quite a few that I would walk out of the emergency room on if I saw them coming, believe me.
 
my perspective

Fortunately I owe my knowledge and understanding of pain assessment and treatment, to my excellent and expensive education as an RN. I was taught a fairly modern approach to pain. Proper assessment and appropriate treatment are essential to being pain free. There ought to be an updated global decision tree for pain. It's not a difficult science to work with if you use the basic knowledge and appropriate interventions to manage pain in it's entirety.

It's rather common sense when you get the hang of pain treatment and medication. A deep process of trial and error, experimentation and elimination. Sadly ...many health professionals are unable to grasp the idea that pain is subjective and objective at the same time.

Maintaing quality of life by helping alleviate pain and it's secondary agonies ...is difficult, to say the least. But given the chance, it can be a chance for a the hope of a more pleasurable life.
 
blahblahblah said:
Thank god for doctors that know when they have a opiate tolerant patient and break out the Dilaudid HP.

Smiles all around.

Last time I was stuck in the hospital for a chest cold I was on daily dosages of bupe [24mg] my system cleaned out quick in 3 days and my doc knew my history as scripted me 4mg of Dilly HP x 3 times daily. It was a nice treat for the common cold.
Click to expand...

No kidding... I often wondered what would happen to me if I went into the hospital for something serious/or not so serious like in your case. I am currently on 75mg methadone daily, and tapering down to 30mg so I can start my bupe treatment.

I have recently been in for surgery for carpel tunnel syndrome (CTS) (right hand first) and they gave me via IV - versed (midazolam) and fentanyl, which knocked me the f*ck out. I woke up and my hand was throbbin like a bitch, they gave me *scoff* Vicoden 5/500 X 20 tabs - 1 every 3 hrs if needed. Ha! Thank god for Ibuprofen.

At the initial appointment before my surgery when I was being scheduled for it, I had a loooong discussion about my methadone maintenance, and was asking what they could prescribe to help surpass the methadone. They looked at me like they didn't have a figgin clue what I was talking about. In fact they had the nerve to say, "well, if you take vicoden, it will just be like taking 2 pain medications." - I had to really bite my tongue and explain how methadone works. I could not believe that these people had no clue or maybe they just did not care, or maybe thought I was a junkey trying to get pills (ding! ding! ding! - right answer!!!)

They are only a Hand specialist after all, not a pain management center, so their knowledge was indeed limited. The vicoden didn't do squat, in fact I took 4 right off the bat and didn't notice anything as far as analgesia, aside from it being equivalent to taking 4 tylenol. For my second surgery (left hand), I told them where they could stick their vicoden, and denied the script from them since it did me no good anyways, and only costed me extra money (guess I could have sold it =D).

Anyways, I have also noticed the increased need for education in the medical field nowadays regarding pain management. It is truly ridiculous, and I found that out first hand, the hard way.

Dilaudid HP 4mg, does the HP stand for "high potency"? What are the 8mg dilaudid called?

Good read anyways, thanks for the article paradoxcycle.
 
HP stands for what you said 'high potency' and it is sometimes given for opiate tolerant patients it is basically just a more concentrated form containing 10mg/mL and other higher concentrations. It cuts down on the amount of solution injected.
 
Last edited:
You must log in or register to reply here.
Top