This past month, one of my family members had orthopedic surgery at what I thought was a solid hospital in North Jersey. During her 8-day stay, I was shocked and dismayed by the poor care she received in dealing with her pain. After all of the education about pain treatment over the last several years, all of the media attention, introducing pain as the “5th vital sign,” etc, pain care is still poor!
What were the problems?
1. Still a focus on treating pain afterwards, rather than preventing it
After orthopedic surgery these days, patients are up and out of bed on the same day of surgery. However, using narcotic pain medication before getting out of bed and before physical therapy, is imperative. Unfortunately, we had to argue with nurses each time we tried to implement this plan. Several times I got the response, “We can’t give pain medication if she doesn’t have pain yet.” The fact that you can use medication ahead of time to prevent pain was not common knowledge.
2. Still a lack of knowledge about pain medication’s predictable – but treatable – side effects
One common side effect of opioid medication is constipation. As for pain itself, trying to prevent this is better than trying to undo it once it’s occurring. The hospital seemed not to understand that this side effect is often preventable with medication and diet.
Second, narcotics in both IV and pill form had initially been prescribed, with a plan to decrease IV meds when pills were adequate for pain control. However, staff often encouraged IV medication even after pills were adequate. Unfortunately one of the common side effects of IV pain medication is dizzyness – not a good side effect when you’re trying to stand up and do PT after surgery. Another goof was that when my family member was transferred to a new unit, only the IV medication order was transferred with her, rather than the option for either medication. So we had the rock-and-a-hard-place choice between IV meds causing dizzyness, or no pain meds before PT. There seemed to be no one concerned about the big picture – how pain treatment could be improved so that PT could occur.
3. Lastly, some problems particular to this hospital, which I hope are not wide-spread. You don’t leave people standing alone with a walker when they’re not suppposed to walk alone. You don’t swing people’s legs up onto the bed swiftly and roughly after they’ve had hip replacement surgery. You don’t wake them up at midnight for a bath when you’ve given them a sleeping pill and pain medication at 10pm. It’s not rocket science, guys.
If you’re hospitalized, be nicely assertive for your own needs and care. It helps to have an advocate and support person with you as much as possible. Lastly, avoid St. Barnabas Hospital in North Jersey 
Unfortunately for us, we learned the hard way that there’s still a long way to go for better pain care.
This week’s Grand Rounds is about uplifting stories and is posted at A Medical Student’s Journey.
14 responses so far ↓
Diana // Oct 20, 2010 at 2:30 am
If I didn’t have so much experience with pain management as a result of my chronic pain I think I would have had a much more difficult time dealing with recent oral surgery.
Luckily I already knew not to try to chase my pain, so I started taking my prescribed medications as soon as I got home. It worked out really well for me, and it definitely helped to be in charge of my own dosing decisions.
I just can’t understand why professionals are still lagging behind on these issues. Common sense goes a long, long way.
flutedoc // Oct 20, 2010 at 9:21 am
Common sense is not part of nursing orders at many centers where care is provided. Baths at midnight occur when a nurse or aide cannot get around to it sooner, because of understaffing. Pain management is relegated to a specialist who must be consulted, and is not available at the time when need is greatest. The residents are not smooth operators when it comes to writing orders and predicting who needs a pain consult. It takes many caring individuals on an overworked staff to change the way hospitals operate. One caring individual can rarely make a big difference after policy is set by insurance companies and hospital management.
Judy // Oct 20, 2010 at 10:00 am
My daughter has RSD in her right leg, and needed 8 teeth out. Rather than have an in-office procedure, she was admitted to our local hospital for an overnight stay. Her pain clinic doctor monitored the general anesthetic and knew how to handle the procedure: as well as the general, the local nerves were also frozen, and ketamine and anti-nausea meds were added to the IV. The American RSD Society has a printout sheet outlining hospital protocol for RSD patients, and the nurses read it and took very good care of my daughter. BUT – and this is a big but – when prescribed morphine did not agree with her and we rushed her to the same hospital’s ER about a year earlier, the MD on call that night ignored the information sheet, actually rested his foot on the bed, did everything he could to ‘test’ – increase – her pain levels; the nurse/lab tech inserting the IV and taking blood tests also carelessly threw down used medical paraphernalia onto the bed, right at her RSD-affected leg. Pain and anxiety levels shot through the roof, and the MD noted on her chart that ‘the patient was dramatic’. Avoid Seven Oaks Hospital ER if you can!
Marsha // Oct 20, 2010 at 11:03 am
Hey everyone, I’ve watched my dad struggle in pain for months now all thanks to the DePuy ASR Hip that he had implanted after surgery two years ago. If you or anyone you know has already had this procedure then it is urgent that you contact your orthopedic surgeon to establish if the DePuy ASR Hip was used in your surgery and then go to http://www.defective-hip-replacement.com/ because the DePuy device was just recalled. Make sure that you know your rights, your health is at risk!
EGrace // Oct 20, 2010 at 1:14 pm
Each time I hear about what I think are medical blunders acting backwards happening to my friends and colleagues and their families I wonder what less knowledgeable people do.
This is atrocious. What can we do?
I’m so sorry it happened to your family member.
How to Cope with Pain // Oct 20, 2010 at 3:40 pm
And this is what happened despite my family member having me as a medical person at the hospital with her. I shudder to think of what can happen to patients without any support or advocate.
Ali // Oct 21, 2010 at 6:44 pm
Thanks for tacling this topic – it is so important to deal well with pain. I write about chronic pain and have a blog to help encourage others – would love your feedback and advise!
Robinn // Oct 22, 2010 at 4:27 am
Pain can have different meanings, depending on where it is used, but in a broadest sense of the term, it is defined as an individual’s basic aversion associated with a threat of harm or harm itself. These threats can either be physical, emotional, or mental. Pain comes in all degrees of intensity; it can be mild, or it can be very intolerable. Pain can also be a preliminary sign of an imminent harm or threat, such as when a part of your body aches due to an impending disease or injury. Pain also causes the organism to protect the injured part of their body, expediting the healing process.
Chiropractor Lawrenceville GA
David // Nov 2, 2010 at 3:44 pm
For thirty years I have practiced physical therapy in Pennsylvania. Work-related injury was one of my key areas of interest (along with elder care, I don’t personally like the term “geriatrics”) .
During those years I always investigated the psychosocialeconomic aspects of pain in addition to the anatomical and pathological influences. I was particularly impressed with the work of Hester & Decelles at the Meninger Clinic, Steve Linton and Gordon Wadell.
In April 2007 I suffered a work-related injury for which I have undergone two surgical procedures. I thought that I was an expert in workers’ compensation having lectured, praticed and written about it. That is, until the work injury!!!
Now when I think of chronic pain (which limits me to 2 hrs/sleep pm), I think beyond anatomical, pathological, biomechanical, physiological, and even pschosocial influences.
When reading a case study, I now consider “system” (in my case, workers’ compensation system) elements that magnify a patient’s/injured worker’s pain. For instance, I have gone for long periods without my pain meds because my claims adjuster failed to re-certify my prescription card or there has been staff turnover which, is emblematic at the adjuster level.
I have always had compassion for those I serve (my patients) however, this has exponentially grown. I often comment that health care systems in general, REALLY kick the “average patient” around after all, look what they’ve done to a veteran of the healthcare system, who commands inside knowledge.
I share this experience with my health care colleagues. When I now lecture to physcial therapy students I ask them to consider this to consider this take away lesson: “First be an ombudsman for your patients/clients then, a health care provider who understands the psychosocial AND system elements contributing to your patients’ disability”.
David // Nov 2, 2010 at 3:48 pm
“Oops! Sorry for the typos, can’t blame them on my disability”.
Ali // Nov 12, 2010 at 5:21 pm
so frustrating! I am thankful that I have a doctor at the moment, who has been proactive about dealing with my pain. But the majority of doctors and hospitals that i have had have been very hesitatant to treat pain before it happens … thanks for helping with knowledge on this topic!
Mrs. Life // Nov 25, 2010 at 11:14 pm
Pain treatment can really stress people, not only the affected but also the people that take care of them. Prevention is best rather than treatment. I was kinda disturbed with #3, did those really happen in that particular hospital?
mary // Sep 13, 2011 at 2:42 am
One of the things that a Patient is bothering of is the management of pain brought by different medical procedures. And the worst that patient can ever imagine of is that the pain brought by a faulty medical device. Just imagine how it can be traumatic to patients are.
Defective hip implant // Oct 21, 2011 at 7:09 pm
Unfortunately I know from my own experience that pain management in hospitals is lacking. When you go to a hospital, whatever your problem may be, you are expecting certain standards. On top of that list is making you better and help with your pain during your stay.
Thank you for the warning about this hospital.
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