Pain Mangement Evaluation & Placebos

[Guest guest]

Debs,

You wrote, " ..then every Friday he will run a test and I wont know what I am

being injected with to see what happens. I will have to withhold meds, so I

am in pain. "

This is a very peculiar method of evaluating a person's pain level,

threshold, tolerance, and/or response to pharmaceutical interventions. In the

US, it

violates proper pain management protocol to require a patient to be in pain

to evoke a response. The more common method is to institute a new regimen at

the base or lowest level, gradually increasing it while tapering down the

patient's current program.

There are several reasons for this. There are two different types of pain

treatments, 1) controlling pain 2) managing pain, hence the word, pain

management. When pain cannot be managed, it becomes uncontrolled, and then,

medication is required to chase the pain. The amount and type of medication

needed to

catch up to uncontrolled pain is not the same as the amount and type required

to keep it managed. Oral Oxycontin may manage pain quite well, but IV

Demerol or Morphine may be required to get it under control. Now, if the

evaluation

is to determine the most effective pain medication to achieve pain control,

then the patient would, indeed, need to be in severe pain. Any evaluation

that puts a patient in pain, when there is an alternative, would, I believe,

violate JCAHO.

The use of placebo's in evaluating and establishing a pain management

program is another issue. JCAHO also has a written position statement regarding

the

use of placebos in clinical practice, not just in clinical trials. Check

out: _http://www.jcaho.org/news+room/health+care+issues/pain+mono_npc.pdf_

(http://www.jcaho.org/news+room/health+care+issues/pain+mono_npc.pdf) It

states

that " Placebos are sometimes used to access whether pain is responsive to

sympatholysis or other interventions. However, the deceptive use of placebos to

treat pain is considered unethical and inappropriate. "

Another good resource is this document which provides the pros and cons of

the ethical use of placebos. Check out:

_http://medinfo.ufl.edu/year2/ethics/pdf_files/Servingtwomasters.pdf_

(http://medinfo.uf

l.edu/year2/ethics/pdf_files/Servingtwomasters.pdf)

This provides an excellent formal argument re: ethical use of placebos.

Karyn E. , RN,

Exec. Director PAI / 1-

Many People, Many Faces, One Voice