CDC Opioid-Prescribing Guideline for Chronic Pain: Concerns and Contexts

by frankieleon/ via flickr by frankieleon/ via flickr

By Jacob Molyneux, senior editor

The CDC’s new Guideline for Prescribing Opioids for Chronic Pain was released this week. The context for this comprehensive new guideline is widespread concern about opioid-related overdose deaths and substance abuse in the U.S.

The guidelines make 12 main recommendations, among them the following:

  • nonpharmacologic or nonopioid pharmacologic treatments should be considered “preferable” first-line therapy for those with chronic pain.
  • a daily opioid dosage limit of morphine milligram equivalents should be imposed.
  • immediate-release opioids should be prescribed before moving to extended-release formulations.
  • urine testing should precede new opioid prescriptions for chronic pain and treatment goals should be set.
  • clinicians should prescribe the lowest possible number of days’ worth of medication for acute pain (often three days or less).
  • prescription drug monitoring program (PDMP) databases should be consulted to determine patients’ past histories of opioid prescriptions.

Some of the recommendations would seem to be no-brainers, such as consulting PDMPs when writing new prescriptions. Others, such as a “one-size-fits-all” daily dosage limit and restrictions on the use of extended release formulations, have raised alarms among pain management experts. See, for example, “I’m Worried About People in Pain,” a recent AJN Viewpoint essay by Carol Curtiss, a nurse and pain management expert, who notes the increased stigmatization experienced by pain patients and the chilling effects of new […]

2016-11-21T13:01:23-05:00March 17th, 2016|Ethics, Nursing, nursing perspective, pain management, patient engagement|4 Comments
Read More

The Balancing Act: A Dying Patient and a Spouse Who Can’t Let Go

Illustration by McClain Moore Illustration by McClain Moore

The Reflections essay in the March issue of AJN is called “The Balancing Act.” The author describes a situation she faced as an ICU nurse in which her efforts to keep a dying patient comfortable were complicated by a spouse’s reluctance to accept the inevitable. It’s often hard to advocate for a patient while honoring the emotional struggle of a close family member. Here’s the start of the essay.

I have just arrived to work in the ICU and am assigned a patient in respiratory distress. Her name is Darlene and her husband Tom is pacing the room. Within 10 minutes, he drinks three cups of coffee, ignoring the cot provided by the previous nurse so he could sleep next to Darlene. His wife has more than one cancer and both are growing. She left the hospital a week ago for hospice care, but has been readmitted after a decision by her husband to reattempt curative treatment.

[…]

2016-11-21T13:01:24-05:00March 9th, 2016|Nursing, nursing perspective, Patients|2 Comments
Read More

Just Breathe: A Nurse’s Tough Love Proves Crucial During One Mother’s Labor

Photo by chintermeyer, via Flickr. Photo by chintermeyer, via Flickr.

By Amy Collins, AJN managing editor

The pain jolted me from my sleep. It was 1:30 in the morning. The sensation was stronger than anything I’d ever felt, and I grabbed my phone to start my contraction timer. I had read loads on labor and childbirth, and everything suggested I was in for the long haul. But my timer was showing the contractions were already only five minutes apart. I spoke with the hospital’s on-call physician, who told me to relax and spend as much time as possible at home so I could be more comfortable.

But within minutes, the pain had increased to a level where it was difficult to talk. The contractions were now three minutes apart and my water had broken. My husband and I decided to go to the hospital.

I’d like to say I was strong and handled the pain of labor well, but I was quickly losing control and succumbing to anxiety. By the time we got to the maternity unit, I was sobbing. The labor nurse assigned to me introduced herself as Jean. She was older and seemed seasoned, with a stern, no-nonsense attitude. She brought me to a delivery room and gave me a gown. Before labor started, my plan had been to see how […]

2016-11-21T13:01:25-05:00March 2nd, 2016|nursing perspective, patient engagement, patient experience|0 Comments
Read More

Nursing Reads: A Powerful New Novel Evokes Diverse Perspectives on an Organ Transplant

613XCHrLJFL._SX396_BO1,204,203,200_

By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

The Heart, a new novel by Maylis de Kerangal, caught my attention with a cover art image suggestive of the vascular and as beautiful as an angiogram. Taking place over a 24-hour period, the novel describes a 19-year-old accident victim who suffers brain death and the people who are connected to the heart transplant that follows: his parents, the doctors and nurses, the recipient of the heart. As a nurse who’s seen the organ transplant process from a number of angles, I wasn’t sure how De Kerangal could possibly navigate such material.

But the novel, which has been ably translated from French, is both subtle and powerful, casting light on the complexity of every character, from the pre-accident vitality of Simon, the donor, to the conflicted gratitude of the heart recipient; from the inexperienced ICU nurse to the surgeons.

Two important characters are nurses, though they are only a part of the larger picture:

Cordelia Owl, Simon’s ICU nurse, is an inexperienced practitioner. She carries out her nursing tasks in a distracted, perfunctory manner, speaking aloud to the unresponsive Simon as she cares for him. In doing so, she inadvertently intensifies the anguish of his parents, who are standing nearby and struggling with the concept of brain death.

Though her behavior shocks the attending physician, she’s not […]

2016-11-21T13:01:25-05:00February 29th, 2016|Nursing, nursing perspective, patient experience|0 Comments
Read More

American Heart Month: Education, Awareness Crucial to Fight Heart Disease

beating heart still © American Heart Association

In 1964, President Lyndon B. Johnson proclaimed the first ever American Heart Month: “It is essential to the health and well-being of our nation that our citizens be made aware of the medical, social, and economic aspects of the problem of cardiovascular diseases, and the measures being taken to combat them.” Cardiovascular diseases has to be treated every day by doing exercise, there´s plenty of exercises you can do to better your health, one of the best ones I know is boxing but there is Some things you’ll need for boxing before you even start practicing.

The tradition has continued every February since then, and the need to raise awareness about cardiovascular health remains urgent: heart disease is the number one killer of both men and women in the United States. According to the Centers for Disease Control and Prevention, approximately 610,000 Americans die of heart disease each year.

Women may be particularly at risk, both because the warning signs of heart disease can be different for women than for men and because of common misconceptions about heart disease risk, such as the idea that heart disease only affects men or older adults. Cardiovascular disease (CVD) kills one in three American women—but the American Heart Association (AHA) says 80% of those deaths could be […]

2018-02-06T10:21:39-05:00February 11th, 2016|Nursing, Patients|1 Comment
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
Go to Top