Re: Pain management
From: Anna Meenan, MD (annam@uic.edu)
Thu Mar 30 09:05:03 2006
OK, just got an e-mail from Ina May, who's temporarily off-list, giving
me the reference for the cross-cultural study I mentioned. Turns out it
was in one of your journals, guys (and gals). Ina May referenced it in
her most recent book "Ina May's Guide to Childbirth". Her's what she
sent me:
Here it is:
Senden, I.P.M. et al. Labor pain: a comparison of parturients in a
Dutch and an American teaching hospital. Obstetrics & Gynecology 1988;
71, No. 4. Anyway, here's my
M summary of it:
A study comparing a group of Dutch women’s expectations of labor pain
with those of a group of U.S. women found striking differences. (1)
Both groups of women were having hospital births and were asked the
following questions within two days after they gave birth: what were
their expectations of pain, did they take pain medication, and how they
would prefer pain to be managed in a future labor? Both the Dutch group
and the U.S. group were informed of the potential negative effects of
pain-relieving medications for labor. Nearly two-thirds of the Dutch
group received no pain medication, in contrast with only one sixth of
the U.S. women. Two-thirds of the U.S. group were given narcotics
during labor, along with some type of nerve block for birth. The U.S.
women expected labor to be more painful than the Dutch women did, and
they expected to be given medication for pain. In both groups, the
proportions of women expecting pain to those who actually received
medication were nearly identical.
She's attending the NIH State-of-the-Science Conference: Cesarean
Delivery on Maternal Request, in Washington DC.
--
Anna Meenan, MD
At Mon, 27 Mar 2006, Meenan, Anna, Kevin wrote:
>
>It has always cracked me up to see the poster on the wall in the
>labor room that says "Are you in pain?" Duh.
>
>Actually, there was some research done on cultural attitudes toward
>pain in childbirth and the need for pain relief in labor, involving a
>comparison between Dutch and American women, which was published
>several years ago in Birth, I think, though I could be mistaken about
>the source.
>
>Anna Meenan, MD
>
>>I agree with you but of course it's not a culture of "better" living
>>through pharmaceuticals, it's a culture of pushing more drugs, it
>>seems at times. As a nurse I understand that JCHAO has emphasized
>>the pain scale and pain relief and has dinged hospitals for not
>>adequately addressing pain management. The result is every hospital
>>I've worked in in the past few years requires RNs to assess pain,
>>using that 0/10 scale, on a regular basis (my present hospital
>>requires double charting on it Q 2hrs!!!!). The pts get tired of
>>being asked. I think it's counterproductive, esp. in labor and
>>birth, where the patients go up to 10 rather quickly ... and PP I
>>think it's obsessive and helps them focus on their pain more than
>>they should. My assessment of pain can be quite different from the
>>pt's, based on what I observe of them. My hospital also hands out
>>the 7.5mg Lortabs, not the 5mg we used to routinely give post op
>>joint replacements (pretty painful postop course) ... what's up with
>>that? The increase in epidurals can't be coincidental either. In
>>fact, the group of patients I've had who routinely are able to do
>>without pain meds or epidurals are those from outside the USA. Must
>>be different cultural attitudes towards pain, birth, &c that enable
>>them to cope -- it'd be interesting to see research on this.
>>
>>Suggestions on how to get rid of that pain scale, or on how to
>>better address this issue than by handing out more and stronger pain
>>meds?
>>
>>Grace RN
>>
>>Lynn Montgomery:
>>Now I have been been doing scopes for 18 years. Over that time, I have seen
>>a progressive increase in the requirement for post-operative pain
>>management, despite my procedures being exactly the same. In the recovery
>>room, patients are requiring much more immediate post-op pain medication. I
>>now discharge patients with Lortab 7.5 mg, #30 and quite routinely get
>>called on post-op day 3 or 4 for a refill - which I typically refuse.
>>
>>I place part of the blame on the hospital's use of its "Pain Scale", where
>>they counsel patients pre-operatively on gauging their pain on a scale from
>>1-10. They are taught that if "they" feel they are greater than a 4-5,
>>their pain is not adequately controlled. Nursing staff doesn't do their own
>>assessment any longer, but rather relies on the patient's own assessment of
>>their pain - hell when the recovery room nurses call to advise me of a
>>patient's post-operative pain, they don't even know the patients vitals.
>>
>>It seems that we have created a culture of better living through
>>pharmaceuticals and we are expected to provide the remedy.
