Wells, Kelly RN; DeCrane, Susan K. PhD, RN, ACNS-BC
West Lafayette, Ind.
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The mystery of death
“Moving Toward the Light” (December, 2013)∗ provides a powerful and poignant account of an end-of-life incident that illustrates how nurses are often privileged to be permitted a peek, however fleeting, of the reality and mystery of death. The patient's dying utterance causes the author to eloquently contemplate the phenomenon of death and the enigma of the next dimension. I think that a nurse who ponders such philosophical matters is a better nurse.
Opioid mortality:Flawed analysis?
I felt the need to respond to “Chronic Pain: Opioid use soars but pain management lags” (Clinical Rounds, December, 2013).∗ The article begins by providing a summary of the impact of chronic pain and the increase in opioid abuse and overdose deaths in the United States, which suggests, to me, that the researchers already suspected an association.
This research brief is accompanied by a quote from one of the authors that “efforts to improve the identification and treatment of pain have backfired, due to an over-reliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike.”
With all due respect, that conclusion can't be drawn from this data, which didn't account for any outcome measures that would suggest that anything backfired. Analgesics and nonpharmacologic therapies, such as heat and cold, are interventions—they're not outcomes. Also, the researchers didn't have access to records that would indicate whether a prescribed treatment was appropriate for the individual patient or whether it was effective. In addition, data likely doesn't contain an accurate account of the use of nonopioid medications or nonpharmacologic treatments because the vast majority of those interventions are available over-the-counter and don't require an office visit.
I'm concerned about the epidemic of drug overdose deaths in the United States; however, we should be cautious in associating these deaths with the assessment and treatment of pain. To try to reduce opioid mortality, we should examine factors associated with these deaths. I encourage clinicians to gather and analyze high-quality data that can provide the answers we need to reduce prescription drug abuse mortality.
—Kelly Wells, RN
—Susan K. DeCrane, PhD, RN, ACNS-BC
West Lafayette, Ind.