Placebo?

Cup of Joe

Cup of Joe

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Ok. So let's say you have a patient who is in mild pain or just nervous or anxious.

Obviously, I don't have anything for pain management, so I just wanted to get a sense or what some of you do to put the patient's mind at ease or take their mind off pain.

I'll usually tell them, "We're just a few minutes away from the hospital" or "I'm going to call the hospital and give them some notice that we're coming."

There's also the oxygen "trick": O2 via NRB or NC and tell the patient, "I'm going to give you some oxygen, just focus on breathing normally. It might help with the pain." I really don't like doing this because 1.) if oxygen is not indicated, then why use it? and 2.) I don't like lying to my patients. Oh, and did I mention: I don't like lying to my patients?

Or am I just over-thinking it?
 
Mild musculoskeletal pain can be treated with reassurance, positioning, splinting, cold packs, and elevation. Narcotics are just one of many ways to control pain.

I would try to avoid the administering of oxygen unless clinically indicated.
 
Cup of Joe said:
Ok. So let's say you have a patient who is in mild pain or just nervous or anxious.

Obviously, I don't have anything for pain management, so I just wanted to get a sense or what some of you do to put the patient's mind at ease or take their mind off pain.

I'll usually tell them, "We're just a few minutes away from the hospital" or "I'm going to call the hospital and give them some notice that we're coming."

There's also the oxygen "trick": O2 via NRB or NC and tell the patient, "I'm going to give you some oxygen, just focus on breathing normally. It might help with the pain." I really don't like doing this because 1.) if oxygen is not indicated, then why use it? and 2.) I don't like lying to my patients. Oh, and did I mention: I don't like lying to my patients?

Or am I just over-thinking it?
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I think you are over thinking it and if I might add a few simple things?

Remember when you got hurt as a little kid and your mom or somebody rubbed it?

That really works because some types of nervous transmission (I am too lazy to type out exactly which and the mechanisms and tracks) actually can supercede pain transmission.

You may have the patient try rubbing it.

The body self splints, natural reflex, have your patient find the position of comfort. (most comfort, respectively)

Do not under estimate ice. (or ice packs) I have never seen it in the US, but there is actually a pressurized cryogen used here in Europe for local anesthetic. You don't need to go that far, just use ice.

A small amount of oxygen (2l or less) may actually "help" because of placebo effect.

You don't have to tell them why it is helping, and I think realizing that it is not somehow phramacologically managing pain or benefiting the pathology means you understand why you are using it and how it is theraputically working. That seems reasonable to me.
 
And distracting them. Have them tell you where they're from, what they do, blah blah blah until you find a topic of mutual interest that you can converse intelligently on.

I recently transported a colonel who had been in charge of all MRE development and manufacture for the army for twelve years. He was a history buff and a dork. I asked him what the most important, life changing thing he'd done while in charge of the MREs. His reply? "It's the condiments. We have hot sauce and Mrs. Dash in every meal. People like that."

Made me laugh, and I was glad for the opportunity to chat with him. Plus that conversation burned up ten minutes of the ride.

People like to talk about themselves. You can get almost anyone to talk if you figure out what their favorite topic is.
 
If you ever transport him again, tell him I love him, lol. Tobasco sauce fixes a lot.

I agree with distraction as being helpful. Even the demographic and med history stuff can work. I can go on forever asking about height, weight, shot records, surgical history, when they last saw a GP, meds they used to be on but aren't any more... You get the idea.

Most of my treatable pain pts are old people who fell down and messed up a hip. They've got looooong medical histories and if you exhaust that there you can always ask what job they did or about grandkids. Grandkids are usually an excellent distraction device. I personally like asking how old couples met. However, this is only a good idea if it is obvious the spouse is still alive.

Kids you can ask about school, siblings and sports. And the really ittle kids love peek a boo. Heck, I use peek a boo to test how sick the little ones are. No reaction is the a bad sign.
 
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Distraction and in the old ladies sometimes just holding their hand seems to help.
 
If you tell them oxygen helps with pain, and it subsequently reduces their pain, did you really lie to them? Just because you don't explain the psych-psysiologic mechanism of placebo by which it worked does not mean you lied. Even if it ends up not helping them, you still didn't lie... e.g. amiodarone helps v-fib....except not every time, right?

You could also just give it without saying (but suggesting) that it's for pain...though the hypnotic suggestion might not be as powerful...
 
bigbaldguy said:
Distraction and in the old ladies sometimes just holding their hand seems to help.
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Yep. I had a call with a little 94 year old lady who told me all about growing up during the depression and the differences in the taste of beef that was grass fed vs corn finished. It was a great chat and she hugged me at the end and invited me over for pie. :)
 
Aidey said:
Kids you can ask about school, siblings and sports. And the really ittle kids love peek a boo. Heck, I use peek a boo to test how sick the little ones are. No reaction is the a bad sign.
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Maybe it's just me but the last pedi I had was an anxiety case and when I got her calmed down I started talking to her about random stuff and we got on the subject of school and she started screaming again about how the girl that beat her up was going to be at school the next day and was going to beat her up again. :wacko:

And no, I didn't pick her up from school thank you very much, I might be dumb but not THAT dumb ;)

Distractions work pretty well. I've noticed a smile goes a long way as well. I'm not really a believer of giving them o2 "because it might help" but that's just me.

Before anyone says it "Nor Masaline" is not ethical or appropriate, even for drug seekers. Half the drug seekers know what it is anyways, here at least.
 
NVRob said:
Maybe it's just me but the last pedi I had was an anxiety case and when I got her calmed down I started talking to her about random stuff and we got on the subject of school and she started screaming again about how the girl that beat her up was going to be at school the next day and was going to beat her up again. :wacko:

And no, I didn't pick her up from school thank you very much, I might be dumb but not THAT dumb ;)

Distractions work pretty well. I've noticed a smile goes a long way as well. I'm not really a believer of giving them o2 "because it might help" but that's just me.

Before anyone says it "Nor Masaline" is not ethical or appropriate, even for drug seekers. Half the drug seekers know what it is anyways, here at least.
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Agreed, it seems that sometimes all a patient really needs is a warm smile and a kind word, in order to forget about the pain. I transferred a lady yesterday who broke her hip, she didn't want any more pain medications from me, but she really just wanted me to talk to her...she seemed quite a bit less anxious after that.
 
if they are comfortable with it; hold their hand.
Older people; the stuffed animals work with, just like they do with the kids.
 
Cawolf86 said:
I would try to avoid the administering of oxygen unless clinically indicated.
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^ This. I never understood how many providers have the mentality that everyone needs oxygen. "it won't hurt them, so why not just give it to them?" I think it just shows at a minimal level that they are incompetent at their job.
 
Veneficus said:
Do not under estimate ice. (or ice packs) I have never seen it in the US, but there is actually a pressurized cryogen used here in Europe for local anesthetic. You don't need to go that far, just use ice.
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Someday people will stop laughing at me when I use cold packs for sprains and the like. It really does work and when it's all the treatment you can provide besides splinting and finding a good position of comfort, they should be used.

I'll hold hands or brace people on the stretcher, whatever they think will help. I had a 35 minute ride this winter with lumbar and back rib fractures and all the crew did was keep me from sliding around on the board, and I could not thank them enough for doing that. They drove slow too, which also cannot be emphasized enough.
 
I've found that ice will do a lot. I don't know if it's a placebo or real for them, but hey, anything that helps.

When I was a trainee we had a known and frequent hypochondriac named Billy. I watched an old timer start an IV and give him a dose of "normasaline." Pronounced, of course, as "Norma-lasa-lean," in one big word. Tell him "it may feel cold, and you may get a little metallic taste in your mouth."

Surprising how much that would work. It was unethical, so they put an end to the practice of starting IVs for the sole reason of fooling a patient, but it was funny the one time I saw it.
 
I had a head ache patient on one of my clinicals in the ER, the medics had given the patient a 10cc flush of ns which reduced the headache from a 7/10, to a 2/10. Sometimes it really is all in your head.
 
Cawolf86 said:
Mild musculoskeletal pain can be treated with reassurance, positioning, splinting, cold packs, and elevation. Narcotics are just one of many ways to control pain.

I would try to avoid the administering of oxygen unless clinically indicated.
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We were always trained to always put oxygen on, it's not going to hurt the pt, it may not help, but it just may...especially when you're dealing with anxiety....oxygen is a valuable drug
 
PapaBear434 said:
I've found that ice will do a lot. I don't know if it's a placebo or real for them, but hey, anything that helps.

When I was a trainee we had a known and frequent hypochondriac named Billy. I watched an old timer start an IV and give him a dose of "normasaline." Pronounced, of course, as "Norma-lasa-lean," in one big word. Tell him "it may feel cold, and you may get a little metallic taste in your mouth."

Surprising how much that would work. It was unethical, so they put an end to the practice of starting IVs for the sole reason of fooling a patient, but it was funny the one time I saw it.
Click to expand...

Hahaha gotta love those old tricks that aren't allowed anymore...:rofl:
 
Oxygen is valuable allright. Additional profit for ambulance company, and cost to patient and insurance company. If anything points to a threshold needed to achieve professional status personally, the use of placebos to make money is not only a prime example, it probably continues fraud and is prosecutable.
 
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