Letter to the Editor by Tanya Ushakof to Ethics and Pain Management in Hospitalized Patients


June 28, 2013

Response by Tanya Ushakof on "Ethics: Ethics and Pain Management in Hospitalized Patients" by Esther Bernhofer, BSN, RN-BC (October 25, 2011)
Reply by author

Dear Editor:

I’m a Registered Nurse of 5 years. I’m certified in medical-surgical nursing and working for Health and Hospitals Corporation as a staff nurse. I am also a student involved in a Baccalaureate Degree in Nursing. Studying nursing deeper and working directly with patients gives me quite an experience and forms a professional opinion about many issues in nursing. Nursing field along with entire health care system needs improvement.

According to the Joint Commission pain is a part of the vital signs (National Pharmaceutical Council, 2001). All medical patients, in hospitals or coming to the outpatient offices have a right for helpful pain management. Pain is a very subjective human feeling. Only patients themselves can actually assess the source and strength of pain. Different medical organizations have their own definitions of pain, but to summarize many of them, I should say that pain is one disturbing sensory or emotional feeling related to tissue damage. We should always remember pain is whatever the patient says it is; it exists whenever the patient says it does.

As healthcare providers, we have to remember our scope of duty; remember to keep our professional commitment to taking care of any patients. An important part of our professional duty is ethical responsibility to control patient’s pain and relieve distress. Not only nurses but all interdisciplinary departments are supposed to participate in this process and ensure the trustworthiness of medical care.

There are so many illegal drugs used on the street. The enormously large value of this “business” is made by selling and using of prescription drugs. According to Drug Enforcement Administration one third of all illegal drugs on market (sold and/or used) come from legal doctors’ prescriptions (DEA Public Affairs, 2012; ONDCP Public Affairs, 2011; U.S. DEA, 2012; U.S. Department of Justice, n.d.).  It’s well known, and I personally know from my co-workers, that about 20-25% of all Emergency Room visits are drug seekers. You can ask any family, they’d have narcotic pain killers in their drug cabinet left from some medical/surgical procedure in the past, because physicians usually prescribe much more pills than it’s needed for pain relief. Americans don’t tolerate even insignificant pain anymore; they are using less natural and holistic remedies for minor pains. Patients don’t think of the consequences because doctors and hospitals, pushed by big pharmaceutical companies, don’t take it seriously either. So it’s a vicious cycle of mass drug users and abusers. The consequences are not only more people becoming drug addicts, but also billions of dollars coming from American tax payers go to covering all those prescriptions and health care costs.

It’s not so easy for healthcare providers to distinguish really sick patients from just drug seekers. But with great experience, they could see the difference in most cases. Believe me that we, nurses, would like to believe our patients; we don’t want to doubt complains of pain.

I think all law makers and politicians should negotiate the subject with professionals when deciding a change of law in healthcare industry. It’s important for media and press reporters to remember that eventually this problem (and this is an obvious problem) will influence them, their families and kids. Our media should remember that when reporting just one side of the dilemma.


Tanya Ushakof


DEA Public Affairs. (2012). DEA to hold nationwide prescription drug take-back day April 28. Retrieved from www.justice.gov/dea/divisions/hq/2012/pr041612p.html

National Pharmaceutical Council. (2001). Section II: Assessment of pain. In Pain: Current Understanding of Assessment, Management, and Treatment. Retrieved from www.americanpainsociety.org/uploads/pdfs/npc/section_2.pdf

ONDCP Public Affairs. (2011, April 19). Obama administration releases action plan to address national prescription drug abuse epidemic. Retrieved from www.justice.gov/dea/divisions/hq/2011/pr041911p.html

U.S. DEA. (2012). DEA’S fifth national prescription drug take-back day results in another big haul. Retrieved from www.justice.gov/dea/divisions/hq/2012/hq100412.shtml

U.S. Department of Justice Drug Enforcement Administration, Office of Diversion Control. (n.d.). Inside diversion control. Retrieved from www.deadiversion.usdoj.gov/prog_dscrpt/index.html