Undertreatment of Medical Inpatients with Narcotic Analgesics

TLDR

A questionnaire survey of 102 house staff physicians in two New York teaching hospitals revealed widespread misinformation about meperidine. The study found that most patients on narcotic analgesics experienced significant pain, with 63 % receiving low meperidine doses (average 90 mg/day) and only one patient receiving >75 mg, and that physicians’ misconceptions—underestimating effective doses, overestimating duration, and overstating addiction risks—contributed to undertreatment and unnecessary suffering.

Abstract

Structured interviews of 37 medical inpatients being treated with narcotic analgesics for pain showed that 32% of the patients were continuing to experience severe distress, despite the analgesic regimen, and another 41% were in moderate distress. Chart review suggested significant undertreatment with narcotics: meperidine in doses of 50 mg every 3 to 4 hours or less (if needed) was prescribed for 63% of the 37 patients; a dose of more than 75 mg was prescribed for only 1 patient. The average amount actually received per day by the patients was 90 mg. A questionnaire survey of 102 house staff physicians in two New York teaching hospitals showed considerable misinformation about meperidine. Many physicians underestimated the effective dose range, overestimated the duration of action, and exaggerated the dangers of addiction for medical inpatients receiving meperidine in a therapeutic dosage range. Physicians who exaggerated the dangers of addiction were more likely to prescribe lower doses of drugs, even for patients with terminal malignancy. The authors suggest that such misconceptions probably lead to undertreatment with narcotic analgesics, causing much needless suffering in medical inpatients.