In the pain control community Demerol is known to be distinctively inferior with a short duration of action, local irritative property, and a toxic metabolite, normeperidine, which can cause delirium and seizures in effective analgesic doses. Pain control in the wider medical and nursing community seems to be met with apathy and confrontation. Health professionals believe that their patients have good pain control so they are apathetic about need for change. Proposals for improved pain control all too often are met with confrontation. Indeed the emperor has no clothes.
Pain control is poor but the old methods are so familiar.
Change is needed but inertia is difficult to overcome. Deletion of this inferior agent will allow the promotion of morphine and other equivalents to a central place for serious, level three pain. The momentum would then allow for other changes in the mystical pain book. Patient centered pain assessment, round the clock rather than prn dosing, rescue doses for unrelieved pain can all become common practices. DFZ is a positive first step to start nation wide meaningful change in the reduction of pain.