pain management

  1. What do you think about trying to control a patients pain when the etiology of the pain is unclear?
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  2. 32 Comments

  3. by   janesny
    IMO just as soon as neuro is cleared and MD has ordered the medication.
  4. by   CMERN
    I second that...once you,ve ruled out NEURO..GO for the Gusto..
  5. by   teeituptom
    Howdy Ya'll
    from deep in the heart of texas

    Pain control, boy that has gotten to be a touchy subject these last few years. And whether the pain is real or percieved we now have to treat their pain. The dosing on pain meds has increased significantly over the last decade. Dosing has gotten much higher and frequency has gotten more often. It isnt all that unusual to give dilaudid 4 and 6 mgs IV push for these patients now a days. In the past dosing of that nature was strictly reserved for Cancer and burn patients. Now we give narcotics out like it is Halloween, Trick or Treat.
    How often do you hear, well I still have a a little twinge of pain can I get another shot for the road. Or they come into triage they are smiling and conversing pleasantly and you ask. On a scale of 0 to 10 how would you rate your pain. Oh my pain is a 10 right now. Actually had a pt tell me that on a 10 scale her pain was at "100". while she sat there calmy and smiled, reminded me of the cheshire cat. I didnt argue with the patient at all. And how often do you hear now, those vicdin dont work I need those 10 mg hydrocodone tablets and I take 1 or 2 every 3 hours on top of the fentanyl patch Im wearing.
    I often wonder where this trend is taking us and to what ends it will come too. And what are we going to do when these meds are no longer effective due to increaseing patient tolerance of meds.
    Will be interesting to watch




    doo wah ditty
  6. by   BadBird
    No one deserves to be in pain. After I herniated a disc in my back I was in so much pain I told the Dr. to kill me or cure me and I didn't care which one. I ended up getting IV Dilaudid, IV solumendrol and was admitted for 5 days, had surgery and fortunately made a recovery. I will never forget how horrible that pain was. My neurosurgeon was wonderful, I never filled my scrip for the percocet he wrote for, all I took after surgery was ibuprofen. I don't abuse pain meds and thank god I didn't need narcs after surgery, but I am grateful that when I did they were
    available. You never know how much pain someone is in, and I know that some people seek pain meds as a high but I would not want to deny anyone relief of true pain.
  7. by   ernurse728
    Bird, that is the key phrase there..."true pain". I would never deny someone pain meds that was truly in pain even if we couldn't figure out why. But I do have a problem with the chronic migraine pt who comes in 40-50 times per year and is allergic to compazine, phenergan, reglan, dhe-45, and tordol. I am sorry but those patients should not continuously get the dilaudid that they want! And the only way to put a stop to it is for the ER doc's to grow a set and take a stand!!!!!
  8. by   l.rae
    oh boy, here we go again!....you know, everything tom says l amen!...Christmas day l had a elderly 1 mo. post-op colostomy in with SBO and in EXCRUTIATING pain...she was there when l came on in the afternoon, her resps were 30's-40's, her eyes just rolled back in her head, she cryed. l irrigated, put in an NG, medicated, MS, dilaudid over and over for hours, her skin was ice cold, and she literally writhed in pain the whole time....hours. Finally the surgeon calls back but he can't do surgery, he thinks she is too compromised in other health issues....gave her some ativan and wigged her out. whew......sigh....nothing worked not even a little. finally admitted her....later that nite in comes the frequent flyer, back pain, and "nothing works but demerol"...well as l go in to medicate her she is playing with some kind of hand held game, and of course her pain is a 10....ya know, it was all l could do not to take her by the hair and drag her to the room of that little elderly lady and say "THIS IS A 10!"..... not to mention her husband kept coming out to the nurses station and telling us "she still has pain"....even though we were in the middle of a code. SOOOOOO after the code expired..l go back in miss 10's room, she is reading a magazine, ..."no l didn't get any relief"....and more demerol is given.......AGHHHHHHHH!.....ANYONE who believes pain is always what the patient says is niave to say the least.....LR
  9. by   teeituptom
    Howdy ya'll

    And the beat goes on on on on
  10. by   kaycee
    Originally posted by teeituptom
    Howdy ya'll

    And the beat goes on on on on

    and on and on and on !!!!!!
  11. by   fab4fan
    Well, I've posted on this before, so I'll try not to repeat myself too much.

    People who live with chronic pain do not always appear to be in as much pain as they may rate. After a while, it's as if your body gets "used to" that pain, and develops coping to some extent.

    I get migraines, and when I have a bad one, I do have to go to the ED. This just adds to the stress and pain, and then if the staff treat me like criminal, it's even worse (and it's not like I'm there every other week).

    I almost feel like for those people who have no sympathy for migraineurs, they ought to have one really bad migraine, one of the 12-24h jobs where you can barely open your eyes, puke your head off, have gait disturbance...the whole 9 yards. Then go to the ED where you are treated with suspicion by surly employees who act as if you're a criminal. It is demeaning.

    I try to give people the benefit of the doubt; yes, there are some "seekers" out there, but I try to remember that pain is subjective, and that many, many factors go into rating it.
  12. by   l.rae
    Originally posted by fab4fan
    Well, I've posted on this before, so I'll try not to repeat myself too much.

    People who live with chronic pain do not always appear to be in as much pain as they may rate. After a while, it's as if your body gets "used to" that pain, and develops coping to some extent.

    I get migraines, and when I have a bad one, I do have to go to the ED. This just adds to the stress and pain, and then if the staff treat me like criminal, it's even worse (and it's not like I'm there every other week).

    I almost feel like for those people who have no sympathy for migraineurs, they ought to have one really bad migraine, one of the 12-24h jobs where you can barely open your eyes, puke your head off, have gait disturbance...the whole 9 yards. Then go to the ED where you are treated with suspicion by surly employees who act as if you're a criminal. It is demeaning.

    I try to give people the benefit of the doubt; yes, there are some "seekers" out there, but I try to remember that pain is subjective, and that many, many factors go into rating it.

    There is so much more to it than that....for instance, do you:
    1.Ask the nurse as soon as she comes with the med...what is that?
    2. followed by ...how much am l getting?
    3.then proceed to tell the nurse...l always need more than that dose, or.....that never works.
    4.have no ligitamate hx of your problem documented with a PMD
    5. present to the ER having tried NOTHING for pain relief prior to coming
    6.NEVER follow up with your PMD
    7.present to ther ER asking which MD is on duty
    8.Allergic to tylenol, ibuprofin, nubaine, compazine and toradol
    9.do not have a PMD
    10.vary your ER visits between different local ER's


    believe me, seekers have a MO, we see them over and over. If there is ANY documented hx or a non frequent visitor, they ALWAYS get the benefit of the doubt.....l doubt very much if you have a true 10 pain you will be reading, playing video games or requesting food and drink......
  13. by   Love-A-Nurse
    hehe, i am just a nosy student reading and thought i would say hello.

    i am very interesting in working in the ed after school.

    hope you don't mind.

  14. by   RainbowSkye
    I've been working as an er nurse for over twenty years. And what makes me want to quit my job nearly every day are the drug seekers.
    Of course, I don't want to see anyone in pain. But pain comes in many varieties, and the one I'm concerned about more and more these days is prescription drug abuse and addiction. I work in a rural er and some days a good 80% of our patients are drug seeking. The drugs of choice in my area are Lorcet and Soma.
    I most definitely deal with all 10 of the behaviors posted by l.rae above, and more. Here's a few of the ones I hear all the time:
    *my doctor is out of town
    *I'm scheduled for surgery on...
    *I can't get an appointment for two months
    *I left my medication in the car and somebody took it
    *I've got my x-rays, mri, ct report right here (carrying around a torn, tattered, ten year old copy) proving I have that heriated disk (or whatever)
    *my doctor died (I heard that one today, and it was true. Of course the doc died in August leaving plenty of time to get a new doc)
    And here's behaviors I see pretty often:
    *have a chronic problem, but no doc or no medications to take when the pain occurs
    *Demerol 100 mg (Nubain 20 mg, Lorcet 10/650) is the only thing that works. The absolute second the shot is injected or the pill passes the lips the pain is gone and the patient wants to go home.
    *Laughing and smoking outside of the waiting room turns into heavy groaning and being unable to be in the room with the lights on the minute the patient is called into the er.
    *Car pooling with one or two other patients with migraine, back pain, whatever chronic pain they may have. I may be cynical, but what are the chances that two of your friends have a migraine at the same time you do? We also have a couple of husband, wife combos.
    *Leaving the er with meds and sharing them with their "ride".
    *Or not having a ride because they just want the prescription (again, usually for Lorcet and Soma)
    I could go on and on, but y'all know the drill.
    And here's what's sad about this to my way of thinking. These folks are using up time, resources, etc which other patients need. And we are doing them no favor by facilitationing their addiction.
    People with chronic pain need a pain management specialist (including, I think, those folks with migraines which don't respond to usual appropriate treatment) so they can have appropriate pain relief at all times. Folks ready to kick their addiction should be helped find an appropriate place to help them detox.
    And to those who may disagree with me and think that I'm one of those "surly employees" who treat patients as if they are "criminals", please understand I am speaking from my own experience only.
    ...An er nurse who gets frustrated, but tries really hard to never take it out on patients and doesn't even treat the real criminals like criminals (I work in an area with lots of prisons)....

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