[fab4fan]

Well, he's not up to standard in terms of practice, and once again, this is not my opinion, it's in all the current literature.

The fact that there are so many negatve comments about people with CNMP just shows how far we have to go in educating practitioners on all levels.

Just do a search on here and look at all the threads about people with migraines, chronic pain, etc.

[jkaee]

[quote]Originally posted by z's playa
[b]Jkaee; I'm the original poster and a migraine sufferer myself. I'm sorry if I offended you in any way. I am aware that it is possible to function with the type of pain that would bring an otherwise normal person to their knees, but you have to admit...although I was waaaay out of line
to say what I said, if she fell into your category of the functional migraineur, she never would have all of a sudden, fallen into "character". Or would she? Do people with migraines find themselves exagerating in order to make others believe their pain is genuine? How sad is THAT?

I find myself having to go the ER once every 4 months for an intractable migraine that gets so bad I can barely talk. At this point I've exhausted my arsenol of meds that include, Imitrex, lots of Naprosyn, Fiorinal and the daily propranalol. For this reason I ask not be given MORE Nsaids. Red flag? No, after 1500 mg to no avail, just a really upset stomach

I understand how easy it is to become judgemental towards others and I've only seen one who raised my eyebrow! God help me when I get into the trenches!



Catherine, you didn't offend me, I was just trying to make a point about people in pain. I don't know whether the woman you saw truly had pain or not, or why she was in the ER to begin with. I understand your frustration. I used to work for an insurance company and I reviewed claims before payment was made. I saw a lot of people go to the ER with "migraines" at 2 in the afternoon on a weekday. It's very difficult to determine if people really had a need to go, and most times I had to refuse payment due to it not being a "true emergency". You gotta love insurance companies! But that's one of the reasons our premiums are so high....between the Med Assistance people or the people with no insurance at all, someone's gonna be paying for it....and usually it's the people that work hard for a living. (Not to offend anyone, I've been on MA myself, but I worked my a$$ off to get off of it as soon as I could!)

Be prepared to see a lot of things that make you crazy when you're a nurse. Believe me, there are so many times I just want to scream at people but, not only will it get you in trouble, they don't listen anyway.

Good luck with all you do!

Jennifer

[hoopschick]

[quote]Originally posted by harry Krishna
[b]OK first off forgive me if my earlier posts seemed a bit smart alic.
And while it is not a law yet, we are under no obligation (yet) to relieve pain totally. This is what I was attempting to get at earlier, that if someone was truly in 10/10 pain and not someone who frequents the ER, chances are they would relish the chance to sleep. That's all I'm saying.

I've worked all over the country (over 25 E.R's) and it is RAPIDLY BECOMING a major crisis facing E.R.'s. You cannot fault your ER nurse to become jaded by the manipulators that all too frequent the ED's. If they choose to vent their frustrations on this board, that is their perogative. It doesn't make them a terrible nurse.
I also work w/ a local agency in a large metro area. I see the SAME Migraine patients (notice pleural) at 4 different ER's!!!!!!! Come on!!!! And it is all too ironic that they are allergic to NSAIDS, Compazine, tylenol, Phenergan, Talwain, Nubain, etc....
It is sad that these types of patients set a sterotype for the other patients who suffer w/ migraines and do not frequent the ER.
.Enough of my spewing.....

sleep is indeed possible when you are in excruciaitng pain, it's called exhaustion. pseudo addiction may be something you should look into, and while it's not law yet, physicians have been sued in civil courts and faced board sanctions for undertreating pain.
the other major thing you may be overlooking here is the fact that pain is not always caused by a physical etilogy, however it does manifest itself as such. as an oncology nurse who served on my hospital's pain committee and ethics board, a migraine sufferer for 31 years, and a recovering drug addict, i know A LOT about pain. the problem seems to be that people are suffering from something that causes them to seek drugs out in the first place, and no i don't feel that the E.R. is the place to fix it, but geezus h., where are they supposed to go? someone, sometime, somewhere, needs to sit down and ask what's really brought them here. I still believe that compassion is mandatory for nurses, if you don't like the job anymore, then maybe it's time to try something else?

proud to be a nurse where we have one of the highest per capita patient use of morphine

[Sarah Kat]

I don't really know much; I haven't even started nursing school yet. I do think that maybe people suffering from pain would probably tend to rank their pain lower than a drug seeker. Almost every person I know tends to "suck it up" when it comes to pain. My late mother-in-law was in pain from her liver and colon cancers for months before she finally explained just how much pain she truly was in. We knew she was experiencing pain, but she put on the brave face. Once she finally took that brave face off and went to the ER she was diagnosed with the cancers.

For instance, my periods are extremely painful, but because I think about how other pain might feel in comparison, I tend to rate the pain lower. I think well, it can't be over a 5 because it's just a painful period. Obviously someone with a worse condition would have a higher rating. Although to me, in reality, the pain feels more like an 8. Any thoughts on this?

[athomas91]

hoopschick - good post!!
i think most of us are just venting, but let's face it - the pt's (at least in the ed i work in) are always medicated for pain - even the ones we know probably have 20 rx at home......so although (i admit) i am very jaded - it doesn't affect my care of the pt -

[SmilingBluEyes]

hope I don't go to the OP's ER for migraine tx in the future. WOULD HATE TO BE accused as a faker.

I outwardly function fairly well with a LOT Of pain.......and by outward appearances I may not seem to have pain to you....but believe me, I do. I have worked with migraines so bad I vomited. I hate to do so but they can strike and there I am, sucking on o2 on the wall canula, hoping for relief. I can't just go home at 3:30 am., now can I?

I have worked with gall bladder pain so bad I could barely stand. But by outward appearances, I seem fine. I even ---gasp---eat. But trust me, the pain is 8/10 minimum. Thank Goodness I carry bentyl everwhere I go. Nothing showed up on u/s so no surgery for me. I will have to be caught in the act of passing a stone, I guess before anything definitive is done. OH well.

It's cultural for me. Being brought up by parents who imparted the strong desire NOT to bother others around me with things like body aches and pain....I am loathe to express any pain or discomfort around me. I try to be stoic. Does that sound like any patients you know? Sometimes I even laugh off pain to cope.

And I agree w/FAB4, sedation does NOT equal pain relief. It does not work that way. I have been so nearly obtunded yet remember severe pain post-op. But to the outward appearance, I am so "out of it" I must be ok??? My husband, not a nurse, saw me recovering from surgery, hardly able to respond yet moaning in pain, and recognized it for what it was. WHY do nurses NOT?

Hmmmm

seems a lot of us have a lot to learn about pain management.

I am worried I will run into nurses like these next time I dare step into an ER for pain tx.

[athomas91]

smilingblueeyes - no one here has left pain untreated - so i think your "fear" of running into one of us is kind of ridiculous - however
i will again repeat - most of the posts refer to pt's that we know very well....as in we see every day - and not the normal pt who seeks tx only when needed.

[harry Krishna]

Originally posted by athomas91
smilingblueeyes - no one here has left pain untreated - so i think your "fear" of running into one of us is kind of ridiculous - however
i will again repeat - most of the posts refer to pt's that we know very well....as in we see every day - and not the normal pt who seeks tx only when needed.

I whole heartedly agree w/ you A.T.
It seems the MORAL MINORITY that also post here like to twist others words or assume that just b/c you talk about a drug seeker, that it doesn't mean you don't medicate them or treat other patients who need pain meds the same as the seeker or without compassion. Gotta luv them though,,,,,,as if they are going to change my view on things. sounds like a cult... and they're recruiting!!!!!!!

[ktwlpn]

Originally posted by harry Krishna
I whole heartedly agree w/ you A.T.
It seems the MORAL MINORITY that also post here like to twist others words or assume that just b/c you talk about a drug seeker, that it doesn't mean you don't medicate them or treat other patients who need pain meds the same as the seeker or without compassion. Gotta luv them though,,,,,,as if they are going to change my view on things. sounds like a cult... and they're recruiting!!!!!!!

Good post-very true....Some of us will jump on the PC bandwagon and flame others for venting about a particular type of patient-often when it is something that hits close to home...Other times it is OK to vent away...ya just never know....Substance addiction-for me is a very challenging type of nursing and I have taken care of many that I call PITA patients of that nature...Drunks and druggies-incontinent and confused and pulling out lines,falling down and seizing....Awful shifts.....But my step dad whom I loved very much died of cirrhosis of the liver.He stopped drinking many years before he became part of my family but it got him in the end.I had to see the frustration and impatience on some nurse's faces when they dealt with the challenges of his care-just like I am sure had been seen on mine in the past.....That's why boards like this are so great-we can b*tch all we want to here and that will give us the strength to face our challenges head on....

[LisaRN2B]

Originally posted by harry Krishna
I whole heartedly agree w/ you A.T.
It seems the MORAL MINORITY that also post here like to twist others words or assume that just b/c you talk about a drug seeker, that it doesn't mean you don't medicate them or treat other patients who need pain meds the same as the seeker or without compassion. Gotta luv them though,,,,,,as if they are going to change my view on things. sounds like a cult... and they're recruiting!!!!!!!

or...as if you are going to change anyone else's opinions...cult? harry Krishna? Sorry, just got a kick outta that!