Is current thinking on pain control creating drug addicts? - page 3

The current approach to pain control has been to believe the pt's self report of pain no matter what. Is this creating drug dependency, and or addiction, in emotionallly susceptible people? Should we... Read More

  1. by   ginger58
    Quote from GardenDove
    The current approach to pain control has been to believe the pt's self report of pain no matter what. Is this creating drug dependency, and or addiction, in emotionallly susceptible people? Should we be concerned? Any thoughts?
    My thought GardenDove is how you feel about the human population and pain. I am a palliative RN and have done a lot of reading, classes and clinical time dealing with the people you're talking about.

    The last statistic I've read is 0.01% of people who truly need pain meds become addicts. An addict will seek drugs illegally, commit crimes to get meds. I've not seen an inpatient with these behaviors.

    As far as the nurse you spoke of running a pain clinic, she indeed may have a lot of pain. That doesn't mean she's there handing out meds by the fistfulls! There was just an article out in one of our California nursing magazines about a whole bunch of nurses working with chronic pain all over the country. They were grateful for the article being written. The only way they can work is to take opioids. They're tired of living in fear of being misjudged, called addicts, fired, etc. Therefore they live in silence.

    Yes, you need to listen to what a patient tells you. It's not up to you to judge what their pain is. Pain is physical, emotional, whatever. Just because a pt. talks on the phone, laughs, sleeps doesn't mean that they're NOT in pain.

    I agree with you that there are docs that are soft in dosing meds in their practices and have this reputation. I don't think this is right either but someday they'll get caught.

    As far as kids ODing on Fentanyl or whatever, parents need to get their drugs locked up or disposed of. Parents need to be accountable for their dangerous meds.

    I really hope that in 2007 nurses can rid themselves of their prejudices about people in pain. I know it's difficult, and I understand the "pain seeking" mentality and the all the rest, but unfortunately humanity has pain and they count on us to relieve it.:angel2: :angel2:
    Last edit by ginger58 on Dec 24, '06 : Reason: forgot the NOT
  2. by   kk2000
    I know I am not addressing the OP's actual question, but...
    I really think it is important to note that people in pain can laugh, joke, eat, etc etc. This is not a very accurate indicator of whether someone is in pain.
    I work, laugh, joke, eat, smoke etc. . I am in severe pain every single day, and most times no one would ever tell by my demeanor.
    That being said, it is a TERRIBLE experience to be in pain and not be believed. After several bad experiences, I will probably never go the ER again unless I am passed out or near death.
    IMHo, better to medicate a few addicts than not medicate a true sufferer. I have been there.
  3. by   annmariern
    For me anyway, in the last 20 years, the swing has been dramatic; I remember a pt screaming in agony from Bowel CA, and nothing helped; the doc that night pumped morphine into her and nothing helped; he was the exception. I have fought with docs for alternate narcs for terminal pts many times and argued about silly doses. I have also been pushing massive doses of narcs to people with pain level ten, yapping gossip on the cell, eating, and having perfectly normal vs. Sickle cell being the main diagnosis. I have had them complain about nausea while eating cheeseburgers and demanding phenergan push, which we don't do. We piggyback. But then theres an instant trip to the bathroom and whoosh, piggyback gone. Personally my pain tolerance seems to be pretty high, doesn't mean I don't feel it, just can tolerate some. It seems that the latest trend is no pain at all. It is just not possible, not without killing you or puting you in a coma. I tjhink we are in the mddle of a quandry. Do we just dope everyone up and hope narcans handy or is the public perception out of wack? You know, CPR always works, it does on TV. And people don't die unless someone screws up. And there should be no pain ever? I think this isn't an exclusively a nursing issue, were just in the trenches. Its a social issue.
  4. by   clemmm78
    Quote from kk2000
    I know I am not addressing the OP's actual question, but...
    I really think it is important to note that people in pain can laugh, joke, eat, etc etc. This is not a very accurate indicator of whether someone is in pain.
    I work, laugh, joke, eat, smoke etc. . I am in severe pain every single day, and most times no one would ever tell by my demeanor.
    That being said, it is a TERRIBLE experience to be in pain and not be believed. After several bad experiences, I will probably never go the ER again unless I am passed out or near death.
    IMHo, better to medicate a few addicts than not medicate a true sufferer. I have been there.
    I have to echo this. My migraines are excrutiating, but because they don't (usually) include nausea, I continue to function. At the point that they're the worst, I wouldn't think that pain can ever be worse than what I have at that time yet it's highly doubtful that anyone could guess how much agony I'm in by my actions. I've learned that well how to hide it. Add to that other types of pain I suffer and if I acted as if I was in pain, I wouldn't be able to move or get anything done.

    Don't judge a person's pain by how they are acting - just because you (the general you, not someone specific) would not be able to laugh or talk on the phone, doesn't mean someone with chronic pain can't.
  5. by   Sheri257
    I have a friend who just graduated with me from RN school. She has had terrible migraines but, now, I'm convinced the meds she's been taking has also made her a drug addict.

    To me, the telltale sign was when she started asking friends for unprescribed meds, even though she's got scripts for at least four meds she's taking now. She now seems to need meds for everything ... going to sleep, anxiety ... you name it.

    Of course, all of this is very dangerous as an RN ... especially taking meds you don't have a prescription for, which she does on a routine basis. I won't be surprized in the slightest if she gets busted on a drug charge once she gets access to a Pixis without supervision.

    All of this started with her migraines and, from what I can see, it's only gotten worse. So, it has made me question the system.

    :typing
    Last edit by Sheri257 on Dec 24, '06
  6. by   West_Coast_Ken
    Quote from Suesquatch
    All drug laws do is create crime.
    So very true.
  7. by   911fltrn
    Now dont quote me on this but i recently did a ceu on a nursing website.

    It stated that less than one percent of people who use prescribed narcotics will become addicted.


    Also im with tweety, i would rather be addicted to a pain killer than to live with chronic pain. If you have ever had chronic pain im sure you would agree.

    Merry Christmas from the E.R.
  8. by   weirdRN
    To address the question directly, No, I do not beleive that the current thinking on pain control is creating drug addicts.

    I have several residents who state a pain level of 8-9 every time I ask. One has had an amputation and the other has diabetic neuropathy. One says his feet are burning. The other says that her entire left side is pulsing in burning white hot waves of pain. Even if I just gave them their meds not even half an hour before. I have addressed the issue with their PMD, and the PMDs say that there is nothing beyond what they currently have perscribed unless we give them Morphine IM continously.

    I am interested in branching out into possibly two areas of Nursing. Wound and Ostomy Care, and Pain Management, and maybe Hospice. I am always searching for new information to help the population that I serve. So far for these two residents, I am woefully at a loss to help their pain.
  9. by   Sheri257
    Quote from 911fltrn
    It stated that less than one percent of people who use prescribed narcotics will become addicted.
    I've read this statistic also but, I've never actually seen the specifics of what they were talking about. Did they track cases of pain after surgery, for example? Or did they track cases of chronic pain over a much longer period of time?

    Because my friend's addiction occurred gradually over a very long period of time. I seriously doubt there's much accurate data on those cases.

    :typing
  10. by   clemmm78
    Quote from lizz
    I've read this statistic also but, I've never actually seen the specifics of what they were talking about. Did they track cases of pain after surgery, for example? Or did they track cases of chronic pain over a much longer period of time?

    Because my friend's addiction occurred gradually over a very long period of time. I seriously doubt there's much accurate data on those cases.

    :typing

    But you can't say that the meds for the migraines caused the addiction. She may have had an addictive personality anyway and would have gotten addicted to something else.

    There's no way of ever proving that X person taking Y drug got addicted to Y because he or she could just have easily gotten addicted to Z if given the opportunity.

    Rules like not giving adequate pain relief for fear of developing an addict don't prevent addictions. These people who were leaning toward that anyway will find something to be addicted to.
    Last edit by clemmm78 on Dec 24, '06 : Reason: spelling
  11. by   dream'n
    Unfortunately, I think the treatment of a patient's pain has more to do with the attending Drs. MO than the patient's symptoms. Some physicians I have worked with are very liberal with the pain medication, and some won't prescribe them in about every circumstance. I remember once when I got a large burn to the palm of my hand. I headed to a local UC (my hand in a pan of water the whole time, as it hurt like heck every time I took it out of the water) and the Dr. there took a quick peek and sent in his MA to put silvadene on and wrap it. When she began to wrap it, I told her I couldn't handle the pain when it was out of the water. She left and talked with the Dr., who according to her said, "it will quit hurting in a few hours, either let us dress it or leave." I then told her that I understood the reason for the dressing, but it really hurt, could he give me something, just ONE or TWO pain pills to last until it quit hurting in the AM? The Dr. refused to give me ONE pain pill! I left and cried all evening and night, until it eventually stopped hurting. Not only was I in pain, I felt angry and judged. Did he think I went from UC to UC asking for ONE pain pill, until I had amassed a whole bottle!? And then to keep up my addiction, go do it over again every couple of days? I mean really.....On the other side of the issue, a Dr. I have personally worked with almost without fail would always prescribe them. I have had to really get his attention (which isn't very easy) when things aren't 'above-board' and he continued to o.k. controlled scripts. We once had a fellow continuously wanting early refills of Ambien 10mg (I know it's not for pain, but it is addictive.) Come to find out, he admitted to taking THREE of them a night, along with other sordid and sundry controlled substances. We sent him to a specialist that switched him to Lunesta 3mg. Then the fellow wanted an early refill again of the Lunesta. Why? Because, again he had been taking THREE a night, only this time with the Lunesta. Dr. was informed and OKAYED the refill! I had to reapproach him, make him sit down and LISTEN, before he got it and denied the early refill. Sorry I've been rambling.
    Last edit by dream'n on Dec 24, '06
  12. by   Sheri257
    Quote from clemmm78
    But you can't say that the meds for the migraines caused the addiction. She may have had an addictive personality anyway and would have gotten addicted to something else.

    There's no way of ever proving that X person taking Y drug got addicted to Y because he or she could just have easily gotten addicted to Z if given the opportunity.

    Rules like not giving adequate pain relief for fear of developing an addict don't prevent addictions. These people who were leaning toward that anyway will find something to be addicted to.
    I see your point here ... maybe she has a addictive personality anyway.

    But, by the same token ... if the drugs weren't so readily available to her legally, would she be still have become an addict? Would she, for example, start cruizing street corners for drugs instead?

    Obviously I don't know for sure but ... it seems like the pattern here was: she needed more and more drugs for the migraines, then she couldn't sleep and needed something for that, then she had anxiety and needed something for that ...

    Then she starts asking friends for pills without a script ... in a profession where this kind of thing can ruin your career.

    I dunno ... I'm just wondering if she would have gone down this path if she didn't have such ready access to the drugs in the first place.

    :typing
  13. by   GardenDove
    People do use drugs to cope with life. I wonder what the difference between drinking a couple of glasses of wine is and taking a pain pill? Really, what's the difference, other than that wine has been a part of our diets for thousands of years.

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