Is current thinking on pain control creating drug addicts?

Nurses General Nursing

Published

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? Is there going to be a backlash to what has been a more liberal policy towards pain relief in the past 20 years.

I bring this up for a few reasons. For one thing, our hospital let go one well liked doctor, the reason we heard being that she was catering to the drug-seeking community with too many prescriptions. We were all aware of her liberal attitude on this and that she was a soft touch in that dept, but when she was apparently suddenly fired, it was a shock.

The hospital clinic does happen to attract more of the misfit population btw. It's a small town, and there aren't too many docs that take new pts. The clinic tends to get more of the riff raff, if you'll pardon me using that term.

Then, our weekend hospitalist got paranoid. He actually told a nurse who called him for pain meds that he didn't want to be fired like Dr So and So was. I also noticed that he was being reluctent to give narcotic orders when I called him.

I was reading the new ANA magazine an article titled Improving Pain Management. It takes the approach of believe the pt no matter what, don't allow people to be in pain. One thing the article condemns is the use of placebos.

I haven't seen placebos used myself, but I personally think they might have a place with a certain type of pt. The reality of the situation is that there ARE drug seekers who are good at manipulating the system. Any nurse who doesn't see that in some people must have his/her blinders on, in my opinion.

So, how do we address that reality without punishing the many people who truly are in pain? Sometimes I think the whole pain control industry is a self-perpetuating machine, and a classic case of the fox minding the henhouse. On the other hand, I wouldn't want to go back to the old days when pts were expected to grin and bear it for fear they'd all end up druggies.

Any thoughts?

Specializes in Family Nurse Practitioner.
This is what i've seen in only 2 years of nursing aften having worked in over 7 facilities.

Thats a lot of jobs and it makes me sad to think that all of those facilities are like you describe. I would have perhaps naiively thought that this is the exception rather than the rule. No easy answers I guess.

Specializes in Day Surgery/Infusion/ED.

At seven + jobs in two years, that would mean someone would be at a facility an average of no longer than four months at a time. Not a lot of time to really have an accurate grasp of how a hospital functions, particularly as a new(er) nurse.

As to the topic at hand, I restate that I would rather err on the side of medicating someone who is a "seeker" than allow someone to be in pain.

Specializes in Palliative Care, NICU/NNP.
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.

Specializes in Home Health, Hospice.

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.

Specializes in vascular, med surg, home health , rehab,.

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.

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.

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

Specializes in Case Manager, Home Health.
All drug laws do is create crime.

So very true.

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.

Specializes in Long Term Care.

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.

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

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.

+ Add a Comment