Is current thinking on pain control creating drug addicts? - page 4

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   tddowney
    I've got my two pennies in hand, so I'm ready to jump in.

    As a nursing student, though an older one with personal experience in chronic substance abuse (etoh in my case), I've obviously not dealt with nearly as many cases as most here, so I'll just make a couple observations and ask a couple questions.

    When assessing a Pt's self-reported pain, how does one view vague answers to the usual assessment questions, especially when the Pt reports high levels, 8-10, of pain? What about the absence of any physical or emotional manifestations of pain, or abrupt changes of affect and/or behavior when the subject of pain is brought up?


    We live in a time when substantial monetary damages are awarded because, for instance, a railroad didn't do enough to keep some teens from climbing over a fence and getting badly injured by a train. Do you really think it will be long before lawsuits are brought against prescribers when a kid dies from a parents Rx pain meds?

    Are we overly discounting the amount of harm addiction does not only to the addict, but his/her family? We often say we should err on the side of giving addicts drugs rather than denying them to a chronic pain sufferer, but on what measures of harm are we basing this judgement?

    It seems to me that a Pt in pain would be interested in every method of easing that pain. If you have a Pt who is is not interested in learing non-pharma pain control techniques, should that be a caution flag? (Obviously here the Pt has to have the pain controlled well enough to be receptive to teaching.)
  2. by   ginger58
    Quote from 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.
    Oh please! Not only has wine been around for years but so have poppies and other plants.

    I hope you're only referring to coping with life when you compare wine to a pain pill.:spin:
  3. by   GardenDove
    Quote from ginger58
    Oh please! Not only has wine been around for years but so have poppies and other plants.

    I hope you're only referring to coping with life when you compare wine to a pain pill.:spin:

    I don't quite get your sarcastic response. I think I bring up a valid point. Humans have been altering their conciousness for thousands of years. Why are some ways stigmatized and others not?

    I hold the view that Modern Medicine is much like a religious system, with doctors being the priests, and medical boards the Magisterium, run by Doctors of the Church of Medicine. In order to alter one's conciousness, one must have the blessing of a priest, who follows the legal system set up by the High Priests, Bishops, Cardinals, etc.
  4. by   ginger58
    Quote from lizz
    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 ...:typing
    If you can muster up the courage to talk to some one in authority please do. An ex-instructor or whoever. If she kills someone you're going to feel really bad and you wouldn't want to feel like an accessory to murder--over dramatic I know. Hopefully the facility she hires in at will do a drug screen.:Santa2:

    Maybe your friend will get the help she needs. I don't think it's the system I think it's the individual doctor and her "friends" giving her meds.:Santa1:
  5. by   leslie :-D
    Quote from 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.
    when people drink or take drugs, to allay psychological pain, then that is the makings of an addict.
    people who take drugs to genuinely abate physical pain, will not become addicted.
    they may build a tolerance but in order to become a full-fledged addict, there has to be a psychological dependence and benefit.
    so if someone is drinking to dull the (mental) pain, then there would be no difference in someone else taking a pill to do the same.
    but people drink for many reasons-not all become alcoholics.
    not all prescription drug users become addicts.

    leslie
  6. by   EthnicBeauty
    I have to say that I think if someone is in pain then they should get the necessary meds to relieve their pain. If someone is an addict then it will come out into the open at some point, no reason to make those in real pain suffer.

    I have a serious problem in my neck, I've been told it's a herniated disc. It hurts like h*ll. When I had an X-ray (b/c that's all he would give me) the lady who did it said it was no wonder why I was in so much pain and she thought the doctor would send me to get an MRI. When I saw the doctor he said "There's nothing wrong with your neck, you should go for physical therapy''. Now if there was nothing wrong with my neck I wouldn't need PT, right? All he would give me was prescription IB profen. I have taken up to two 800mg pills and it didn't even touch the pain I was feeling. I even told the doctor that vicodin was the only thing that worked for me and he just shrugged his shoulders. The pain has been so bad that I've cried myself to sleep after laying there for hours because I can't fall asleep the pain is unbearable. So yes, I believe patients should be believed when they say they are in pain!
  7. by   PANurseRN1
    I suppose your doctor would rather you develop an ulcer from NSAID overuse.

    Sorry you have such an uncaring PCP.
  8. by   ginger58
    Quote from EthnicBeauty
    I have a serious problem in my neck, I've been told it's a herniated disc. It hurts like h*ll. When I saw the doctor he said "There's nothing wrong with your neck, you should go for physical therapy''. I even told the doctor that vicodin was the only thing that worked for me and he just shrugged his shoulders. The pain has been so bad that I've cried myself to sleep after laying there for hours because I can't fall asleep the pain is unbearable.
    I am so sorry that this has happened to you. I had a disk herniated in the lumbar spine and that was painful. Norco/Vicodan didn't work and I sat home crying--here I am a palliative nurse and take care of my patients' pain and I can't get what I need for my pain.
    I had a pt. that was admitted with the same and given morphine which did work for her. If this happens to me again I'm going to get what I need legally!
    These docs needs to experience these problems, suffer a little, and then be only offered an OTC drug for their pain!
  9. by   ginger58
    Quote from GardenDove
    I don't quite get your sarcastic response. I think I bring up a valid point. Humans have been altering their conciousness for thousands of years. Why are some ways stigmatized and others not?
    I hold the view that Modern Medicine is much like a religious system, with doctors being the priests ... In order to alter one's conciousness, one must have the blessing of a priest...
    If I sound sarcastic I think it's more worry. We're now off the subject of people really needing pain medicine and those worrying about addiction. I worry that your patients won't get what they need for their pain. Especially the "riff raff" you mentioned.

    People don't have to go to the "Church of Medicine" to alter their consciousness. Get some dope, alcohol, glue, etc. I thought we were discussing those in need not getting what they need because some health professional is worried about the person becoming addicted and those professionals that are loose with their prescriptions.
  10. by   grandee3
    I think I failed to mention that I work in an LTAC, our length of stay can be anywhere from 10 days to 45 days. We get a lot of 30 something's who have old injuries from either work related or sometimes from their long addiction to pain meds, ie falls, broken bones etc.
    They come to us a few days post op or post hospital for long term care. I know these pts can still experience some severe pain, but when they are c/o nausea and eating fried chicken at the same time and want a push of Phenegan, I have a problem with that. And then, they want the med pushed real fast and not diluted, to me that's a problem.
    When I said they can go out to smoke, I am referring to a pt we had who took her Dem?phen push then went outside with her cig and was fould asleep in her wheelchair with a lit cig burning her gown! What would have happened it the pt was injured by setting herself on fire because she was medicated? What happens to that nurse in court? Does her license survive? Please, advise.
  11. by   teeituptom
    The current treatments out there highly designed at creating and turning people into drug addicts.
    Vicodin used to come in 2.5 mg tabs and 5 mg tabs. only a long time ago. Then increased it to 7.5 mgs, then to 10 mg tablets. They are now researching the feasibility of a 20 mg tablet.
    We have turned drug addiction into a socially acceptable form of behaviour.
  12. by   SK-222
    Being a chronic pain sufferer, this thread unfortunately hits home.

    Unfortunately, I almost suffered my own recent death and eye-opening experience as the result of undertreatment. Full story at the link: Pain Relief Network Blog Archive Jessica’s Story

    Reasons the DEA is evil:
    Since the spinal injury (multiple fractured vertebrae) in 2001, I've suffered from chronic back pain. I'm miserable not being active and pushing the limits on a regular basis, but at the same time I need prescription medication just to get by, especially with my harshly severe pain. It sucks. I'm lucky to have an excellent doctor, but as with most physicians, there is an EVIL entity known as the DEA who threatens them and also ensures legit pain sufferers continue to suffer. Because of a small percentage of people who abuse/misuse prescription meds, the DEA (drug enforcement agency) threatens doctors, prescribing licenses, etc. In my opinion, the penalties should be harsher for not treating pain than accidentally giving meds to someone who will abuse them. Much like the rest of our fouled up healthcare system in the US, the DEA is nothing more than a huge flaw and joke. When it comes to voting on passing laws and such, if there is ever a senator or otherwise who is all for dismantling or striking down the DEA, they will certainly get my vote.
    Another example many can relate to where the DEA has continued to screw up: There are idiot methamphetamine makers and users. They forgot there are people who suffer from chronic nasal allergies, eye irritation, etc., but once again, they sided with the druggies, making over-the-counter meds (such as Sudafed, etc that contains some key ingredient in making meth) making the OTC meds harder to get. Sure, the restrictions might make a black market for the druggies, but that also means the rest of us who are legit and occasionally took the tablet of our choice, get to jump through stupid hoops to get what works. Tylenol is more "dangerous" and can cause liver failure if taken too much at once, yet that's freely available. Benadryl allergy is something I used to take which was good for my sinuses. Just recently the formula changed and it's no longer effective. The DEA is good at constantly revealing their own flaws. Bottom line: the DEA DESTROYS LIVES.
    Physical pain can be deadly...
    The DEA and other related medical organizations have failed in countless ways. Putting this in layman's terms so all reading can understand; in my back I have discs that are herniated up through the bone, making sitting for long periods of time painful. Getting through a day at work often means I need to take meds to get by. As I type this, I've needed nothing for a couple of days; I'm doing good at the moment. Pain (at least for me) is a cycle with good and bad days. If I don't need anything, I don't take it. I have no problem cold-turkeying prescription narcotic pain meds when I have no pain, and I have NO withdrawal symptoms, etc., there's not a psychological addiction problem by any means. No different than taking allergy medicines that [sarcastic] my favorite agency [/sarcastic] has badly regulated.
    Unfortunately, because prescriptions are limited on how much can be taken and doctors can only comfortably prescribe so much without the DEA destroying them (the physicians), and the lives of their patients. So many times I've had to resort to taking Aleve, Tylenol and other over the counter poisons in such high quantities, but in some ways I am amazed I am not dead yet. It's no secret the U.S. Health"care" system is in a state of imminent collapse. There was a period of time where I was unemployed, essentially homeless (surviving by staying with my ex-inlaws) and in tears daily while doing a physical job just to make some money. Though I had health insurance at the time of my accident, this kept me from working for some time, so I lost it, and subsequently had no health insurance, no doctor, no medicine, so I was taking 20+ tablets of Tylenol through the day and Ibuprofen and/or Aleve just to function, keep moving, etc. That was also less than a year after the spinal injury. At one point when I did go to a poor persons clinic with what little cash I had, I was given Celebrex and Ultram (tramadol). All I can say, is that's like saying "gee doc, thanks for not believing me." A major insult!! High priced designer drugs that are only minimally and/or not as effective and quadruple the price are another obvious example of drug manufacturing companies wasting money and resources, making healthcare less affordable.
    Countless times I have had to take an excess of Tylenol and anti-inflammatory medications (Ibuprofen, Aleve, etc). Now I'm fortunate to have insurance, a good job, etc., but am limited on the number of prescription pain pills in a given day. I never exceed a prescription; as I don't ever want to put a physician's butt on the line, so never take more than what I'm allowed. They work hard to get the letters " M.D." after their name, plus, there are too many repercussions if a person is abusing the Rx meds. It's not worth the risk of losing a good physician who also fears the DEA.
    All too often I question the sanity of bothering with saving for retirement, etc., because I honestly don't think I'll live that long. Having nearly died once from liver failure secondary to Tylenol poisoning (had no doc or prescription meds, but had to work to live and eat), and now again from similar causes of being undertreated. I certainly do NOT blame my doctor for my recent near-death experience. The DEA is to blame, and if I should ever die because of a lack of medication, my will would be for a pit-bull attorney to sue the DEA and give the money awarded to my loved ones.
    A explanitory paragraph:
    As to the details of my recent near-death experience; I will not post exactly what I took, as the herbs (legal kind, obtained at healthfood store) are easily obtainable, I would never want to assist in a suicide. All things internet, certain things are not meant to be public. I have disclosed exactly what I took/mixed with my doctor; and since waking up in ICU on ventilator with family by my side worrying I'd be brain dead *if* I ever woke up because they didn't know how long I had been down without oxygen, I'm now afraid of taking just about any and everything unless it is under my doctors direction.
    Details/My personal near death experience story:
    It was Tuesday, October 24th, 2006; pretty much a normal week. Life had been going good and I'd been a happy person, so no depressing issues were going on. That day, however, was exceptionally bad. From the time I woke up that morning, I had taken a total of three "vicodin"(hydrocodone) from morning until evening when arriving home from work. Never exceeding 3 tablets, but that accounts for the opiates showing up in low quantity on my toxicology test. I took Aleve throughout the day in the usual excess quantity (have had none since leaving the hospital). Had done stretches, took multiple breaks, laying on the floor trying to stretch out my back, etc., using "Ben Gay" muscle rub cream, ice, any and everything to get relief. Even though the ER (emergency room) is right across the street, there would never be a point going there; they're notorious for both undertreating and not treating pain. They simply label any person with a pain problem as a drug seeker, and act accordingly. But then they expect the person to pay an overpriced bill, often for services not even rendered - of course, that much is an issue on it's own. I'd better be bleeding to death or unconscious to consider going to the ER, and even then I might fight a person about going if I can.
    So back to that fateful day: I had gone home and still in excruciating pain. I probably resembled the hunchback of Notre-Dame trying to move around. I took an Ambien tablet as per my normal bedtime routine (and yes, only *1* tablet). About one hour later, it was not working and I was in too much pain to sleep. It was at this point I created an accidental death-cocktail consisting of herbs and OTC meds. At that time though, I didn't care if I lived or died due to the amount of physical pain I was in, my actual intention was that by playing pharmacist with just legal stuff, I'd knock myself out and sleep good until noonish or so the next morning. The longer I stay horizontal (laying down) the better the back feels. Needless to say, when I woke up the next day with a breathing tube down my throat in the ICU(intensive care unit), the first question I scribbled down on a piece of paper was "What happened?". I was a bit confused not waking up in my own bed. After an auto accident (before the spinal injury sustained while snowboarding), I woke up in an ICU on a machine breathing for me, so this was a situation I remembered. This time though, because the day/night before were not anticipated to turn out this way, I was wondering if I had been in another auto accident or something and was not entirely sure what was going on.
    The Frightening Saga of 10/25/06:
    Luckily I don't remember that morning/day, but as it has been relayed to me: At about. 7 a.m. I was found completely unconscious on the bathroom floor. Toilet lid was up with my business unflushed - very uncharacteristic for me. Pants apparently were pulled up. It appears I had finished my business, pulled the sweatpants up, and it appears I passed out before turning around to flush, close the lid, etc. I'm told my bed was barely touched and obviously not slept in. They say me and the floor were covered in puke. No vomit in the toilet, so I'm guessing my body may have vomited/rejected things after my lights were out. I'm told I was called by my name and that I looked up then closed my eyes again, but that obviously "no one was home". 911 was called. Onlookers tell me they intubated me right on the hall floor by the bathroom and started bagging(term used on manual breathing for a patient). They were told I had a weak pulse but not breathing. I suspect one or two things; I had been breathing throughout the night, shallowly and respiration just wasn't barely detectable and/or God is obviously not done with me and sent me one heck of a wake up call with this one!
    My mother and aunt knowing all this drove to the hospital. What understandably frightened my mother was that shortly after her arrival, the chaplain went to talk to her in a private room, telling her that they didn't know if I would be brain damaged or ever come back to consciousness, be normal, etc. In reviewing my chart upon my waking up, I see they had used narcan amongst other meds, but since this was NOT an opioid reaction and no one knew what I took at the time, it did not bring me to consciousness. The reversal drugs/meds are known as "antagonists" but I know exactly why what they gave didn't work, and since all this took place and confiding in my doctor what was in my system, pieces of the puzzle were coming together for those who care so much about me.
    To make this all too true story even more over the top; it was the boss who became the primary doctor looking after me, also not knowing anything. For those reading this and aren't aware, I work as the second hand for a group of doctors on a regular basis and we have a fairly close personal friendship and know one another very well. My primary physician is out of the area, as it would not been kosher and more or less in poor taste for my bosses to be prescribing narcotic medicines for me. We're all close, but also keep things appropriate, professional, etc., even when snowboarding, wakeboarding and playing outside of the office. Puzzling to them was the fact they also knew I had not been depressed or exhibiting signs of despondence, etc. I care very much for them, and I know the reverse can be said. On with my personal story....
    Wednesday afternoon (10/25) about 3 p.m. I had regained consciousness. Apparently during the night I had aspirated emesis. (layman phrase: inhaled puke into my lungs) Aspirate your own emesis and you'll earn a breathing tube and an E ticket to the most creepy sensation in the world; getting junk suctioned out of your lungs through a breathing tube has got to be among the worst freaky sensations I can think of. Extubation wasn't all too pleasant a feeling, but a relief at the same time. I couldn't really vocalize well immediately after. Two weeks or so after the incident, I STILL had a sore throat and was somewhat hoarse. At first was coughing up blood clots and such, so apparently it was a rather traumatic intubation (endotracheal intubation: term means breathing tube shoved down throat). Also, when I came to in ICU, I was somewhat sad when I found out my favorite sweatshirt had been cut to shreds by paramedics, but all considered, I have nothing to complain about.
    Reflection:
    Most bothersome to me; I NEVER intended to hurt or scare anyone, myself included. It's a shame that my physical pain yo-yo'ed so out of control that any of this took place. Thanks to the DEA my medical insurance company is shelling out some big bucks after this one. I'm done "playing pharmacist". At this point, I confided in my doctors (bosses and regular physician) on exact details (again, no need for details and suicide seekers on the net getting hold of this info) and on the road to more definitive treatment. I have a referral and pending appointment with a pain specialist in the area to see if perhaps localized pain injections or other reasonable medicinal methods might be more appropriate. Also for myself, I am seeking counseling, as I don't ever want to get to a point pain-wise that I'm in such a crisis that I think death is the only answer. So many flaws in the healthcare system though. How could anyone afford the aftermath of my recent issues and go on to heal? Shutting down and/or decreasing the power of the DEA would sure be a good start.
    Of note, I've shared this with my PCP and we're working on getting in with a pain specialist, etc. The most unfortunate thing; there is no way I would have gone to the local ER that frightening night when at the end of my rope from pain, as they probably would have simply labeled me as a "drug seeker" and done nothing more than send me a bill but have done nothing to treat the problem.
  13. by   leslie :-D
    such an incredibly disturbing story, jessica.
    my ears were going nuts, hearing all the rings of truth you so articulately expressed.
    md's prescribing habits are mind-boggling, arent' they?
    they refuse to help those who truly need it yet can't write enough for those who are addicted.
    both situations suggest the ubiquitous threat of the malingering dea.
    so pain remains undertreated and so desperate that sufferers resort to their own creative devices; or in the absence of any plausible solution, suffering continues.
    i wish all who are victims of chronic pain, would empower themselves by learning the legalese for abandonment, neglect and undertreatment.
    then become so enraged at the audacity of the naysayers and all others who judge.

    i'm pleased that after all you've been through, you're finally being referred to a pain specialist.
    peace be with you jessica.
    i'm glad you shared your story.

    leslie

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