Is current thinking on pain control creating drug addicts? - page 5

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   SaharaOnyxRN
    Quote from GardenDove
    Sahara,
    Yes, you describe perfectly the dark side to our current approach, and it's cost to the healthcare system. These types of people are also a drain on our Emergency Depts. I think part of the problem is fear of litigation.
    I think that's what it is, too. I think doctors are fearing litigation so much, that they prescribe, prescribe, prescribe. It's sad that it's come to this, and it's not going to get any better, I fear.
  2. by   SaharaOnyxRN
    Quote from Jules A
    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.
    I wish that it was the exception. I love my new job because I work with renal patients and they are wonderful. We don't get many drug-seekers because we don't get what you would call a "medical" patient. And these patients are truly sick, yet, they don't complain and call for pain medicine every 30 minutes. Like someone said earlier, I also, have seen so many young, otherwise, healthy people that are going to smoke every 2 minutes and walking all over the hospital and watching the clock so they can see when they can get their next fix. And I know that they are there for that reason, because they'll say something like: "Make that shot good and strong" in other words telling me not to dilute it. Or they'll say, "Push it fast, I don't feel anything when you push it". I guess because I push it slow and carefully. This is all too common. And these types of patients will work you to death and keep you away from the patients that are much more acutely ill. I tell you, I am beginning to get a bad taste in my mouth from it all.
  3. by   grandee3
    Jessica, my heart goes out to you. Please keep us posted on your progress. Like I said earlier, the docs give the seekers all they need and then some and the poor post CABG gets Tylenol.
    I think you are right on the money as to this horrible problem. Please remain an avecate for those who suffer in slience. Well wishes ane hugs to you.
    Last edit by grandee3 on Dec 26, '06 : Reason: my keys are sticking
  4. by   LouRN92
    I haven't read every single post on this site but here is my take on pain control from my ER experience in a small rural town. Many of our patients can't afford to see their PCP because they have no insurance, they often end up in the ER for their pain needs. Some of them are abusers of meds and have specific pain control contracts with their PCP's that allow them to have specified amounts of the needed meds in a certain time period.

    That said they will Dr shop, counting on the fact that we have many different doctors each weekend in the ER who might not look up their chart and find the contract or who might be willing to give them meds.

    One patient this weekend ran out of his Norco and ended up showing up 3 times in a 30 hour period. I was there 2 of the 3 times. I was very sympathetic, non judgemental and charted his pain level and complaint. The doctor gave him Flexiril, then Toradol and finally the last visit I gave him IM Dilaudid and Phenergan.
    The Dr told him he really needed to get the issue sorted out with his PCP. Will he? probably not, he can't really afford to. And he admitted that he is more or less addicted.
    That said, I do think that nurses are so much better about providing pain relief in general to all patients. Our state requires that we take a pain control course to renew our license. I feel that in our hospital most post op patients, trauma patients, dying patients, and ER patients get compassionate care and good pain control/relief.

    Obviously this is a complex issue.
  5. by   Sheri257
    Quote from SaharaOnyxRN
    And these patients are truly sick, yet, they don't complain and call for pain medicine every 30 minutes. Like someone said earlier, I also, have seen so many young, otherwise, healthy people that are going to smoke every 2 minutes and walking all over the hospital and watching the clock so they can see when they can get their next fix. And I know that they are there for that reason, because they'll say something like: "Make that shot good and strong" in other words telling me not to dilute it. Or they'll say, "Push it fast, I don't feel anything when you push it". I guess because I push it slow and carefully. This is all too common. And these types of patients will work you to death and keep you away from the patients that are much more acutely ill. I tell you, I am beginning to get a bad taste in my mouth from it all.
    I've had the exact same experience. This one woman would always lie and try to trick me into giving her more drugs. She'd say night shift didn't give her anything when, in fact, they did 30 minutes ago. She literally took all of my time ... constantly riding the call lights for meds I couldn't give any sooner than what was prescribed. No matter how many times I explained it to her ... she would keep riding the call light.

    Very frustrating to say the least ... because they do work you to death and take you away from other patients.

    It's funny because I just had knee surgery this morning and one of the MD's was really surprized when I told her that I haven't been taking any pain meds for my knee injury, which I've had for months now. I got scripts for pain meds but never filled them.

    When she asked why, I said I'm a recent nursing school grad and, I just didn't want to take pain meds unless I felt really needed them ... being in the healthcare field and all. I guess I'm just paranoid because of what happened to my friend and, ice really helped with the pain anyway.

    She said that was good because if I do need them I won't have the tolerance that other patients have and the meds should work well. I've got a bottle of Vicodin and, maybe I'm crazy but, my leg just doesn't feel that bad. The ice machine seems to be doing the trick.

    So I'm not going to take the pain meds, at least for now.

    :typing
    Last edit by Sheri257 on Dec 26, '06
  6. by   tddowney
    Quote from lizz
    I've got a bottle of Vicodin and, maybe I'm crazy but, my leg just doesn't feel that bad. The ice machine seems to be doing the trick.

    So I'm not going to take the pain meds, at least for now.

    :typing
    I've got a bottle of Percocet for a root canal I had a couple weeks ago.

    I got it filled, but never used one. Ibuprofin did the trick nicely.

    Between us, with all our leftovers, maybe we can be drug lords.......
  7. by   ginger58
    Do you think that the increase in the mg's in the Vicodin could be due to the fact that 2.5mg tabs probably weren't effective, and by going to the 10 mg tabs they can use less Tylenol?
    "The current treatments out there highly designed at creating and turning people into drug addicts."
    I'm sorry but your blanket statement scares me for all the patients out there that are in pain! Unfortunately, you're one of many with this mentality.
  8. by   Zizka
    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? 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?
    In the nursing care setting I think the opposite is true. It's human nature to not want to work and therefore providing people with pain management is usually just another chore. You have to give it out, chart it, etc.

    For PRN medications the nurse will look to excuses to not give. Couple that with a judgemental, "christian/purtianical" society and we'll be turning away more needs than people wanting to get "high".

    HTH (hope that helps)
  9. by   Sheri257
    Quote from Zizka
    In the nursing care setting I think the opposite is true. It's human nature to not want to work and therefore providing people with pain management is usually just another chore. You have to give it out, chart it, etc.

    For PRN medications the nurse will look to excuses to not give. Couple that with a judgemental, "christian/purtianical" society and we'll be turning away more needs than people wanting to get "high".

    HTH (hope that helps)
    I don't have any problem with giving prn pain meds ... not at all. But when patients are constantly riding the call light, trying to get you to violate MD orders and taking all of your time away from other patients ... that really drives me crazy.

    :typing
    Last edit by Sheri257 on Dec 27, '06
  10. by   jill48
    This is such a touchy topic. My own personal belief is that if you are in pain, you shouldn't have to be. With my patients, I encourage them to take pain medicine when they are in pain. Especially if they have physical therapy. I don't think they can get the full benefits of therapy if they are in pain. But I have also had many patients who say that other nurses have tried to get them off the pain pills. So I guess it's just that we all have different beliefs about it. I'm in geriatrics now, so i'm not too worried about my patients turning into junkies.
  11. by   Maedele
    Hello and Happy New Year to eveyone


    I haven't read all of the responses, hopefully I wont repeat something what was posted before. My thought on pain management is "pain is what the patient says it is" period!!! as some of you also stated. There also is a difference between drug " addiction" and "physical dependency". When a person takes opiods / narcotics for pain management they will experience physical withdrawl once they stop taking their pain medication or if they wait to long before they take their next dose. This is a normal physical response. Most of the time the dosage prescribed is just enough to cover the pain, and there is nothing "left" over for a "high" for these patients.

    Nurses and Doctors often mistake a person crying or being withdrawn after stopping opiods/narcotics for signs of addiction, when in reality they are suffering from pain.

    A drug addicted patient will experience physical withdrawl also, but he/she is seeking drugs for a "high" and therefore also experiences psychological/mental withdrawl and often become aggressive and combative. ( I was told by a Doctor working at a Meth clinic)


    Pain management has and always will be one of the biggest challenges in the medical and nursing profession, that is why we need to advocate for our patients at all times without prejudice.

    Just my 2 cents worth
  12. by   PANurseRN1
    Quote from lizz
    I don't have any problem with giving prn pain meds ... not at all. But when patients are constantly riding the call light, trying to get you to violate MD orders and taking all of your time away from other patients ... that really drives me crazy.

    :typing
    That must be it. They're doing it to deliberately annoy you. It couldn't possibly be because their pain is inadequately managed. It's all an evil plot!
  13. by   ginger58
    Quote from Maedele
    Hello and Happy New Year to eveyone

    Pain management has and always will be one of the biggest challenges in the medical and nursing profession, that is why we need to advocate for our patients at all times without prejudice. :
    Well said..."at all times without prejudice."

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