Is current thinking on pain control creating drug addicts? - page 6
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
Jan 10, '07I am going to go against what the majority of the posters are saying.
I agree with "better to medicate a few addicts than not medicate a true sufferer".
However, when a patients walking around, laughing etc and then you enter the room and they go into a display of pain very different from what you observed seconds before, it is suspect. It is also suspect when a person c/o pain 10/10 and their BP is on the low end, their pulse in normal, resper are lower etc. Pain is stressful on the body, there are going to be changes in vitals with over/undermedicating pain.
Pain is whatever the patient says it is? Not always.
What about, do they have a reason to have pain? I work with inmates and this is the key to proper Dx. They complain of pain? They are worked up, watched when they don't know they are being watched (reports by medical staff, security cameras, officers reports of inmate behavior etc). If there is no source found or if their reports are inconsistent, they are not getting narcs and/or they are sent for a referral to a specialist. For sure there are a few that are drug seekers that get narcs but narcs shouldn't be handed out like candy.
To the person that says,
"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".
How about working them up and finding out if there is something medically wrong? And narcs are not always the answer. How about non drug therapies like heat, cold, music, massage, distraction, NSAID's other non narc meds.
If things don't add up and narcs are still given because "pain is whatever the pt says it is" you are just feeding into the addiction (predisposed or not) and enabling a behavior that is destructive to a persons life.
Unfortunately I think the old way of being stingy with pain meds decades ago has bounced way way to far in the other direction and we are feeding some peoples addictions.Last edit by VegRN on Jan 10, '07
Jan 10, '07at my hospital we have 10 minutes to administer pain med after the patient asks for it or else we can be reprimanded. I have no problem giving pain med and most of the time it is to people than sincerly need it and do actually get relief and are able to rest after receiving it. However I have a major proble with the drug overdoses (accidentally took too much trying to get high, messed up or whatever). These people have a specific personality that I can not tolerate and have no sympathy for..after they have scared the wits end out of their family they wake up being the "victim" and poor me..the family hovers over them and jumps at the slightest glimpse of pain. Do they really have to have that tube in their nose..it bothers them soo much, do they really have to be on the ventilator cant they have anything to drink. Then when they are able to talk it is a continuous explanation that No you overdosed on drugs your doctor does not want you to have anymore..then they usually sign out AMA but I enjoy it when they get to have a mental hygiene hearing and end up getting locked up in a psych facility.
Jan 10, '07I had a pt who I discharged yesterday. She was a stepdown pt with a hx of COPD and psyche problems. She was admitted for increase SOB and decrease LOC. She also was a chronic pain pt with non-specific back pain in addition to being low-functioning person in general.
She was on 40mg oxycontin QID, and had admitted to taking an extra oxycontin the day of her admit. She seemed very drowsy to me and I mentioned to the doc that it appeared to me that this lady was overdrugged. Pharmacy chimed in that oxycontin is a BID drug and should not be a QID drug. The doc was not her primary, but the doc from that rural clinic whose turn it was to do hospital rounds, she was in a hurry to discharge the pt and get back to the clinic.
I got the feeling that it will likely be swept under the rug.
Jan 10, '07For me, it's really simple.
I am not the pt; I cannot know their true level of pain. Therefore, if the MD is willing to order it, I am willing to give it - period ..... unless giving it would kill the pt. (imagine a 20mg MS order to a pt w/ resps of 6pm)
If grown adults want to ruin their lives by taking opioid meds when they don't need them; no skin off my nose. OTOH, people that need pain meds shouldn't have to beg for them, and shouldn't have to justify that fact to people that have NO PERSONAL STAKE in the matter.
Nurses, keep your judgmental attitudes to yourself.
Jan 11, '07For the most part, I am amazed that most of these posts (and I have read everyone of them!) are pro pain relief.
I am a chronic pain sufferer myself and have worried for years about addiction. There are many stories of nurses being addicted to medications. The ER at the small, rural hospital where I work are very judgemental when it comes to pain medication.
If I had a trauma or an MI, I would want to go to our ER they are great. But when it comes to a flare of chronic pain, they feel everyone is either a drug-seeker or they should handle their chronic illnesses during normal office hours. I guess that I should try and schedule my pain!! If I could I would write if off my calendar!!!
Even people with chronic pain and high tolerance to pain meds need appropriate medical care during non-office hours. This is a touchy subject for me because I have been to the ER for relief of a migraine and received Toradol. If something like Toradol would work, I could take it po at home!
This is just my humble opinion that I felt the need to voice because this is a subject that affects my everyday life. I wish non-pharmacological methods would work for me. I have too many obligations that are not optional to slow down at this point in my life.
We are a long way from making pain control a settled issue.
Jan 11, '07Better to treat an addict, then to deny a person in pain.
Sort of like "better to set a guilty man free, than to imprison an innocent man"
Jan 11, '07I am so happy and thankful for my pain MD and the time released pain medication he prescribes. Getting relief from pain has taken me from a person unable to work and just tolerating each day to a functioning nurse and person. The medication has never made me feel different mentally but still I do not take medication when I work. Fortunately, I work part time and am able to get enough relief during my off time. For years I felt like just a big wimp that should be trying harder and was made to feel guilty for wanting relief from my discomfort. Today I feel human again and thank God for finally getting a diagnosis and my pain MD to treat me.Last edit by harley007 on Jan 13, '07
Jan 11, '07To deny pain relief to a suffering human being flies in the face of everything I thought a nurse should be. But nurses are human too and we all come with our own set of rigid beliefs, as flawed and predjudiced as they may be. The older I get and the more I read and learn about chronic pain, addiction, and drugs, the more I realize just how wrong my view on these subjects have been all of these years. At least for me, they were wrong. See, I use to believe that when I went to the doctor for stitches, fractures, or whatever, that the "all-knowing doctor" would know exactly how much pain medicine each injury or illness was worth. If he didn't give me anything for pain, I supposed I must not be hurting bad enough to warrant pain medicine.
As far as pain was concerned, I kinda felt that only "wimps, pansies, and drug addicts" would dare ask for anything for pain, but in reality I didn't really know what a wimp, pansy, or drug addict looked like other than the negative stereotypical image I had of them. It wasn't until about 4 or 5 years ago that I began to "change my tune" about how I viewed pain. It wasn't as if a lightbulb went off in my head but it was rather a very long process that continues to evolve even to this day.
The evolution of my views regarding the bureaucracy of pain control and management was due, in most part, to the whirlwind of doctors, nurses, hospitals, clinics, and everything in between that my husband and I were subjected to once he became ill. Not only was I angry at my husband for being ill, I was also angry and dissolusioned with the myriad of healthcare providers that we came into contact with. As my husband suffered incredible pain, he was poo-poo'd by some doctors because they could find no reason for his pain, he endured painful procedures from specialists who were treating him based on a misdiagnosis and then, when he continued to complain about the pain, was passed to other doctors. Never once was he given anything more substantial than a Darvocet or 5mg lortab for his pain, and only then was it very sparingly given. My husband didn't care...at that point, he would have eaten anything if it promised the slightest relief in his pain. He was loaded up on Bextra, Vioxx, ibuprofen, naproxyn, and all NSAIDS in between, he was taking SSRIs and anti-seizure medications, but nothing helped with the pain that he was experiencing. My husband began to question himself saying, "this couldn't all be in my head could it?" After 2 years of hell and a marriage almost in shambles (because the doctors had me convinced that there was nothing wrong with the man I had been married to for over 10 years and he was just seeking drugs), he was referred to a pain clinic who in turn took over all aspects of his care. Finally someone believed him. There really was something wrong. They didn't immediately and without disregard start writing large amounts of strong opiates, but they did help to keep him comfortable while searching for the reason for his pain. They set up appointments with hemotologists, orthopedists, oncologists, internists, and surgeons and they coordinated the care between all. In all honesty, now that I look back on it, these doctors saved my husband's life. Not only did they get to the root of his medical problem, but just the simple fact that they believed him gave him hope for the future because I believe that if he had to go another 6 months like it was, he would have killed himself. He was in that much despair.
It would be nice to believe that all of the doctors who treated my husband did so sincerely and to the best of their ability. However, since becoming a nurse, I know better. Although my husband never onced asked for certain prescriptions, I'm sure that most of the doctors and nurses were thinking behind his back that he was just looking for drugs. That seems to be what a lot of healthcare workers think based on comments that I've heard from other nurses in the hospital and from some comments made on this board.
I know that there are bad people out there, but I also believe with all of my heart that most people are good, sincere, honest, and law-abiding. 9 times out of ten, if someone tells you that they are in pain, then just maybe they really are in pain. To deny anyone adequate pain control of any kind, for any reason (other than if it's not in the patient's best interest at the time),is heartless and inhumane.
I don't know about any of you here, but try as I might, I'll never be able to see through the eyes of another human being or physically feel what they are feeling, just as no one will ever be able to see through my eyes or feel what I feel. If we really could "walk a mile in each other's shoes," I think we would have a much kinder and gentler society. After 2 years of going through what we went through, I would never want any patient to have to needlessly suffer because I doubted their sincerity or because they didn't look the part of someone in pain. I did not go to nursing school to police and ferret out drug abusers. If I wanted to do that, I would have gone into law enforcement.
Jan 11, '07I'm not sure we are creating addicts, I feel we are aiding in their addiction. Heck, we are now starting Iv's in the loby at triage ,giving Dilaudid. (I havn't done this but other nurses have , I personaly will refuse...If they're that bad they should be in a room, that is a law suit waiting to happen !)./ But any way, Other hospitals in the area don't do that but by gosh we have to keep up our pres gainy scores. Seems any more the idea of "striving for 5 " on the presgainy equated into leaving with a script for narcotics. I work in Ohio, One of our docs moved to Denver. He said he about fell over when he gave a script to a pt with a fairly bad injury ,for vicodin and the pt told him. oh no...that's way to strong, can I get just some motrin.:spin:
Jan 11, '07I think it's the same as with guns, guns don't kill people, people kill people. Drug addicts create drug addicts. My doctor will only give me Darvocet for my chronic pain. I have herniated discs, sciatica, degenerating spine, several pieces of metal (plates) and he says after taking this medication for 6 years that I am becoming used to narcotics; NO MY PAIN HAS GOTTEN WORSE!!!!
Jan 11, '07As nurses, we need to insure that we believe a patients pain is where they say it is and how bad they say it is. Period. It's not up to us to pass judgement on whether or not they really "need" the pain relief or whether or not they have an addictive personality or a "junkie" mentality or an exsisting drug issue. We are supposed to be a patient advocate, trying to insure they are as comfortable and as pain free as possible. Offering alternative therapies, if possible and available, help for patient comfort but bottom line is we all feel pain, and react to it, differently, and none of us are capable of actually knowing how much pain (physical, emotional or spiritual) another human is in. Empathy, regardless of what our patients faults and shortcomings are, is part and parcel of what being a nurse is all about.
Jan 11, '07Quote from grandee3ONLY TYLENOL?? That person must have been in a lot of pain, and that sure wasn't right.I hate it when we tell the doc a pt is taking pain meds every 4 hours and still complaining about pain but have no problem going outside to smoke or laugh and joke on the phone.
The doc would tell us he is going to lower the dose and after seeing the pt, he gives them even more pain meds and the pt down the hall who just had a foot amputated or a CABG only has Tylenol ordered. :angryfire
I hate the term clock watcher. I had 4 impacted wisdom teeth removed years ago and got a Tylenol #3 Rx that was q4h. Sure enough, when 4 hours passed my jaw was hurting. If I was in a position to have to ask a nurse for the pill, would this mean I'm a clock watcher?
Besides, in a general sense we are all drug seekers. When we get a headache we reach for the OTC pain relievers, when we get heartburn, we reach for the antacids, when we are constipated, we reach for the laxatives, and so on.
Jan 11, '07I think it should be outlawed to mix phenergen + analgesic IVP to give as a pain remedy. We all know these patients are looking for an extra kick! And nausea doesn't occur spontaneously with MS!:angryfireLast edit by CaLLaCoDe on Jan 11, '07