Is current thinking on pain control creating drug addicts?

[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?

[Sheri257]

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

[jill48, ASN, RN]

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.

[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

[PANurseRN1]

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!

[ginger58, ASN, RN]

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."

[VegRN]

I 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.

[burn out]

at 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.

[GardenDove]

I 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.

[clee1]

For 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.

[donormom]

For 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.

Karen

[RNOTODAY, BSN, RN]

Better 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"

[harley007]

I 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.