LTC Drug Addicts

  1. Has anyone else ever worked with LTC residents that were on a lot of pain medications but it was not clear why they were being given them regularely? I hope I worded that right...I'll explain...

    In our LTC, we have a 67 year old woman who has had both hips replaced previously and claims that she has chronic hip pain. This woman in the past was treated with numerous narcotics and I believe she has an addiction. She is a manipulative woman; as well as being of sound mind.

    These are her pain meds...

    Oxycontin 40mg BID (0500 & 1730hrs)
    MOS syrup 5mg PRN (which she asks for every day at 1400hrs).
    Morphine 1mg s/c PRN (which she asks for everyday at 2200hrs)

    She also regularly requests gravol 50mg @ 0500, 0900, 1400 & 2000hrs.

    There are absolutely no non-verbal cues of her being in pain and she is so manipulative etc that she will lie and tell you all sorts of stories to get her medications. The staff are so tired of her games that they just deliver her gravol etc at the appropriate times without waiting for her to ask anymore. This woman will inspect what is in the medication cup before you leave too, just to make sure that her gravol is there.

    Needless to say, this woman is complete PIA (I could go into more details but I'll save you all the trouble).

    From my understanding, when the doctor would come visit her, he would just say "okay, what can I prescribe for you to help you to feel better," and would write down what she wanted.'
    Why do they do this? Is it not only aiding her drug addiction?
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  2. 56 Comments

  3. by   CoffeeRTC
    I see this alot in our LTC. The MDs just want to make the res happy so they don't have to deal with them. Has the IDT discussed her meds? What about a pain clinic to assess and suggest treatment.. I always try to get them to see the "Pain EXperts" "so we can better treat your pain", I also would see if you can get a Psych consult...What about reminding the MD about state and Fed regs as far as overmedication.... Is her only DX Hip replacements???
    What's the gravol for? Nausea from her pain meds? If she is in losts of pain, I would suggest asking for more long term meds or a Duragesic patch.....Good luck, please update...
    Last edit by CoffeeRTC on Jun 8, '03
  4. by   Disablednurse
    People in pain being doubted about their pain is a pet peeve of mine. I am in chronic pain and hurt all the time. I am on Neurontin, Elavil, MS Contin, Effexor, and oxycodone for breakthru pain and I take it two or three times a day. I do not just sit around the house crying or moaning and groaning. People react to pain in different ways. Not everyone just curls up in a ball and prays for death when they are in pain. If I see something on TV that is funny, I laugh, it does not matter whether I am hurting or not. Yes doctors ask me what can we do now for your pain. You know what you have taken, what you can take and what does not work. Do not be so quick to judge. Secondly, someone is in a nursing home, what difference does it make if they are addicted. They are old and going to die in most cases. What can it hurt? Nurses need to be more careful about judging others. I did years ago before I had to start living with pain. I quickly got over it. I do not mean to sound like I am coming down hard on you, this is something I have had to put up with at one time and I know how it feels. JMHO
  5. by   nrw350
    I would be concerned if a resident developed a reaction to the pain medicine and died. I would hate to think what would happen to staff if the thought got out that they assisted the resident maintain her addiction. I am not criticizing or anything, just voicing a concern.
  6. by   jude11142
    Good Post!!!!

    I am also a nurse who suffers from chronic pain. The issue of pain control, addiction vs tolerance, etc.........is also a pet peeve of mine. Many are too quick to judge people who live in daily pain. You are so right when you said that you "laugh at something funny" and so on. I have live in pain for over 20 yrs. and though I may have a smile on my face that doesn't say that inside I am hurting bigtime. I learned long ago, that I could either lock myself in my own little world and let the pain take over my life or I could learn to deal with and try to control the level of pain that I have and live a productive life. I chose the latter. It wasn't always easy as I'm sure you know our medical professionals don't always know how to treat us/or they refuse to prescribe the meds that will help. I never underestiimate a pts pain. I have had coworkers say, "pt in rm 2 is always calling for her percocet an hr before she is even to get it"(could it be that is because the pt knows that it will take maybe an hr to get it). I hope that not only other nurses but also the doctors learn how to better treat chronic pain and not be so quick to label them.

    Your post was right on target.

    JUDE

    Originally posted by Disablednurse
    People in pain being doubted about their pain is a pet peeve of mine. I am in chronic pain and hurt all the time. I am on Neurontin, Elavil, MS Contin, Effexor, and oxycodone for breakthru pain and I take it two or three times a day. I do not just sit around the house crying or moaning and groaning. People react to pain in different ways. Not everyone just curls up in a ball and prays for death when they are in pain. If I see something on TV that is funny, I laugh, it does not matter whether I am hurting or not. Yes doctors ask me what can we do now for your pain. You know what you have taken, what you can take and what does not work. Do not be so quick to judge. Secondly, someone is in a nursing home, what difference does it make if they are addicted. They are old and going to die in most cases. What can it hurt? Nurses need to be more careful about judging others. I did years ago before I had to start living with pain. I quickly got over it. I do not mean to sound like I am coming down hard on you, this is something I have had to put up with at one time and I know how it feels. JMHO
  7. by   duckie
    Originally posted by Disablednurse
    People in pain being doubted about their pain is a pet peeve of mine. I am in chronic pain and hurt all the time. I am on Neurontin, Elavil, MS Contin, Effexor, and oxycodone for breakthru pain and I take it two or three times a day. I do not just sit around the house crying or moaning and groaning. People react to pain in different ways. Not everyone just curls up in a ball and prays for death when they are in pain. If I see something on TV that is funny, I laugh, it does not matter whether I am hurting or not. Yes doctors ask me what can we do now for your pain. You know what you have taken, what you can take and what does not work. Do not be so quick to judge. Secondly, someone is in a nursing home, what difference does it make if they are addicted. They are old and going to die in most cases. What can it hurt? Nurses need to be more careful about judging others. I did years ago before I had to start living with pain. I quickly got over it. I do not mean to sound like I am coming down hard on you, this is something I have had to put up with at one time and I know how it feels. JMHO

    Much of what you have said I agree with as I too live with pain daily. First off, a psych. consult is not a bad idea as my MD recently pointed out that when you suffer chronic pain, you can be in depression from the attempts of daily coping and I have to agree my attitude has changed since being put back on one. I sing praises to the Duragesic patch, it has made a big difference in my pain levels. I also have Norco for breakthrough pain. To judge anothers pain level is not our job and it is very hard to know what is real and what is not. Recently we sent a lady to the ER that was laughing and joking with the EMT's that looked at us like we were nuts for sending her. She was having a full scale MI, how each of us handles ourselves are very different. I do not judge, if they say they have pain, I accept they have pain. I don't announce to everyone at work on those nights when I could hardly get out of bed that morning, or the pain I am in after lifting, transferring and the such. Perhaps she does watch that clock, just praying for a few minutes of relief, please give her the benefit of the doubt.
  8. by   gizzy76
    To everyone who's replied so far...I did not intend to offend. I do believe that a person's pain is their own perception and what they say it is, is what it is. I guess my biggest part of the post was wondering why doctors just accomodate these requests and not give her a pain patch then?
    Also, call me crazy, but I find it hard to believe that pain comes on regularly timed intervals. She calls to the minute almost each day for her PRN's. Also, when you try to assess her pain for your charting she can't even look you in the eye, she looks away as though she is lying. All of the nurses in our facility are concerned and feel relatively the same way.
    I was not doubting her pain if it came across that way.
    My apologies.
  9. by   kids
    Having a patient with chronic pain forces us, as nurses, to rethink everything we know about pain and addiction. Dealing with a patient with poorly managed or un-managed chronic pain is very frustrating.

    I diseased hip can cause nerve damage that is not relieved by replacement...the replacement itself can cause chronic pain.

    You patient needs a pain management consult. If that can not be done then she needs an IDT conference that included a Pharmisist and the doc.

    Off the top of my head (from my own experiences) the timing of her requests for PRNs are consistant with break thru pain. A good start could be changing her over to MS Contin 30mg Q8 hrs around the clock. Is she on an anti depressant? Tricyclics are a valuable addition to a pain mgmt routine, unfortunately they are contraindicated in the elderly. Some of the new SSRI (type meds) can be helpful especially Effexor XR and to lesser degrees Zoloft and Paxil. A smooth muscle relaxant with a short half life at HS can also be of benefit.

    There are several nurses on this BB who are chronic pain sufferers on medication and are living our lives, some of us are fortunate in that we can still work.
    Last edit by kids on Jun 9, '03
  10. by   gizzy76
    From what I understand, many routes have been tried with this woman with different medications. I did ask her tonight when I delivered her morphine injection at 2200hrs whether or not she felt her pain was well controlled. She said yes, so I will leave this one be. Once again, sorry if offended anyone.
  11. by   kids
    You didn't offend anyone

    I happened to read some good stuff on chronic pain today (I have failed back & spinal stenosis).

    Here is a link to what I was reading (I tend to click and follow so it took me a while to dig up my starting point)

    http://www.cnn.com/HEALTH/library/PN/00035.html

    PS...she might think her pain is well controlled because she doesn't know any better...that it *might* be possible to control it without a near-constant stream of drugs.
    Last edit by kids on Jun 9, '03
  12. by   Tookie
    Another group for consultation for her pain management may be Palliative care -
    At our LTC / nursing home we would consider that all our resdints are in a trerminal stage of their life or they would not be admitted to our care inthe first place - This palliative care we deliever an be in the form of paracetamol to a syringe driver and can take from 3 moths to 10 years depending upon both the resident and the care.
    I think a pain consultant, as well as other areas that may be useful would be a good dtart - is she interested in any actitivies - would she respond to some spiritual guidance - depening upon her beleifs. -
    Please do not think this is a criticism of your original post - It is question often asked and dificult to resolve - - Yes she may be manipulavtive - may have been all her life that way - What would her social history / ie family information tell you - maybe she would have some pain releif through a spa, massgae or aromatherapy -

    Good luck with your resident - l am sure you are giving her goodcare - maybe too if you sit quietly and explain to her that you are concnered about her quality of life she may share an alternative idea with you

    Sorry if l am begiingin to go of in a tangent - but it is an interesting issue - often the person who has comlpained so long mey erspond to a different approach. If l remeber correctly you said she is lucid - she maybe just really frightened and need reassurance both with knowing things will be on time and that she will be trated as both an individaul and with respect and dignity

    BTW - like others here l too use medication to get going and try and have an active day - it frightens the life out of me that ultmately l may end up in a facility whereby l cant control my medication intake -

    Again - good luck and l am sorry for raving on yet again

    Tookie
  13. by   ScarlettRN
    I am going to use this thread to ask a question. I have a chronic back problem that the doctor told me last week was not going to go away and that I need to live with pain meds for the rest of my life. He suggested I seek counselling because it is bothering me emotionally. I have very little tolerance for my problem because I work in the ER and deal with the drug seekers daily....and have begun to hate myself for needing pain meds.
    My question is this: I was given a Duragesic patch starting last week. I have not seen any significant difference in my pain--at times--since then. I think the top has been sliced off of it, but before, I could achieve total pain relief when it got bad when I was taking lortab....but was worried about the tylenol content. Should I expect total pain relief from the Duragesic? I have ben so careful about the lortab that I managed to keep my daily intake below 6 a day after 5 years of taking it. What I am worried about is asking for something for breakthru pain so soon after taking the duragesic. I don't want the doc to think I am becoming a drug seeker. That seems to be the over riding fear in my life--being thought of as a druggie.
  14. by   Disablednurse
    First of all, Gizzy76, I was not offended.

    Now, I never get total pain relief, even with taking the oxycodone for breakthru pain. It gets it down to a level that is more tolerable. Also my pain management MD is going to try to find a psychologist that is in my group for my insurance to try to help me deal with the pain. I do know what everyone means by not wanting to be thought of as a druggie. I cannot even tell my family what I am taking for pain because I don't want to have to listen to lectures about taking too much stuff and needing to tough it out. Even with pain meds, I have to tough it out. I cannot make them understand.

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