Pain control in narcotic addicted pt

Quit Floating Me, BSN, RN · Jul 20, 2013

I wonder if everyone here who is defending the drug seeker that just wants pain medications ever had to care for patients like (and administer that IV Dilaudid with Benadryl q2 hours, q3 hours or q4 hours) that over a period of time.

I also have a pretty good idea who is really in pain based on other assessment skills and those who only want medications. But alas, we are not doctors, we do not have the right to withold medications ordered by the physician UNLESS vital signs do not permit it (very drowsy, hard to arouse, low HR, low BP, low RR etc) - in which that case the physician should probably be notified. :angrybird10:

monkeybug · Jul 22, 2013

I wonder if everyone here who is defending the drug seeker that just wants pain medications ever had to care for patients like (and administer that IV Dilaudid with Benadryl q2 hours, q3 hours or q4 hours) that over a period of time.
I also have a pretty good idea who is really in pain based on other assessment skills and those who only want medications. But alas, we are not doctors, we do not have the right to withold medications ordered by the physician UNLESS vital signs do not permit it (very drowsy, hard to arouse, low HR, low BP, low RR etc) - in which that case the physician should probably be notified.

Really? Are you God? Sylvia Browne? Miss Cleo? The Dog Whisperer? How do you really know. That's our point. You think you know, but you may not. People with years of chronic pain under their belt may not have objective signs that someone experiencing a unique episode of pain will have. This doesn't make their pain any less or any less deserving of treatment. As for having to care for patients "like that," I'll say it again. Those drugs don't come out of your paycheck or out of your hide. Give them, and be grateful to your deity of choice that you personally know so little about pain.

BrandonLPN, LPN · Jul 22, 2013

I wonder if everyone here who is defending the drug seeker that just wants pain medications ever had to care for patients like (and administer that IV Dilaudid with Benadryl q2 hours, q3 hours or q4 hours) that over a period of time.
I also have a pretty good idea who is really in pain based on other assessment skills and those who only want medications. But alas, we are not doctors, we do not have the right to withold medications
ordered by the physician UNLESS vital signs do not permit it (very drowsy, hard to arouse, low HR, low BP, low RR etc) - in which that case the physician should probably be notified.

Well, why should a nurse be allowed to hold physician ordered pain meds, unless there's assessment data to back it up? Why is that something to say "alas"about? Can you imagine what a slippery slope it would be if a nurse could just say "no, they're not really painful" and withhold the med?

If it really bugs you so much, look at it this way: when you give a drug seeker PRN narcs you're still treating them. Even if they're not "painful" in the way you or I define the word, they still have something going on physically and psychologically where giving them the med is the most therapeutic thing you can do at that time. You're not working in a detox facility. Deciding unilaterally that it's time for them to go cold turkey is not a very "nursey" thing to do.

wooh, BSN, RN · Jul 22, 2013

I wonder if everyone here who is defending the drug seeker that just wants pain medications ever had to care for patients like (and administer that IV Dilaudid with Benadryl q2 hours, q3 hours or q4 hours) that over a period of time.

Why no!!! I'm sure you're the only one here that EVER had to do that!!

lmccrn62, MSN, RN · Jul 22, 2013

I wonder if everyone here who is defending the drug seeker that just wants pain medications ever had to care for patients like (and administer that IV Dilaudid with Benadryl q2 hours, q3 hours or q4 hours) that over a period of time.
I also have a pretty good idea who is really in pain based on other assessment skills and those who only want medications. But alas, we are not doctors, we do not have the right to withold medications ordered by the physician UNLESS vital signs do not permit it (very drowsy, hard to arouse, low HR, low BP, low RR etc) - in which that case the physician should probably be notified.

Your comments scare me! Since when are you so empowered to know who is drug seeking and who isn't and who is in pain and who isn't. Perhaps you could share with us your keen insight. I am glad I am not your patient.

ToothFairy(5) · Jul 23, 2013

Well, why should a nurse be allowed to hold physician ordered pain meds, unless there's assessment data to back it up? Why is that something to say "alas"about? Can you imagine what a slippery slope it would be if a nurse could just say "no, they're not really painful" and withhold the med?
If it really bugs you so much, look at it this way: when you give a drug seeker PRN narcs you're still treating them. Even if they're not "painful" in the way you or I define the word, they still have something going on physically and psychologically where giving them the med is the most therapeutic thing you can do at that time. You're not working in a detox facility. Deciding unilaterally that it's time for them to go cold turkey is not a very "nursey" thing to do.

I agree.

I work in a detox and don't withhold. If the person is due a narc, I give it period. Withholding can have harmful effects. If the COWS or CIWA is still high and the person is not comfortable I call the MD. No one suffers on my watch, period. We never let anyone go cold turkey though.

Quit Floating Me, BSN, RN · Jul 23, 2013

You're not working in a detox facility..

Actually, I am.

And thanks for all the flames. It was getting a little cold here. Remind me to never share my opinion/thoughts on any matter on this website (hey, isn't that the purpose of this website?). You guys are horrible. Thanks for the berating, name calling and downright nasty comments. I forget how nasty nurses could be.

BrandonLPN, LPN · Jul 23, 2013

Actually, I am.
And thanks for all the flames. It was getting a little cold here. Remind me to never share my opinion/thoughts on any matter on this website (hey, isn't that the purpose of this website?). You guys are horrible. Thanks for the berating, name calling and downright nasty comments. I forget how nasty nurses could be.

OK, my bad. I thought you said you worked med/surg

But I still think wanting to be able to withold meds becasuse you can "tell" that theyre not really painful is not a good way to go about medicating people. Regardless of setting.

You have an opinion that, apparently, is not shared by a number of us. Hence the replies. Don't take it too personally.

Jory, MSN, APRN, CNM · Jul 23, 2013

Hello all:
In my practice I have encountered several instances of objectively addicted pts being prescribed massive amounts of narcotic medications. May I make it clear that these are not pts with low pain tolerances, these are confessed addicts with telltale signs and symptoms of narcotic addiction. They will manipulate, exaggerate symptoms, fabricate symptoms, and will go to great lengths to have more meds.
My question/comment is this: After all physical causes of pain are ruled out, isn't it simply enabling to allow this population to remain admitted with increasing amounts of pain meds to satisfy ever increasing self reports of pain?
Perhaps our mantra of "pain is whatever the pt says it is" should be modified to "pain is whatever the pt says it is until objective signs prove pt reports of pain to be unreasonable."?

Rule #1 of pain: The pain is what the patient says it is.

I don't have a DEA number and I don't prescribe...my responsibility is limited to communicating my thoughts to the prescriber and to make sure that the dose isn't lethal ONLY I am responsible for administering..otherwise, it falls on the pharmacist.

It is the physician, not the nurse, that has to answer for it. I don't work for a drug rehab center and drug addiction is mostly a choice.

However, you also have to remember that if an addict has true pain, it will take a much higher than normal dose to get that pain to an acceptable level.

Other than that, I don't get in the middle of it when I float to adult floors. I communicate and chart what I am supposed to and let the physician make the decision. After all, at the end of the day, all it does is 1) Gets you into trouble if the physician complains 2) The physician gets another nurse to administer the meds. 3) You are still in trouble.

That is why, I don't argue with it.

Jory, MSN, APRN, CNM · Jul 23, 2013

Wow! I think there was a misunderstanding...I'm talking about the ones whose pain is NEVER under control because we've amped up the doses and overrun their mu and kappa receptors for 20+ years. When it still hurts on hydromorphone, vicodin and percocet for breakthrough pain, it's time to look for other solutions.
I was in no way doubting the legitimacy of their pain! They're crabby because their life hurts! And IMO, they're hooked because of us!

No, they are hooked for two reasons:

1) Because of illegal drugs

2) Because of physician's prescribing prescription opiates on an OUTPATIENT basis. Unless someone has been in a burn center or in the hospital an extended period of time (as in, several weeks or months), no, they are not addicted because of a few days of morphine following a surgery.

I rarely take a Tylenol and had a surgery where the IV meds were not controlling my pain following a major surgery..it wasn't even tolerable. The RN was a little nasty when I kept telling her that what she was giving me wasn't touching it.

I know what it's like to NOT have a drug problem and have a nurse assigned to you that holds back pain meds. They heard about it during the evaluation.

Quit Floating Me, BSN, RN · Jul 23, 2013

OK, my bad. I thought you said you worked med/surg
But I still think wanting to be able to withold meds becasuse you can "tell" that theyre not really painful is not a good way to go about medicating people. Regardless of setting.
You have an opinion that, apparently, is not shared by a number of us. Hence the replies. Don't take it too personally.

So I should be Flamed for having a different opinion? I went back and reread my post and I do find my comment stating that I know who is in pain or not is inaccurate and wrong. There really is no definitive way to tell. On that note I would never never withhold medication because I felt like it. I was actually commenting against those nurses That do withhold medication.

Still the responses that I got to my comment Was like a pack of starving dogs fighting over a tiny morsel of food.

Quit Floating Me, BSN, RN · Jul 23, 2013

Well, why should a nurse be allowed to hold physician ordered pain meds, unless there's assessment data to back it up? Why is that something to say "alas"about? Can you imagine what a slippery slope it would be if a nurse could just say "no, they're not really painful" and withhold the med?
If it really bugs you so much, look at it this way: when you give a drug seeker PRN narcs you're still treating them. Even if they're not "painful" in the way you or I define the word, they still have something going on physically and psychologically where giving them the med is the most therapeutic thing you can do at that time. You're not working in a detox facility. Deciding unilaterally that it's time for them to go cold turkey is not a very "nursey" thing to do.

I am. I work on the a dial diagnosis unit so I get clients with mental illness and/or addictions along with detox. I have handed out my fair share of Librium for etoh WD and clonidine for opiate wd. I do not hold meds just because and I am sorry my message came across that I did. That is appalling!!