Pain control in narcotic addicted pt - page 6

by dankimal 8,624 Views | 73 Comments

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... Read More


  1. 0
    Quote from leslie :-D
    and what about those "crabby, opiate-hookde" pts, who have legit pain?
    some do, you know.

    leslie
    it is also used as an analgesic ...
  2. 3
    Quote from Hearticulture RN
    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!
    I don't think I'd say that they are hooked because of us. Sometimes we are enablers, but if they are that intent to get the high of dilaudid, morphine, etc., they will find it from somewhere else. That doesn't mean that I think we should throw pain meds at them for the sake of giving them pain meds, but we shouldn't use this as a reason for denying pain relief.
    OB-nurse2013, GrnTea, and xtxrn like this.
  3. 3
    Big questions I have:

    Would witholding pain meds do anything at all to help cure an addiction in the absence of the rest of the addiction treatment protocol (and the patient's consent)?

    Or does witholding pain meds just help nurses avoid the squidgy feeling of "participating"in the patient's addiction, without attention to whether or not this helps the patient?

    Is unmanaged narcotic withdrawal medically better or worse for the hospitalized or outpatient addict than getting their "fix"?

    Clearly successful addiction recovery is the best medical option. But how do the people who go that route get there? And how can we most effectively help?
    wooh, GrnTea, and OB-nurse2013 like this.
  4. 0
    Quote from KYGirl1976
    As an ER nurse I can tell you that whomever came up with the adage, "a patients pain is, whatever they say it is" never worked in an ER. Rule #1--- Pts lie. The 1-10 pain scale is so ridiculously misused that many patients arrive in triage and immediately explain to me how their pain is a 10/10, (with normal vitals and while they laugh along with the friends they brought with them, text, sneak outside to smoke, eat, drink, and otherwise be merry!!!!) What about using the FLACC scale? Implement something that takes into account a patients demeanor and what would be considered innate human physical responses to pain. FLACC has been used in infants and patients who lack the ability to communicate (i.e. trach&vented, MR, brain injury etc). I chart against patient demeanor, and behavior when I am in triage. Our frequent fliers and narc seekers can tell me their pain is a 10/10 and I will chart that, right along with..."pt observed laughing with friends while in waiting area" "pt reports continued abdominal pain and rates 10/10, with increasing nausea and vomiting. Pt eating Taco Bell Beefy Cheesy burrito, hard shell taco supreme, and Mexican Pizza at this time. No vomiting observed" "Pt observed smoking multiple times and advised by security there is a No Smoking policy within 100 feet of hospital entrance. Reports increase in cough at this time."

    I work behavioral health and use the same charting you described. Well said.
  5. 2
    Quote from ToothFairy(5)
    I work behavioral health and use the same charting you described. Well said.
    I agree about qualifying pain. I don't agree though with the attitude that can sometimes go along with it. I don't think it's up to me to always decide who is being honest and who is not. Unless you are working in a rehab facility
    applewhitern and ToothFairy(5) like this.
  6. 1
    Quote from L&DRegisteredNurse
    I agree about qualifying pain. I don't agree though with the attitude that can sometimes go along with it. I don't think it's up to me to always decide who is being honest and who is not. Unless you are working in a rehab facility

    Which I do. I never withhold the pain med though. I do document the behaviors that go along with what the patient says versus behavior before and after. The MD & therapist can go from there.
    OB-nurse2013 likes this.
  7. 3
    Quote from L&DRegisteredNurse
    I agree about qualifying pain. I don't agree though with the attitude that can sometimes go along with it. I don't think it's up to me to always decide who is being honest and who is not. Unless you are working in a rehab facility
    So true! Besides, pain is a personal experience, and like all personal experiences it can cause unique reactions. If this is the first time you've ever really had pain, you may go nuts. If it's the 1,413th day you've lived with pain, you very well might laugh, smile, play on your phone, and go about your business. If I stayed in bed every time I hurt, I would never get up and I could add decubiti to my chronic pain! I've learned to function in pain most people couldn't take simply because I must. Some days no one, except perhaps my husband and best friend, would have any idea how much I hurt. I learned long ago that no one wants to hear about it, or see it, or have to deal with it, so I mask it. It's easier than having those exhausting, aggravating conversations like, "Have you tried exercise?" "Have you ever cut out gluten?" "What about Excedrin Migraine? That works for my headaches!"

    Pain meds aren't deducted from nurses' salaries. We don't get points against our licenses if we administer them. Nurses should keep their judgments to themselves and just follow the orders. I walked around with a fractured humerus for a few weeks because, compared to what I lived with every day, it was uncomfortable but nothing really spectacular. So if I ask for pain medicine, even if I'm smiling and playing Angry Birds when I make the request, then I need it!
  8. 4
    I think the bottom line is, if the patient has a valid order for the PRN narc, and their respirations and LOC and all that are copacetic, then just *give* the darn narc.

    I was working with a nurse who would always get all a-flutter when a particular resident would ask for a PRN Ativan/Norco cocktail every night when he was "clearly" neither anxious nor painful, just chilling out and watching TV.

    Weary of hearing her complain about this for the millionth time, I replied one night that if I were a resident in a nursing home and this was what my life had come to, well, I'd probably want to get a little buzz on once in a while just to take the edge off, too. She looked at me like she was about to get the vapors and faint.

    Some nurses let their own personal judgements play way too big a role in their nursing practice.
    Last edit by BrandonLPN on Jul 18, '13
    chare, Esme12, monkeybug, and 1 other like this.
  9. 0
    Quote from xtxrn
    I don't think that was it- at least that's not how I read it We used Buprenex during detox for some addicts, and it does work well for getting people off of drugs- I don't have any experience with it for pain control. And, yes- I would agree, when those other narcs don't work, something else is needed. Maybe not addicted- but high tolerance and dependence
    They gave me Buprenex when I had my C section. I LOVED it. It worked well, I could get about 4 hours' sleep, and no side effects. Then again, a Tylenol knocks me out, so I have a teeny tolerance anyway. Not sure how I would be if I were on routine pain control.
  10. 1
    Quote from ToothFairy(5)
    Which I do. I never withhold the pain med though. I do document the behaviors that go along with what the patient says versus behavior before and after. The MD & therapist can go from there.
    See then I think you have a very difficult job. I would find that very difficult and I think after many years it would be hard to not have any judgment.
    ToothFairy(5) likes this.


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