Rate Your Pain - page 2

There's all sorts of pain. There's physical, emotional or a combination of both (and probably a lot more descriptive words that can be used). The most difficult part of pain for a nurse is to put... Read More

  1. Visit  Nurse_Diane profile page
    3
    I have a hospice pt who was an Oxycontin addict (heavy user) for several years prior to his dx. He is now is hospice care for Lung CA w metastases pretty much everywhere. He weighs about 80#. I am continually titrating his po Oxycontin and Oxy IR for his comfort. He is on very large doses of each. He takes 270mg of Oxycontin qd and receives 40mg doses of Oxyfast q1 hour prn for breakthru.

    To NOT give him these large doses because "he's an addict" is not only unethical I feel, would be malpractice on my part. I advocate for him w our hospice Doc. and titrate his meds as needed.
    Munch, jadelpn, and SoldierNurse22 like this.
  2. Visit  SoldierNurse22 profile page
    2
    Quote from Nurse_Diane
    I have a hospice pt who was an Oxycontin addict (heavy user) for several years prior to his dx. He is now is hospice care for Lung CA w metastases pretty much everywhere. He weighs about 80#. I am continually titrating his po Oxycontin and Oxy IR for his comfort. He is on very large doses of each. He takes 270mg of Oxycontin qd and receives 40mg doses of Oxyfast q1 hour prn for breakthru.

    To NOT give him these large doses because "he's an addict" is not only unethical I feel, would be malpractice on my part. I advocate for him w our hospice Doc. and titrate his meds as needed.
    EXACTLY. Addicts get sick, too.
    jadelpn and Nurse_Diane like this.
  3. Visit  Munch profile page
    0
    Quote from tokebi
    Wow Steve, what's your suggested alternative then? Get rid of all narcotics and leave all those patients writhing in pain? Snatch away all those antidepressants with which many people finally found a control of their lives?

    There are devastating effects on healing process if pain is not controlled. I shudder at the thought of patients denied of adequate pain meds on oncology wards or in hospice especially.
    Agreed...I thought the days of surgery without anesthesia went out the window with the bullets patients used to bite on.

    I forgot to add in my original post...I know a pretty famous quote by an English Judge named William Blackstone: "It is better that ten guilty persons escape than that one innocent suffer." This is obvious in regards to the criminal justice system..better to have guilty people out on the street than someone who did not commit any wrongdoing locked up for life. I feel the same in regards to medicating patients;

    I would rather give 2mgs of dilaudid IVP with 2mgs of ativan IVP to what turned out to be 100 drug addicts(of course without knowing at the time they were addicts) than to deny one person in legitimate, severe pain.

    Maybe I am still bitter about being burned that one time of being accused of drug seeking in the ER and then after the accusations turned out I had a really bad bowel infection...or maybe I am a left-sided nut job...call it what you want. But I think it's more criminal to deny a LEGIT suffering patient more than to medicate a suspected drug addict. That being said...if it's in my face someone is malingering I will be the first to bring my suspicions to the MD. If they have had twenty ER visits in the past three weeks for the same thing with no concrete evidence..maybe they do have pain..then the doctor needs to refer them to a pain management clinic. Also if you are on the fence on someone being a seeker then you can always check their controlled substance history(well nurses can't but doctors can...at least here in NY state, they have a data base with a patients name, the actual name of the controlled substance(s)(schedule II-V) they had filled, the strength, quantity, if they were from different prescribers(it doesn't give the ACTUAL name of who prescribed it, just if it they were from different people), the date it was filled and the pharmacy. I mean I have better things to do than play detective and chances are if I am on the fence about someone I will probably not go out of my way.

    But then again, I don't work in the ED so I can't really speak of the frustration of how many patients I see daily trying to get a free "fix" off the hospital. Most of the people I take care of are really sick, genuinely hurting a need a lot of meds for their recovery. Of course I am sure one or two bad apples slip through...but I am not going to let them ruin my day(totally not worth it) I was going to go into law enforcement but I didn't(that being said...I don't go around breaking the law either...I worked way too hard to get to where I am to throw my license away)...

    We can try to get them help...detox, rehab, NA meeting referrals..but unless they hit bottom and are ready to get clean for THEMSELVES, nothing will change. By not giving them their 150mgs of Demerol or 3mgs of Dilaudid isn't going to give them that "AHA" moment and ask for detox and rehab...bets are they are going to go elsewhere to score. That being said...I have to repeat myself...I will NOT medicate a known drug fiend with no medical issues...a drug fiend with a legit medical problem.say cancer or a gunshot wound is a whole different story.
    Last edit by Munch on Jun 13, '13
  4. Visit  subee profile page
    1
    Quote from Munch
    Agreed...I thought the days of surgery without anesthesia went out the window with the bullets patients used to bite on.

    I forgot to add in my original post...I know a pretty famous quote by an English Judge named William Blackstone: "It is better that ten guilty persons escape than that one innocent suffer." This is obvious in regards to the criminal justice system..better to have guilty people out on the street than someone who did not commit any wrongdoing locked up for life. I feel the same in regards to medicating patients;

    I would rather give 2mgs of dilaudid IVP with 2mgs of ativan IVP to what turned out to be 100 drug addicts(of course without knowing at the time they were addicts) than to deny one person in legitimate, severe pain.

    Maybe I am still bitter about being burned that one time of being accused of drug seeking in the ER and then after the accusations turned out I had a really bad bowel infection...or maybe I am a left-sided nut job...call it what you want. But I think it's more criminal to deny a LEGIT suffering patient more than to medicate a suspected drug addict. That being said...if it's in my face someone is malingering I will be the first to bring my suspicions to the MD. If they have had twenty ER visits in the past three weeks for the same thing with no concrete evidence..maybe they do have pain..then the doctor needs to refer them to a pain management clinic. Also if you are on the fence on someone being a seeker then you can always check their controlled substance history(well nurses can't but doctors can...at least here in NY state, they have a data base with a patients name, the actual name of the controlled substance(s)(schedule II-V) they had filled, the strength, quantity, if they were from different prescribers(it doesn't give the ACTUAL name of who prescribed it, just if it they were from different people), the date it was filled and the pharmacy. I mean I have better things to do than play detective and chances are if I am on the fence about someone I will probably not go out of my way.

    But then again, I don't work in the ED so I can't really speak of the frustration of how many patients I see daily trying to get a free "fix" off the hospital. Most of the people I take care of are really sick, genuinely hurting a need a lot of meds for their recovery. Of course I am sure one or two bad apples slip through...but I am not going to let them ruin my day(totally not worth it) I was going to go into law enforcement but I didn't(that being said...I don't go around breaking the law either...I worked way too hard to get to where I am to throw my license away)...

    We can try to get them help...detox, rehab, NA meeting referrals..but unless they hit bottom and are ready to get clean for THEMSELVES, nothing will change. By not giving them their 150mgs of Demerol or 3mgs of Dilaudid isn't going to give them that "AHA" moment and ask for detox and rehab...bets are they are going to go elsewhere to score. That being said...I have to repeat myself...I will NOT medicate a known drug fiend with no medical issues...a drug fiend with a legit medical problem.say cancer or a gunshot wound is a whole different story.
    "Drug fiend"? Really? One cannot be a "drug fiend" and not have a medical issue. It IS a medical issue - among psychological and spiritual deficits.
    jadelpn likes this.
  5. Visit  EGVnurse profile page
    0
    I've been working on a 30-bed orthopedics unit for a little under a year...so I am very familiar with pain assessments. I had a doc explain to me that bone pain is one of the worst types of pain and I took that to heart. Many of our patients come out of surgery with epidurals, perineurals, PCA pumps (dilaudid, fentanyl), Q pumps, around-the-clock pain med administration, etc. But I worry sometimes about causing low BP and respiratory depression. In our older patients I have that fear of delayed renal function. I once administered PO pain med and then breakthrough IV pain meds as well as oxycontin, to a patient post-op day #1 hip replacement; she was a&ox4, RR WNL. She also received BP meds in the AM; her BP and HR were WNL. But then the physical therapist came to get her out of bed and her BP plummeted. We put her in reverse Trendelenberg and bolus-ed her. Fortunately her LOC didn't change throughout. But it really worried me about administering pain medications in addition to BP meds & PT. Any advice or tips or experiences regarding safe pain medication administration? Thanks!
  6. Visit  Kidrn911 profile page
    2
    I personally dislike the pain rating sysytem. It know it is subjective. I know it is all we have. But when you have patients rating pain at an 11 on a 1-10 scale, that is having too much fun. It isn't anywhere close to being accurate.
    Ir15hd4nc3r_RN and canoehead like this.
  7. Visit  NurseOnAMotorcycle profile page
    2
    Quote from Kidrn911
    I personally dislike the pain rating sysytem. It know it is subjective. I know it is all we have. But when you have patients rating pain at an 11 on a 1-10 scale, that is having too much fun. It isn't anywhere close to being accurate.
    I agree. The conversation goes like this:

    Me to pt who c/o cough x2 days and is laughing with friends and texting: So how would you number your pain if 0 is no pain and 10 is the worst pain of your entire life?
    Pt: 10. Tee hee.
    Me: ok, so this the worst pain in your life. I'll let the provider know.

    Sigh.
    Ir15hd4nc3r_RN and canoehead like this.
  8. Visit  Munch profile page
    0
    Quote from subee
    "Drug fiend"? Really? One cannot be a "drug fiend" and not have a medical issue. It IS a medical issue - among psychological and spiritual deficits.
    You know what I mean...a legit medical issue that warrants the treatment with narcotics. My uncle was the perfect example(not to air my families dirty laundry)..had turned his trading office on wall street into his own drug factory of sorts..he was a self-proclaimed drug fiend(his words, not mine)...not only did he sell and make the stuff, he absolutely loved it. Long story short...he was watch by the DEA and the FEDS, got busted, was out on bail till his court date, got cancer and was in the hospital for the rest of his miserable life. If he had been denied medication because he was under the watch of the federal government, that would constitute cruel and unusual punishment. He had two medical problems...his love for controlled substances(of all kinds..ups and downs) and cancer. Sorry but cancer supersedes the addiction and thankfully the doctors didn't even pay attention to the latter, but more of the former.

    Now how do you treat someone who has his/her jones on for opiates when they don't want to be treated? and my apologies if my wording offended you..not my intent... I just try to cut to the chase and not beat around the bush and use euphemisms.
  9. Visit  Munch profile page
    0
    Quote from EGVnurse
    I've been working on a 30-bed orthopedics unit for a little under a year...so I am very familiar with pain assessments. I had a doc explain to me that bone pain is one of the worst types of pain and I took that to heart. Many of our patients come out of surgery with epidurals, perineurals, PCA pumps (dilaudid, fentanyl), Q pumps, around-the-clock pain med administration, etc. But I worry sometimes about causing low BP and respiratory depression. In our older patients I have that fear of delayed renal function. I once administered PO pain med and then breakthrough IV pain meds as well as oxycontin, to a patient post-op day #1 hip replacement; she was a&ox4, RR WNL. She also received BP meds in the AM; her BP and HR were WNL. But then the physical therapist came to get her out of bed and her BP plummeted. We put her in reverse Trendelenberg and bolus-ed her. Fortunately her LOC didn't change throughout. But it really worried me about administering pain medications in addition to BP meds & PT. Any advice or tips or experiences regarding safe pain medication administration? Thanks!
    Where I work we also have patients with PCA pumps and around the clock IV and or oral pain meds...especially some elderly people that have fallen and have gotten a TBI as a result..it's a fine balance with the pain meds and the blood pressure issue. I know it's not much of a tip, but a couple of co-workers on my floor carry a vial of narcan with them at all times...and they've had to use it more than a few times for the very reason, of a bottomed out BP or respirations or both...after that happens we get the MD to re-write for a lower dose and hope that helps...discontinuing all pain meds is inhumane of course especially if they are fresh from surgery...were on narcotics BEFORE the surgery long term..the narcan is really going to hurt them unfortunately...it's a necessary especially with someone who's never had an opiate history before and they come out with a PCA...I know some of our surgeons and anesthesiologists tend to be more liberal with the pain meds, which most of the time is a good thing..but sometimes patients have a low tolerance for the meds and it backfires.
  10. Visit  Steve123 profile page
    0
    It's not our place as healthcare providers to decide what a patient's pain really is. We need to look at our patients as whole people and assess carefully.

    This kind of theories are written for us by those who wants us to be primitive drug pushers...
  11. Visit  montinurse profile page
    0
    Steve, I agree with you 100% I think it all boils down to people doing these studies and the ones who invented the pain scales sit in a different world (non clinical) I would like to see a pain scale that includes the nurses assessment. The problem with our society is that we feed the addictions and everyone knows it. Luckily some of the doctors I work with listen to me and value my opinion. Some don't. Anyways, with the psych eval and EDO, that person will be back next week for the same problems. The hospital is a safe haven for homeless, socially inept drug addicts.
  12. Visit  cadawasp profile page
    0
    I am going to weigh in on both sides. I am a hospice nurse that now works in the office due to chronic pain secondary to spinal stenosis, so I have been on both sides of this issue. As a hospice nurse I frequently needed to work with a report of "a little, not too bad, to the worst ever" I always believed my patients and sometimes needed to convince them to take the pain meds. One thing that was not mentioned was the use of adjunctive medicines such as neurontin or Lyrica for nerve pain, Cymbalta or Elivil for nerve pain, NSAIDs or steroids for bone pain. The use of these in addition to the opioids or even alone can help with pain. This is one of the reasons that knowing where the pain is and a description of the pain needs to be asked to help find the type of pain and how to medicate the pain.
    Now as a chronic pain patient. I have taught classes with a pain level of 10, no one else to teach the class and able to "fake comfort". People who knew me could tell but not a group that did not. I have been taking either neurontin or Lyrica (moving from one to the other and back) for about 10 years now. My pain doctor added Cymbalta at some point for both nerve pain and depression. During this time I have been using Vicodin ER for breakthrough pain. I have also had three surgeries on my back during this time and have used a PCA pump post surgery of dilaudid. I did find myself unable to just stop the Vicodin after the surgery recuperation and needed to decrease it so I could return to prn use.
    We need to look at many aspects of our patient's to understand their pain needs the cause of the pain, type of pain, what has worked in the past and what has not to name just some of what we need to know. Realistically that is hard to do with the time constraints in the hospital but knowing severity, cause, and description can help to see that our patient's are cared for in the best way possible.


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