Have you ever done/wanted to do this?

Specialties Med-Surg

Published

You know how it is when you have these patients who are A&Ox4, laughing, talking on the phone, going out to smoke but when it's time for their IV pain medication all of a sudden "oh I'm hurting so bad, I need my pain medicine" as soon as you give it they get up and go out to smoke. The ones I love are the ones who hold up the closest port when you come in, "here you can give it here" or "you can push it fast, the burn doesn't bother me". Well anyway, I have been so tempted to push NS instead of pain medicine I'm sure this would be illegal if not immoral since we are not supposed to judge a patients level of pain. More than 20 years ago when I worked in a Doctor's office he would occasionally have us give an injection of NS in place of pain medication and the patient was happy and pain was relieved. Any opinions?

Specializes in Cardiac Telemetry/PCU, SNF.

I've had patients in rotation where you think about this. Like the one you walk past and he/she's doing just fine until the moment you ask and then starts moaning. Or the one who knows exactly when the next dose is due and is on the bell when that clock hits the time. But I always say to myself that pain is a subjective thing and I can't possibly know how they feel. But the other thought crosses the mind.

Funny story about this though...

My wife was tending bar one night at a crappy job and this very intoxicated gentleman kept asking for more. She wanted to cut him off when he walked in the door, but management wouldn't back her on it, so she did what we all have thought of. Poured him his rum & coke, mostly coke with a splash of rum on the top so he would smell it and be a happy camper, then called him a cab and sent him home.

Cheers,

Tom

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Specializes in Med/Surg, Ortho.

We see these come in frequently,, admitted with nonspecific abdominal pain. Given IV meds but are up and going as soon as the medication arrives. You have to remember the abdominal pain is a s/s of withdraw, and that very often seems to be the case with these.

NO i wouldnt do the placebo thing, i dont feel it is ethical. But, usually when these folks are switched to PO,, and realize they arent getting IV anymore,, they miraculously get well and are discharged soon after.

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Specializes in Neuro/Med-Surg/Oncology.

I definitely see where the thought crossed your mind. I had a pt who was on 20 mg Methadone q12h and was getting Dilaudid IVP 2-4mg (of course the 2mg did not work) q2-4h for ABD pain. He had complications from Crohn's and was addicted. At 2am one night he was completely stoned and was asking for his Dilaudid again 30 min after I gave the first dose. I told him that I couldn't give it to him until 3:30. The other nurse I was working with and I were talking. Seem's he was only doubled over in 20/10 pain when we were in the room. I decided to let him go until he asked for it even though I told him that I would be back when it was due. Had to go in the room again to hang an antibiotic at 5am and he said he felt so much better, but he wasn't due again until 5:30a. :rolleyes: I told him that I hadn't given it yet b/c he was finally sleeping soundly and hated to disturb him. Asked him to rate his pain and he stated 4/10. I told him to let us know when it got to be 7-8/10 so we could stay ahead of his pain. I even asked him if it built up gradually or hit him fast and he said that it builds up gradually. I had not even made it to the nurses station when he rang out. His pain was suddenly off the scale again. Imagine that. :icon_roll I'm not a rehab nurse, so I gave it. He was clear headed. What was I going to do? He was already seen by the pain clinic at our hospital. I think he was depressed from being sick and other life curcumstances that he couldn't face life without being stoned.

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I have never given a pt a placebo, but I did hear a funny story at work about a similar circumstance.

There was a pt that constantly came in complaining of some kind of pain or another and would get pain medications. Apparently the nurse's thought the pt was a seeker. (i'm not saying she was or wasn't, just telling the story) So anyway, the nurse did an assessment and spoke to the doc about the pt. The doc told the nurse to ask the pt if it hurts between her eyes when she pees. He just made up something assanine that could never be related. So, the nurse went in to the pt and said "I spoke with Dr. so and so about your pain and he wants to know if by any chance you experience pain between your eyes when you urinate". The pt says, "well yes, as a matter of fact I do". Go figure :rolleyes:

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