RNs, I got a question about pain meds

[tarotale]

I tell you, working as an RN, you start to see a pattern in every corners. When you get a report, the minute the ED nurse says "the patient is obese", your immediate reaction is "okay, CHF, BNP higher than Empire State, probably diabetic with messed up kidneys, etc, etc" or you will get a report saying that the patient has "allergies" to toradol, acetaminophen, and morphine, and you start chuckle and think "this one is looking for dilaudid!"

I am not condoning to be judgmental, but you know what I am referring to about the "pattern." I have question to experienced nurses and non-experienced nurses likewise; do you think that socioeconomic status has impact on how much pts are "pain med seeking?" For example, I work in the "hood" (don't live in it, thank God) where most of pts are... of low socioeconomic status and 8/10 will do and say any rotten lies to get more pain medicine; I mean we all have seen it; a pt who is watching TV or talking on a phone, laughing with friends, then turning to you and say they got pain 10/10; having seen so much of that, I don't believe what the nursing school teaches about the "golden scale" of pain, which is whatever the heck they say it is.

I saw men in their 60s and 70s on IMC floor recovering from open heart surgery and they tell me "oh I will try to do without it." and this was from a hospital that I worked before where the clientele were relatively more educated and wealthier.

So this led me to this curiosity; does socioeconomic status affect one's pain med seeking behavior? From my experience so far, the hypothesis seems to prove itself true. I want to hear your experiences.

[brownbook]

A patients reaction to pain is physical and psychological. At the physical, down to the DNA level, opoid receptors vary from person to person, but more importantly from race to race. If their pain receptors do not react to morphine or other opoids, they are not going to achieve pain relief.

Psychologically they have been condition over react when experience pain. Knowing that whatever the nurse puts in their IV won't work and no one will believe their complaints of pain.

By over react I mean tensing up and convincing themselves (no matter what) that the IV or pain pill won't work.

I believe there is evidence that black people at a genetic level have less or different opoid pain receptors than white people.

I am assuming that by lower socioeconomic level from the hood you mean black people?

[nursefrances, BSN, RN]

When I ask a patient about their pain and they pull the laid back/relaxed "10/10". I ask them could it be worse? This sometimes stops the laid back position. They wonder what I mean. And I ask nicely, could your pain be worse than it is now. They say, "well, yeah." (of course it could be worse. Do you see how relaxed I look?) I explain it isn't a 10/10.

I would reeducate them on the pain scale and how the goal is to keep their pain level down so they don't get to a ten. They will usually change their answer to a six or seven. I might also say a ten is like child birth or someone cutting your arm off. They get a kick out of that one.

[uRNmyway, ASN, RN]

okay seems from many of you that socioeconomic status does not affect habit of drug seeking... I am surprised to hear that the drug seeking habits are of equivalent prevalence in both kinds of hospitals that serve high and low socioeconomic status. Man, is everybody hooked on these meds? I don't quite get it.[/quote']

Well, I do kind of agree

with you on this. I do work in a hospital now, with generally lower socio-economic status. I definitely see a difference between seeking behavior now than I used to see.

[Whoatemyburger]

Pain meds seekers are pain meds seekers . Period ! I honestly hate them . Specially when I have really sick people to care for and here they are wide awake and laughing calling you every 3 hours on the clock for dilaudid . Once in a while you get the nice ones who are willing to wait extra five mins for you. I had a horrible pt that almost hit me with the IV pole over pain meds . Can't forget that one !!!!!

[MrChicagoRN, RN]

Poor people with little or no insurance who are seeking meds go to the ER

Those with financial resources can see their doctors, pick up the Rx at Walgreens or CVS Afterwards.

[Fiona59]

^^^This^^^

I'm amazed at the number of young people (21+) that have their parents stay at the bedside with them 24-7 and seem to dictate their lives.

An the parents always know better than you. I now tell them the patient is an adult and legally I need their written permission on the chart before I can discuss their care with anyone.

Sheesh, by the time I was 21, I was married and living on another continent. My kids would die of shame if I pulled some of the stunts I've seen these helicopter mamas pull

[Esme12, ASN, BSN, RN]

I will tell you....I have worked both ends of the spectrum. I have worked where you counted the penetrating woulds and if they had a good O2 sat...they waited. I have worked where the entitled felt you were the servant...I once had a patient (who called himself a member of the hospital...he had a medical record number) who wanted me to tell the pilot of a commercial airline to divert an entire aircraft because he was a member of this said hospital....he had a dilated pupil from scopolomine.

I found addiction is addiction. Seekers are seekers regardless of what they wore or the color of their skin. Wealthy people were as addicted as the poor if not more so because they could pay for the MD's compliance. I found the entitled children of these people obnoxious and ill mannered. While I have worked in one of the most "rough" areas of the US....I was more threatened by an American Airlines pilot who threw me into a wall because he waited too long for his child to be seen for a chin lac.

Addiction does NOT discriminate.

There are studies that indicate the people of color may have a different response to pain and are more sensitive....

[h=3]Role of Race on Pain & Analgesia medscape: requires registration but it is free.[/h] Pain sensitivity appears to differ among different races/ethnicities. There is considerable evidence to suggest that African–American and Hispanic patients report lower tolerance for experimentally induced pain compared with Caucasians. ^[77–79] Moreover, there are reports of racial disparities in the prescription of opioid analgesics in the management of postoperative pain. ^[80] Recently, we have demonstrated that race is associated with an unequal burden of perioperative pain and opioid adverse effects in children. Specifically, African–American children had higher postoperative pain and Caucasian children had higher incidences of opioid-related adverse effects following tonsillectomy.

there is also evidence that red hair people do as well.

A growing body of research shows that people with red hair need larger doses of anesthesia and often are resistant to local pain blockers like Novocaine. As a result, redheads tend to be particularly nervous about dental procedures and are twice as likely to avoid going to the dentist as people with other hair colors, according to new research published in The Journal of the American Dental Association.

Researchers believe redheads are more sensitive to pain because of a mutation in a gene that affects hair color. In people with brown, black and blond hair, the gene, for the melanocortin-1 receptor, produces melanin. But a mutation in the MC1R gene results in the production of a substance called pheomelanin that results in red hair and fair skin.

The MC1R gene belongs to a family of receptors that include pain receptors in the brain, and as a result, a mutation in the gene appears to influence the body’s sensitivity to pain. A 2004 study showed that redheads require, on average, about 20 percent more general anesthesia than people with dark hair or blond coloring. And in 2005, researchers found that redheads are more resistant to the effects of local anesthesia, such as the numbing drugs used by dentists.

[traumaRUs, MSN, APRN]

Here is a study from the National Institutes of Health

The perception of pain in others: how gender, race, a... [J Pain. 2012] - PubMed - NCBI

[annie.rn]

When I ask a patient about their pain and they pull the laid back/relaxed "10/10". I ask them could it be worse? This sometimes stops the laid back position. They wonder what I mean. And I ask nicely, could your pain be worse than it is now. They say, "well, yeah." (of course it could be worse. Do you see how relaxed I look?) I explain it isn't a 10/10. I would reeducate them on the pain scale.

Great idea! I'll use this.

[annie.rn]

Oops, put my comment at the bottom of the quote somehow.

[ClearBlueOctoberSky]

What about the countless professionals who seek or are addicted to pain meds? They are certainly not in the lower socioeconomic class. Addiction isn't confined to just one class.

And as an aside, as someone who is allergic to multiple pain meds, whatever isn't controlled with Tylenol, Ibuprofen, or Aspirin, I just suck it up and deal with it. Knowing all too well the stigmatism and supposition surrounding those allergies, I would rather pass out before asking for pain meds.