Drug seeking patients? - page 12

What do people think about the term drug-seeking patients? I guess I have a hard time with it because usually these people are complaining of pain and who are we to judge whether they are or are not... Read More

  1. by   allaboutthefamily
    Quote from ecnav
    I'm thinking about 'evidence based medicine'. Why not employ polygraphs -lie detectors- in the pain assessment. Like bispectral analysis used in anesthesia, polygraph science might help identify factitious complaints. Like bispectral, it wouldn't be the sole determinant, just another source of information leading to more complete patient assessment.

    :typing
    A polygraph would not be the way to go IMO. They are not exceedingly accurate in controlled experiments (in some 25-50% inaccurate). Furthermore, a polygraph measures respirations, skin moisture, temp, etc. all things that are affected by acute or chronic pain. That is to say it would be hard to tell when someone was lying or just experiencing a bout of acute pain. I have heard of a technique to "trick" polygraph machines, by creating your own pain (i.e. digging nails into palms, putting a pin in your shoe) you can actually raise the measured parameters during baseline questions making subsequent lies appear as truth. I know I wasnt very clear in this post, I just have never subscribed to the accuracy of a lie detector and would defenitely not believe EBN based upon polygraph machines. I do think you are headed in the right direction though, perhaps imaging studies of the brain would be more in line with what you wish to accomplish.

    Even this would not solve the problem, because we cannot very well image every patient complaining of pain, but it would give us a better idea as to the scope of the problem.
    Last edit by allaboutthefamily on Apr 7, '08
  2. by   nanacarol
    The patient who OD on cocaine really did not receive the appropriate treatment from his primary physician. Taking him off of his addictive medications without addressing the addiction failed the patient. It would have been great if you and the other nurses had had other resources to refer the patient to. Our responsibilities are far reaching. nanacarol
  3. by   nanacarol
    Why not take it a step further and really investigate the source of the pain, whether it is physiologic or physical, chronic or acute, whether it is emotional or spiritual. That would be the real appropriate strategy. But we don't usually have the time or training to do any of that. So we should be faced with merely taking the patient's assessment and report in lieu of any stand out explicit data that refutes the patient's complaint and medicating the patient. We are not the drug police, we are to minister to the patient not add to the patient's stress and feelings of being devalued. nanacarol
  4. by   sociostudent
    i have often thought of going to canada or mexico, even, to find out what's wrong with me. i live in texas, and so canada seems like a long way to go. but mexico is only 8 hours away.
    the point i wanted to make with my original post, is that a person in chronic, unrelenting pain is eventually going to do whatever it takes to relieve their pain and suffering. if that means crossing a border or using a substance illegally even (smoking marijuana, etc.), they'll do it. and if doctors are unwilling to provide any pain relief (or nurses are unwilling to push them) to those who are truly in pain, that person is going to be nonfunctional in their daily life (unable to work or take care of their family) and will suffer from mental health problems due to chronic, untreated, and unbelieved pain. the best-case scenario would be for the physician, nurse, and patient to all work together to treat the pain (multifocal modalities such as physical and emotional therapy, as well as pain medication) in a setting that is nonaccusatory or non-biased. if the patient is truly in pain, they will be more than willing to undergo the drug-testing, the mandatory therapies if it means that the pain will ease. however, outside of a cancer treatment setting, i have not seen this truly happen yet.
  5. by   I love my cat!
    Quote from sociostudent
    the point i wanted to make with my original post, is that a person in chronic, unrelenting pain is eventually going to do whatever it takes to relieve their pain and suffering. if that means crossing a border or using a substance illegally even (smoking marijuana, etc.), they'll do it. and if doctors are unwilling to provide any pain relief (or nurses are unwilling to push them) to those who are truly in pain, that person is going to be nonfunctional in their daily life (unable to work or take care of their family) and will suffer from mental health problems due to chronic, untreated, and unbelieved pain. the best-case scenario would be for the physician, nurse, and patient to all work together to treat the pain (multifocal modalities such as physical and emotional therapy, as well as pain medication) in a setting that is nonaccusatory or non-biased. if the patient is truly in pain, they will be more than willing to undergo the drug-testing, the mandatory therapies if it means that the pain will ease. however, outside of a cancer treatment setting, i have not seen this truly happen yet.
    excellent points!
    then i read articles like this:
    nursing homes undertreat dementia patients' pain

    from article:
    researchers at the university of north carolina chapel hill evaluated data for 551 residents of six nursing homes across the state and found that residents who were cognitively impaired were less likely to receive regular doses of pain medication or to receive pain drugs at all.
    this was despite the fact that dementia patients and cognitively healthy patients had similar rates of often-painful conditions like cancer, osteoarthritis and degeneration in the spinal disks.
  6. by   traumasurfrn
    hey been there! i am rn with ER, Trauma, micn, and Er charge. Over 9 years experiance. I too have Chronic pain been on fent patch for 5 years same dose, no impairment loc, but has improved my quality of life greatly. I was in Er and 400 lb guy feel on me in the ambulance bay, herinated my neck and fx my back, 4 surgeies later, neurogenic bladder, bowel and saddle anesthsia. my pain is controlled very well unless i lift something heavy then i am in bed with severe pain. Lately i have been trying to go back to work in hospice or homehealth where moving patients is less likely. Anyway, i look very healthy and after i get hired i let them know about my past medical history and the use of the patch, because i believe in being honest, and then i get that look (drug seeker look) and this job is not for you look, I almost want to cry everytime. Maybe i should just give up and go work at lowes. any advice, thanks
  7. by   clee1
    You hx is none of your employer's business.

    You only need to tell them about your working limitations, not your treatments.
  8. by   RNTwin
    i here "obecalp" works really good for chronic pain....
  9. by   Bobylon
    I can't say much ..... at times, I feel I'm working in a pain clinic (I'm sorry, but if someone rates their pain as a 10 out of a possible 10 level, they won't be resting comfortably, sedately, and mellow. Perhaps they don't understand the concept of the PRS, or perhaps they just want their high/low...... I am not going to judge, just going to do what I can). My facility policy is if someone complains of pain, it gets documented and treated with whatever med is available to administer at that time. Someone who can't get their Dilaudid push, but can have a Vicodin will then want a Phenergan push along with the Vicodin, with absolutely no c/o nausea, which cracks me up - and ticks off the RNs. We get our share of apparent "drug seekers," but .... we're not here to judge, and if the doc has meds prescribed, then the pt gets them when available. It's not MY call...MDs are primarily responsible for the great prescription addiction problem in the US.
  10. by   imintrouble
    There are pts who come to the hospital simply for drugs. Admitting that fact doesn't make me heartless. I give the pts whatever I have ordered, as soon as I can give it. I never withhold meds. I don't give them a hard time. But I won't call the MD at 0200 when the pt sobs for more drugs. Especially when they lay in bed quietly talking on the phone, until staff comes in.
  11. by   msnobodycares
    Everyone is a seeker and out to sell pills to junkies. Everyone...including your sainted grandmother. The xray of the kidneystone is just a clever ruse to fool you into believing they are in pain. Dont fall for it. They will get a woozy high on that shot you give and then peel out in a wheelchair and head out the door to go party! And that gaping wide wound in their head, well thats just strawberry jam...they arent hurt at all....NOOOOO.
    Seriously, is it that important? Cmon!
  12. by   GLORIAmunchkin72
    "...we're not here to judge, and if the doc has meds prescribed, then the pt gets them when available. It's not MY call..."

  13. by   Catedi
    A wise nursing instructor told me, "It is not for us to judge. Regardless of a pt's issues in the outside world, once they enter the hospital, they are equal in the eyes of the caring nurse." I love that saying and use it when I feel judgment start to bubble up. It helps me stay in the moment with my patients, and that's where I need to be.

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