Drug seeking patients? - page 6
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
Jul 6, '02As a nurse if they have an order for pain meds then I will give it as long as I don't think they are in jeopardy, but... There are drug seeking patients PERIOD!
Jul 8, '02In my never ending quest to search for possible new treatments for my diseases and conditions I frequently search the net as do a lot of patients. In fact, the internet is somewhat responsible for my being able to finally get diagnosed. Now mind you, I have seen over 40 physicians in the last seven years and as I replied in the above post I have run the gamut from accusations of faking, malingering, making it up because I'm a nurse, making it up because I found it on the internet, etc., to finally being believed. I'm sure you get the point.
You know, I think it is really sad that I cried with JOY when I finally got all my diagnoses: Chronic Regional Pain Syndrome types I and II (aka reflex sympathetic dystrophy), Fibromyalgia/CFIDS, Myofascial Pain syndrome, POTS, Dysautonomia, Aortic Insufficiency, Neuritis/Neuralgia, Brachial Plexus Neuritis, Long Thoracic Nerve injury, Thoracic Outlet syndrome, Phrenic nerve injury, Bilateral Trochanteric Bursitis, Impingement syndrome rt shoulder, Cubital Ulnar Nerve Entrapment, Carpal Tunnel syndrome, Degenerative Joint disease and Degenerative Disc disease, Facet Joint Disease, Uncovertebral Joint Spurring, Cervical Spondylosis, Herniated Thoracic and Lumbar Discs, Bulging Cervical Discs, Sciatica, Meralgia Paresthetica, SI Joint Dysfunction, Plantar Fascitis, Occipital Headaches, Femoral Neuritis, Insomnia, GERD, Vestibular Neuronitis and possible Lupus. Oh, I forgot- and Depression.
Why would the above cause me to feel even a shred of hope or joy??? Because I thought the suspicion and accusations would stop!!! I could finally get treatment without being judged. Wrong!!! For the most part my disabilities are invisible as I don't flash my extremities with the swelling and discoloration. Yes, I have a handicap placard and I only use it when I absolutely have to. The only reason that I can even go anywhere or do the little driving that I do is because I am on MS Contin and MSIR. Because I don't "look" sick I get stares and sometimes even cruel comments and arguments from people who don't think I have the placard legally. They get told to blow it out their a$$. I'm not shy.
I am unable to tolerate any of the anticonvulsants such as Neurontin and Tegretol etc. because they render me incoherent which defeats the purpose of taking them. I can completely attest to the fact that at least the TCA antidepressants such as Nortriptylin and Elavil DO have an impact on the pain, not a lot but I'll take whatever I can get. I was really a skeptic at first but I'm a believer now.
I can assure you that even though they are not supposed to help at all with neuropathic type pain the opioids are the only things in the way of pain meds that have helped. In a more perfect world my dose would be raised at my next office visit with the PM doc because I have been on my present dose for almost 1.5 yrs.
Behaviour such as clock watching is a sign that a pain pt. is undermedicated. As a matter of fact, UNDERMEDICATION is a huge problem for most pain pts. We try our best to avoid ER's -at least most of us do, to avoid the judgement, the looks, the suspicion. When I call the Pain Service the doc on call usually ok's an additional rescue dose and says see your doc at your regular visit. In the last 4 years I have only called twice and that's because my husband said he would call if I didn't. I've sobbed in excrutiating pain, begged for God's mercy, and prayed for SLEEP rather than having my husband take me to the ER. Yes, SLEEP. I have learned to live with the pain while I sleep, when I sleep and IF I can sleep and STAY asleep. It doesn't mean I'm not hurting but more than likely I've passed out from exhaustion. Actually, sleep is a legitimate coping mechanism.
I am reminded of it every time I roll to either side and even when I am on my back. My rt shoulder blade is so winged that it protrudes from my back onto the mattress and caues pain and pressure. I am unable to sleep on my abd because of adhesive capsulitis and limited cervical ROM.
So, if you see a pain pt sleeping don't be suspicious and think that all is well- be happy that the pt was able to get some merciful peace from the agony but they are very likely to still be in pain. It takes a LOT of energy to try to employ cognitive behavioural techniques and distraction to avoid letting yourself FEEL how much you hurt.
I will go to great lengths to NOT let you know that I am hurting as badly as I do. I won't scream, grimace, or attempt to PROVE to you that I hurt. Why? Because it is degrading and demeaning and I'd like to retain my pride- integrity also prevents me from having to put on a show. I am an honest person and I'd much rather be in pain at home in miserable pain than having to report and repeat my extremely lengthy history ad nauseum for the gazillionth time only to be met with the "look". I have exhausted every possible intervention, modality, and cognitive behavioural technique before I give in and ask for additional help because I've been burned. At this point my trust has been severely tested. You know, I can't even stand to repeat my own history and have to listen to it myself!
This experience has motivated me to do all I can to let docs and nurses see it from the patient's point of view from "one of their own". Sometimes I am appalled at the resistance but that won't stop me from trying to advocate for myself and patients in pain. Those jerks that have abused these very necessary meds have set pain management back so far- but it really wasn't that far ahead to begin with! LOL!!! It's so aggravating that their irresponsible behaviour makes it so hard on people like me.
What has really hurt has been the disbelief from my fellow colleagues. I spent 23 yrs. caring for others but when I needed it the most I was horrified. Please be compassionate and try to think of the impression you will leave on your pain pt. I know there are patients who take advantage of you. I am asking you to open your minds and your hearts to those of us who are legitimately in need. Remember, you might not be able to see our pain but at least give us a chance to tell you why we are there without judging us before you've even talked to us for a while.
If I can help even ONE pain patient avoid the doubt and suspicion of their complaint, then I guess I will have succedeed. My heart is just broken that I am too ill to practice nursing ever again. You are so lucky that you still can even though many times it is tiring and exasperating. At least you can still go there and experience what nursing is all about.
While searching the net I came across some info on one of my favorite pain sites.
There are several excellent articles about pain and pain management.
Dr. David Marley on "Opioid Addiction and Abuse"
The CME/CE section entitled " Care of the Patient with Pain"
and I encourage you to read the "Ask the Doctor" section. Check out the "Ask the Doctor" archives.
AND I would be remiss if I didn't ask you to read about Reflex Sympathetic Dystrophy now known as Complex Regional Pain Syndrome typesI and II and also Central or Thalamic Pain (aka Shoulder Hand Syndrome- sometimes happens after CVA's or MI's - it's a form of RSD). It is extremely difficult to diagnose and is far more common than one realizes.
One more thing- check out the articles on preemptive treatment of pain where it is discussed doing incisional blocks and epidurals before a pt's surgery to avoid being bombarded with pain signals. There's even an interesting article about treating pain in premies.
So if I can do my part to get the word out- so be it!
I thank you for your patience or impatience if that's the case for reading my lengthy replies. I am so happy to have found this site to be able to converse with other nurses even though I can no longer practice. I am amazed at the number of injured/disabled nurses.
Warm personal regards,
Jul 8, '02Originally posted by fab4fan
1. Vital signs are not accurate indicators of pain.
2. Behavior is also not an accurate way to measure pain; pts. will do things to distract themselves from pain.
3. Sleep/sedation does not equal pain.
4. Misleading a pt by giving NSS IV push and letting them think it is a pain med is ILLEGAL; placebos MUST be given with pt consent. You will have no leg to stand on if a pt finds out and tries to sue.
5. Calling someone a "drug-seeker" is an inflammatory a judgemental statement, and is considered inappropriate in any of the reputable pain mgmt. materials.
6. Everyone, including addicts, has a right to appropriate pain control; there may even be times when giving an addict a narcotic for a limited time may be appropriate and even necessary; again this is in reputable pain mgmt literature, e.g. AHCPR guidelines, ASPMN literature, etc.
7. Pain is whatever the pt says it is, and exists whenever the pt says it does--M.McCaffery MSN, RN
8. In line w/ #7, the pt self report of pain is the most reliable indicator of pain.
The problems of patients are hardly ever black and white and so we _cannot_ say there are no legitimate patients that fail to receive adequate pain relief. We also cannot say their are no addicted patients requesting narcotic pain relief. Life sure would be simpler if we could say either one of those things. Just as false reporters of child abuse, rape, and almost anything else complicate pictures, so do addicts who do manipulate the system for pain medicines.
Now lest some of you object to the phrase "index of suspicicion" above. This term is a fine and not prejudicial term. It describes the ability to think broadly about a subtly presenting but often devastating health care problem. ER nurses must always have an index of suspicion for ectopic pregnancy in females of child bearing age with lower abdominal pain. If they don't, they will miss this subtle presenting problem. So they must suspect it in the "mayor's" teenage daughter and the respectable married woman who's hubby had a vasectomy and the widowed peri-menopausal woman. Let me tell you those can be uncomfortable situations, but if the nurse and ED doc don't do it, someone can die. We work to increase our index of suspicion all of the time on subtle but devastating health care problems like the woman's unique presentation of acute MI, acute aortic aneurysm and child sexual abuse.
However, here we have a framework that practically forbids us to have an index of suspicion for addiction, an all too common and devastating problem. I find that disturbing.
Now my ideal world IS NOT one where nurses run around acting on hunches about addiction and confronting their hapless patients right and left. Being the person who has possession of the narcotic keys (and power over them) requires compassion and thoughtfulness. However, patients with chronic pain need pain management by a single doctor or group of docs and they need to understand their obligation to not doctor shop and to stay within the rules of their pain contract, which should include a plan for breathrough pain. Nurses who interact with patients that tick their "index of suspicion" for addiction should document, document, document and communicate with the primary care giver. If they can have a positive relationship with the family, they may come to understand the dysfunction or lack of dysfunction that addictive vs functional behavior can create in a family, though I would guess that families that deal constantly with a member's chronic pain experience some of the problems related to families coping with chronic illnesses (a no-brainer, right?)
Gee, i wish we could make a sweeping pronouncement about addiction and say that it does or does not ever occur, but it really is more complex than that.
Jul 8, '02Hello Molly J
I agree with you about the "index of suspicion" and to fail to address the issue of addiction would be egregious. Pain and the failure to treat it and it's udermanagement is also destructive to lives, families, and communities. I guess where I feel the most sensitivity regarding this issue is when judgemnetal behaviour is projected on the patient right from the start without even having any information except a personal bias. I did not mean to imply that addiction should never be suspected.
Fortunately, there are nurses such as yourself that would hold your index of suspicion to yourself until you have made your assessment. There are also nurses who wear their suspicion on their sleeves before you have even had a chance as a patient to open your mouth. They look at why you are there, see "pain" and out comes the attitude.
By the time that pain patients get to the point where they have finally been diagnosed as accurately as possible they have been to several different doctors- this has been documented in many studies. In my own case, what looks like "doctor shopping " is NOT the case.
Yes, I have seen over 40 different docs over the last seven years. In all but 3-6 occurences right at the start of my " diagnosis seeking " with a cyanotic, cold very painful arm I have been REFERRED to almost every one of the docs I have seen. The exceptions are at the onset of the RSD symptoms when my primary , neurologist, and neurosurgeon had NO answers and accused me of making it up. How in the world can you make up fingertip temps of 69 degrees and shoulder temp of 81 degrees measured while having an NCV/EMG? ( the neurologist accused his assistant of turning the a/c too low and reprimanded her right in front of me!) I knew something was VERY wrong with me but I kept being told that I was making it up or faking it. The other changes in docs came with insurance provider changes.
I can see where this might appear to be "doctor shopping" to some but if time is taken to elicit a fair and complete history there are also the circumstances when insurance changes necessitates changing pcp's and specialists who are managing (now that's a relative term!) care. For the most part I went in the direction the docs pointed me- kind of like being a hot potato getting passed around. By the way, each one had a different diagnosis to add to the confusion- mine included.
Your analogies are great and make perfect sense. I would hope that more staff would develop this mindset. You have obviously been provided the knowledge to understand that each entity is a separate problem. You either took the time to educate yourself or it was provided to you by another source or both and more. Nurses who are faced with these issues in their areas of practice have a responsibility to seek clarification through education.
I wholeheartedly agree that there are addicts and people who would go to any lengths to obtain their drug(s) of choice. Personal experience with family members and when I was working in NICU provided the opportunities for me to witness it firsthand sometimes. The hospital where I practiced was a large, pediatric, tertiary refferal hospital locatecd in the city. Our patients ran the entire economic spectrum and proved for any doubters that problems with drugs was not an entity confined to a lower economic bracket.
There is so much room for education regarding both the issues of pain management and addiction. Let's hope that as time goes on more nurses will be amenable to learning and understanding the difference. It is a very frustrating issue for all involved. After my experiences I just wanted to explain from my point of view what it feels like to be labeled unfairly and incorrectly. It felt wrong and I felt the need to speak up regarding a patient's perspective.
If by some miracle I was ever able to return to practice I would hope that my experiences would help me bring to the table some greater perspective on the matter to make an assessment based on all of the ways an accurate assessment should be made.
It is apparent in my zeal to attempt to provide further depth and understanding that it seems like I feel that most nurses don't take the time to get the info from the pt or that I am naive about the possibility of addiction. However, I think it is just a reflection of what happens when a nurse doesn't take the time to educate himself/herself about all of the issues. There can be a significant amount of emotional damage that may inhibit a patient from seeking the necessary treatment because they are afraid of repeating a very negative experience. It is exactly why I will not go to an ER when my pain has flared despite all interventions that I have employed to get it under control. I've had many hours of mind numbing pain that could have been helped but wasn't because of my own hesitation to avoid all the hassles it involves to seek emergency treatment for pain.
I hope that none of you would have to experience some of what I have. But if you do for your sake I hope your nurse will be educated and informed regarding pain management vs. addiction and will not inflict personal biases on you.
Hopefully, the pain patients bill of rights and sincere efforts on the part of hospital's etc. to provide the education needed for nurses to make good decisions will shed some necessary light on this problem and will spare some patients a lot of misunderstanding. I think Margo McCaffery's intentions are to basically tell nurses and doctors to hold back the index of suspicion until the facts have been explored but not to indiscriminately provide treatment. She seems to be saying to give the patient the benefit of the doubt. By looking at me you would never guess that I am a pain patient. I make every effort to wear nice clothes and makeup in an attempt to feel halfway normal. The only way one would know would be to look at my arm and to interview me or to touch me- now that would definitely get a strong reaction.
Thank you Molly J for taking the time to reply. I appreciate your views. You are obviously very educated regarding addiction and have provided some excellent analogies.
Warm personal regards,
Jul 9, '02Pappy,
To me "doctor shopping" is when a patient is getting narcs from 2 or more doctors and those doctors DO NOT know that another doctor is prescribing narcs for that patient. This is how addicts keep a ready and complete supply of narcs on hand: multiple sources. Complex care patients often have multiple specialties involved and ideally they all know about each other and interact and, for the outpatient, only one of the those docs does the pain management.
Jul 9, '02There was nothing in my post that stated that addicts don't exist; what I was saying was that many of the things nurses use to label someone a "seeker" are not accurate measurements.
For that matter, to call someone an "addict" is to make a medical diagnosis...nurses do not make medical diagnoses. Usually, the term is used arbitrarily and in a derogatory manner.
Pts. with chronic non-malignant pain usually try very hard to look "normal". This winds up being a double edged sword: Look too good, and no one believes your pain is that severe...look bad and you're overdramatizing your symptoms.
Even "doctor shopping" may not be a hallmark of an addict. People with chronic pain have usually tried multiple doctors and multiple meds...I prefer to think of them as being "pain relief seeking", something that I don't believe is a crime.
I work in the ED, and yes, there are people that are looking for their fix. But I don't believe it's my job to determine if someone is an addict or not...there's not enough time to do the kind of evaluation that's needed, and again, this is a medical determination.
I live with a chronic pain condition, too; unless you have had these labels tossed at you, you will never be able to understand how truly devastating it is. I am so very thankful that after 15 years of suffering (in silence, a good deal of the time, since no one wants to hear about your pain) I was able to find a doctor who had the intelligence and compassion to realize that I needed relief.
If you have any doubts about someone requesting pain meds, ask yourself this question: Will providing pain medication improve this person's quality of life. It won't, in an addict. In someone with chronic pain, it usually does...it lets them get out of the house, go back to work, socialize, etc.
Pts. with chronic pain don't usually experience a "high" like an addict does...pain pts. will usually have no idea what you're talking about when you refer to it. That's because the drug is relieving their pain...there's nothing left over to give a "buzz."
True addiction rarely occurs in pts with chronic pain. Tolerance does occur, over time, but tolerance is a physiologial reaction, it is not addiction. So when someone says that his/her pain med no longer works, please don't assume addiction.
Obviously, this is a topic that stirs a lot of emotion. I would just ask that we use care and discretion when suspecting addiction; it is a complex illness that cannot be made in a cursory eval.
Jul 10, '02Molly J and fab4fan- thanks for the discussion. I have enjoyed the opportunity to share thoughts with all who have replied.
Fab4fan I totally understand when you say nobody wants to hear about your pain. It sure is a good way to see who your real friends are. The ones who can't take it or don't know how to be supportive bolt like lightening.
Fab4fan, I am so sorry that you also endure a chronic pain problem. I hope you are getting the relief that you need and I will keep you in my prayers. I know you completely relate about how it feels to be accused of making it up.
Just one more thing before I end my post. About 1.5 yrs ago while being treated for the inevitable depression I was seeing a psychiatrist for my antidepressants. In spite of all the above listed diagnosis he had the nerve to say to me "Shame on you for having to take pain medicine. Don't you know the human spirit is capable of tolerating great amounts of pain?" Go figure! It just blows my mind. He also accused me of possibly being an addict. He really hurt my feelings!
After him I started seeing a pain psychologist and a great PT who has done positional and myofascial release, body talk, facilitation of lymph drainage, cranial sacral work and taught me several cognitive behavioural techniques.
Again, thank you all for the discussion of this topic. Pain free lives to all.
Warm personal regards,
Jul 10, '02i dont care if my pts are seekers. yeah some of them are. if the doc orders the meds i give them as ordered. most times the docs know their pts are seeking. i can think of one pt in particular who was always coming in for pancreatitis until they cut his pain meds. he walked out AMA and we havent seen him since.
my job is to give my pts the meds they are ordered. what is the average length of a hospital stay? 2, maybe 3 days? none of my pts are going to get addicted in that amt of time. if they already addicts the drugs im giving arent going to make much of a difference one way or another. i dont have a judgemental attitude when i give the meds. i just give them and i treat everyone with respect...thats my job
i hate that so many nurses hold pain meds when they think someone is a seeker. i have argued with more than one nurse about this. i dont care what they do while they are on duty but im not taking the chance of not medicating someone in pain. ive had this done to me. i just wont do it.
equally, i hate that docs undermedicate the elderly. i cant tell you how many times i have had to FIGHT for morphine for my elderly pts with huge decubiti. i had a doc stop me from giving morphine to a pt they were debriding. "she doesnt need it, there arent many nerve endings under the dermis. it doesnt hurt"
pt was nonverbal...and yes it did hurt her. she flinched and moved all over the bed.
why on earth would this surgeon not want me to give her 2mgs of morphine while he debrided her woulds?
its just cruel
Jul 10, '02The problems of pain, chronic pain and drug seeking are very complex and I think the one thing that I do agree with is that it is hard to build sufficient knowledge of someone to legitimately confront addiction when it is present. I want to acknowlegde that many of us who work in ED's and have very rare patient contact with an individual; see a patient for a single hospitalization that lasts mere days; AND for those of us in the ED that cope with pain patients who don't have the financial wherewithal to have a doctor of any kind and hence are "unassigned" can have real problems with identifying a patient in trouble and finding a system with which to work in order to do a referral (either for appropriate pain management or addiction eval). On the other hand, for many clients the ED is the patient's last health advocate.
All of you are correct when you say that you cannot identify addicts on the strength of a short contact or a scattered ED visit. But when patients are repeaters, you can get a flavor of their issues, just as you get to know how Mrs. Smith's chest pain presents (in her elbow) or how Mr. Jones' drool turns purulent when he's got a pneumonia.
You know good care is always the combined efforts of patient, doctor and health care team, whether we are talking diabetes management, pain management or whatever. The responsibility of a patient is to be the best possible historian and to bring a list of all current meds (or the actual meds) to any health care visit. All of these "duties" fall especially hard upon the chronically ill patient, when they may have so many doctors involved in their care. This means that pain management clients must be up front about what meds, how often, who prescribes.
Recently my local hospital has seen a significant increase in pain mangement clients OD'ing on their pain meds and dying. They were all out-patients. Do you doubt these folks had contacts with nurses in the years, months and days leading up to their death?
Now many of you have posted that you feel terrible about neglecting someone's pain. No argument there. That is why I always say, sooner or later when we talk about this issue that the nurse must take very seriously her "power over" patients when she carries and controls the narcotic keys.
Do any of you feel bad about feeding an addicts addiction?
Does the term "iatrogenic illness" mean something to you?
The first act of a nurse concerned about addiction is not to quit giving meds that are ordered (unless the patient is over-sedated and it is a matter of life or death). It is to start gathering data, just like you do when your floor patients start to show early PE signs. It is to communicate with the patient and the family and the health care team. The business of effective confrontation is not a flash in the pan. This may be a patient you refer to a case manager or psych nurse consultant that understands addiction.
Somewhere between the wasteland of "I never confront it" and "I just treat 'em ugly", there's got to be something else. That something else is awareness of the problem (it happens), index of suspicion, a willingness to get to know the patient and the family to see, hear and feel the impact of the issue on them, awareness of appropriate resources for referral and a willingness to be patient with what may happen next. (nothing/the status quo, slow change "This usage is costing me something", treatment, with potential for relapse or recovery). All of what I said also is true for your repeater drunks in the ED or in the hospital.
Remember, when you don't take the time to assess and intervene on addiction problems (and boy is it hard) you are writing off a significant and all too frequent problem.
Again, floor nurses and ED nurses may not have time to solve this problem, but they should act as case finders and know how to communicate with key people and encourage appropriate referrals.
Jul 10, '02I believe in the patients. If they say they have pain, then they have pain. We have this one senior who askes for pain meds every time you look at her. "Can I have a pain pill"?, "Can I have a pain pill"? She is not able to identify pain anywhere. her blood pressure is 108/58,not indicative of pain, her pulse rate is 62, also not indicative of pain. She wears a duragesic patch that is changed q 3 days.
Her MD won't give her anything than extra-strength Tylenol!
She will be asleep and if you have to go in her room and she wakes up by accident, she says "Can I have a pain pill"! it is very exhausting telling her over and over she just had one, or she has to wait another hour or two hours. Any suggestions? ShygirlLast edit by shygirl on Jul 10, '02
Jul 10, '02"Power over patients"?? I've never felt this way; to my mind, it sets up an antagonistic relationship between nurse and pt. I've always felt that we needed to collaborate with our pts., not have power over them.
There is some very interesting information on the term "drug-seeker" in the latest pain mgmt. manual by Margo McCaffery. I was tempted to quote it here, but since I didn't ask her permission, let's just say that the pain mgmt. community takes a dim view of the term (and not just Ms. McCaffery).
We could probably go around in circles on this issue, but I doubt at this point that we're going to change each other's mind.
BTW, I did work in a substance abuse center, so I am familiar with seeing true addictive behavior; I can count on one hand the people I've seen in the ED who actually fit the diagnostic criteria.
Seeking relief from pain is not a criminal offense.
Jul 10, '02Reading all your posts makes me wonder what you'd all do if I were your patient??
I have three bottles of narcotics sitting on my desk, all written by different physicians, different narcs, for different reasons.
My history... I have Benign Intracranial Hypertension (aka pseudotumor cerebri) causes severe headaches. I take Darvocet for breakthrough headaches when my Maxalt doesn't work. I also take Topamax and Verapamil for this.
I have also passed 13 kidney stones this year alone. I have hyperparathyroidism causing this. Therefore, I keep Lortab 7.5mg tabs on hand for the pain prn. Last script for 20 tabs was filled 2 months ago, still have 2 left, got the next one filled just in case....
Last week I had surgery for a ruptured ovarian cyst, thought it was my appendix, took care of both. Told my surgeon what I was already taking, so he was aware of my previous narcotic usage. He asked me if I wanted to take Darvocet at home post-op. I declined, stating I didn't want to build up a tolerance to the Darvocet, since this was what seemed to work for my headaches. He seemed to concur, as this was a chronic condition. He then wrote for Vicoprofen, stating there wouldn't be as much Tylenol running through my liver. He did seem to overdo it, tho...wrote for 50 tabs with 2 refills....seemed a bit much.... Wondering if the pharmacy reports back to him when I refill each of those and he's looking for me to be a seeker? Nope, didn't need the last bottle...LOL.. (however, I did need a few from the 2nd due to a raging wound infection, pus running out my incision..gross).
Anyway, it IS possible for some patients to need different narcotics from different physicians... My Darvocet is written by my neurologist... can't take the Viccodin for the headaches, just makes them worse (look it up, it's a contraindication to take it with elevated CSF pressure, which is when I'm having a headache).... yet I can't take the Darvocet for the kidney stones, it doesn't touch the pain.... And the Vicoprofen? Well, the was the Surgeon's choice, I just didn't need that much Tylenol this week, I guess...he didn't need to write for THAT many, tho!
Another comment I wanted to make... Yes, patients can laugh when they're in pain. When I went to the ER with my abdominal pain last week, I was able to laugh with my co-workers while I was being evaluated. That's just how I cope with pain. It doesn't mean I don't have pain! I've had chronic pain for so long, I'm able to hide it untill you have no clue I'm hurting so badly I can't see straight. Yes, my blood pressure, heart rate and temperature showed my pain, but I was still able to joke around. That's just how I work.
And no, I don't go to work under the influence of narcotics, in case you're wondering! LOL
Have a good one, and thanks for listening!