Overuse of opiates?? Opinions?

kittylvr · Jul 8, 2004

We just had a 19 yo on our floor that had her nipple pierced several months ago and has been in the hospital every month since. In the beginning I'm sure the pain was legitimate from the infection and nerve involvement, BUT this week she was on our unit getting 5mg morphine(Q3hrs), AND 30mg ms contin(scheduled tid), AND 2 percocet every 4 hours. She still complained that it wasn't enough. She would ask for the morphine and as soon as she got she would be up and out the door to smoke!!!! This drives me crazy, if you are in that much pain then how do you get up to go out and smoke!!! Somethings I will never understand I guess.

moia · Jul 8, 2004

well...I am a nurse and I am going to try to help you understand.

I hurt my back...and yes I felt every wince from everyone...oh yeh...back pain...righhht...

so I went to work because that is the response I got....do some exercise...take a tylenol.....I tried rest...I tried cold..heat..physio......I had progressive acute sciatica but you see I was embarrassed......I kept going to work...because all the nurses loved to belittle pain and make fun of back injuries....

so I tried to get off the couch on a day off...I screamed until I vomitted.....MRI...2 herniated discs....I took pain medication and lots of it and I lay on the couch hoping that the pain would kill me or end...

I had surgery 7 weeks ago after suffering for a year because you see no one believes in back pain or back injury anymore......even with a MRI....they say take vioxx or percocet or oxycontin..neurontin.. ...it will get better on it's own...some days I cried all day...sure I was being driven insane by nerve pain that never stopped...some days I got up had a shower and went shopping determined not to say a word because of the LOOK everyone gives you...ohhh back pain ...rigghhht

so some days I am sure you would look at me and think..well it can't be that bad...she is clean and coherent and walking...and having a smoke...so I am a liar in your eyes...

after surgery I have slowly and carefully regained some part of my life again... I had to stop my meds...I didn't believe I needed them anymore...I had horrible side effects from stopping antiseizure medications which are truly the only treatment available for neuropathic pain...I am a nervous wreck because my brain has been stripped of all the neurochemicals that protect it.....

I had a horrible injury with agonizing pain...it lasted over a year......I wanted desperately to go to the er...I went once...the nurses all gave me the look...back pain...rigghtt...I never went back

I suffered because of nursing judgement and crappy attitudes...

why nurses think they have any right to judge another human beings pain is beyond me...I think it is disgusting........just a nice moral superiority moment...well....it can happen to you just like it happened to me...turned that patient just a little wrong... and you will get to be at the other end of the look at the junkie speech

what is interesting...I never had a doctor hand down that morally superior judgement.....just nurses.

If you have a problem with pain management and you think your patient is a liar and the treating physician is a fool maybe you need to stop and have a look at yourself....I know people want to vent...but nursing and pain control has been a never ending nasty problem and I think nurses need to cut it out....give the patient the medication ordered...if they continue to complain call the doctor and address it...save your look at the dumb junkie moral superiority ...it's hard enough to endure pain but to have to endure some snotty nurse calling you a liar is just too much.

I refuse to give nurses the right to judge pain and I thank GOD every day I didn't have to rely on a nurse for access to pain control... despite continuous education this attitude prevails...that is why doctors prescribe...if we left it to nurses everyone would get a tylenol and gravol only if they vomit with three witnesses.

before this happened I was a big pain control advocate...all my patients got pain services if the standings failed...I worked with nurses who gave NOTHING in 12 hours to open heart patients and whined that they wouldn't cough and their sats were terrible....it never occurred to them the patient was in agony...they were too scared to ask for relief because they were told by the doctor the nurse will give you pain relief....they didn't want to challenge the nurse...what a terrible thing that in 2004 nurses still behave this way.

I don't care if you think 125mg of demerol is way too much......it's not your business...your business is to assess and evaluate and watch for side effects and address those...

Pain control is not a power issue...nurses act like it is...pain control is a compassion issue and it's time to start thinking what if it was ME in this bed? What if I had abdominal pain and nausea that came and went with a terrifying force and NOONE could figure out why?

I had an emergency appy after a 6 months of that....the appy was a disgusting dessicated pus filled mess.....i was told i had stress and perimenopause...see I didn't have a temp or much of a white count...it was only until an er doc thought things were just a little too weird that he called in a surgeon and he opened me up to look around and was shocked at the mess...I had ultrasounds and a ct that showed nothing...

so some poor schmuck is lying in a hospital bed because they FEEL sick...please don't tell me someone spent 8 hours waiting to be seen in an er on a whim...you can get drugs a lot easier than that...treat them with some dignity...it could be you.

Stop using pain and pain medication to feel superior...yes you are really lucky...you don't have pain...feel grateful..... but when you begin to think that your patient is a liar and a junkie..stop and remind yourself...that could be me..or my child or my loved one...

Cynicism is incompatible with compassionate nursing....believing your patient is a liar and a con artist means you are NOT giving good care...you may think just because I do everything ordered I am doing my job...the patient knows you think they are a liar...you are not hiding your disgust..it's coming off you like cheap perfume and as a patient I have had more than enough.

I understand nurses want to vent but for me this is not a venting issue...it is a power and superiority issue...it is belittling and degrading.

Shed13911 · Jul 8, 2004

I think you wrote a wonderful porthole into what pain is to the person that is suffering. I have had severe back injuries and so far have had 3 back surgeries. I get the same feeling about what others believe when it comes to my pain. :crying2: I try to manage as long as I can and do try to function in the everyday world. I have a legitimate cause for the pain so why am I still being judged? Many people can not begin to imagine what we go through so why do they judge. :angryfire Give the meds the doctor ordered and let him/her decide if the patient is having pain. I applaude your honesty and insight!!

Tweety, BSN, RN · Jul 8, 2004

Moia, thanks for sharing your story. Gives a nurse much to think about.

I refuse to get defensive. Your pain and you are not the type of patient I was talking about. I can't say I've seen anyone talking about using pain medicine to feel superior, but your perspective is entirely different and I will quietly dismiss myself from this discussion.

I will only say there is a difference between venting one's frustration and actually acting on that frustration by not believing a patient leaving them suffering when they say they are suffering. I'm not that kind of nurse, but as I said I refuse to defend myself or my venting.

NiteShiftNut · Jul 8, 2004

i guess after 3 horrible nights on the floor i can now go to bed satisfied that i am snotty, judgemental, and i have a superiority complex. who knew i was on such a power trip? i guess this isn't the place to vent after a long night. i think i'll take 2 lortab for my headache and go to bed. :smokin:

teeituptom, BSN, RN · Jul 8, 2004

oh feel free to vent away

I used to feel that way when I was younger

Now that Im older and mellower

I just give what the doctor orders

life is so much easier that way

and do we give way too much at times. YES YES YES

I will let you youngsters fight that out

NiteShiftNut · Jul 8, 2004

oh, i'll give it, it's not the giving part i have a problem with, it's when i've given dose after dose, and i'm calling the doc for the third time to ask for another increase in dosage and the doctor reeeeeemmmsss my a**, and refuses to up the dose, then i get to tell the patient that the doctor won't order any more narcs, so then the rest of my night is spent being called in the room every 2 minutes and being cursed at because i can"t give any more cookies to the crying baby. meanwhile, honestly sick patients are suffering from a lack of care because i am tied up dealing with a cokehead. if the care is bad and they are so upset, why don't they just leave ama, quit threatening it, take a hike to the er up the road and get a new doctor and a new nurse to pump you full of narcs, and don't let the door hit you in the butt on the way out........aahhh, i feel better. sometimes you just need to vent after a bad week.

Quickbeam, BSN, RN · Jul 8, 2004

I see two distinct issues here. First is the patient with a legitimate pain complaint. Second is the professional user. Two different problems but sadly the first gets shortchanged often because of fears of the malingerer/symptom magnifier.

I've seen this from both sides...I did work comp disability for many years...we'd get surveillance on people supposedly "totally disabled by pain" putting a new roof on their house or dropping a new engine into their truck. But of course they are on total disability from work. There are scammers out there, no question.

On the flip side, I've had joint pain since I was a child. No one ever took it seriously and I went though a whole lot of MDs who just blew me off and told me to take Advil. When I collapsed 2 years ago after a long car ride, my MD referred me to a rheumatologist and ortho. I found out I'd had JRA, untreated for all these years. My joints are dust. The Ortho asked me a question burned in my brain: "how is it possible you have lived with this pain?" Well, let's see. If no one takes your very specific pain complaints seriously, it is hard to get a proper diagnosis. You figure maybe everyone hurts like this, you just have to suck it up somehow.

I don't know what the answer is. Most MDs I know are scared to death to give anything more than Tylenol. When my husband had sinus surgery , the discharge nurse said she could not give us scripts for anything post-op. My husband was white with pain. It took 4 hours of my refusal to move until they got him a script for 2 days worth of Vicodin. That was all he needed but I had to make a federal case to get it.

Sorry to be so long winded. I'd like to think there was a way to effectively deal with the addicts, the mentally ill, the scammers and malingerers and still treat legitimate pain complaints completely and compassionately. That's the health care system I want.

leslie :-D · Jul 9, 2004

Sorry to be so long winded. I'd like to think there was a way to effectively deal with the addicts, the mentally ill, the scammers and malingerers and still treat legitimate pain complaints completely and compassionately. That's the health care system I want.

ditto ditto ditto quickbeam. unless you have never cared for a drug seeking manipulator, you will not empathize with the emotional baggage it takes from you.

furthermore, i consider myself adept at assessing pain and would never deny someone who is in pain. but as i've stated before, i have no compassion for drug-seekers in anyway, shape or form...whether they be nurses who divert or patients who take up too much of your precious time.

and it's a very natural vent.

fab4fan · Jul 9, 2004

well...I am a nurse and I am going to try to help you understand.
I hurt my back...and yes I felt every wince from everyone...oh yeh...back pain...righhht...
so I went to work because that is the response I got....do some exercise...take a tylenol.....I tried rest...I tried cold..heat..physio......I had progressive acute sciatica but you see I was embarrassed......I kept going to work...because all the nurses loved to belittle pain and make fun of back injuries....
so I tried to get off the couch on a day off...I screamed until I vomitted.....MRI...2 herniated discs....I took pain medication and lots of it and I lay on the couch hoping that the pain would kill me or end...
I had surgery 7 weeks ago after suffering for a year because you see no one believes in back pain or back injury anymore......even with a MRI....they say take vioxx or percocet or oxycontin..neurontin.. ...it will get better on it's own...some days I cried all day...sure I was being driven insane by nerve pain that never stopped...some days I got up had a shower and went shopping determined not to say a word because of the LOOK everyone gives you...ohhh back pain ...rigghhht
so some days I am sure you would look at me and think..well it can't be that bad...she is clean and coherent and walking...and having a smoke...so I am a liar in your eyes...
after surgery I have slowly and carefully regained some part of my life again... I had to stop my meds...I didn't believe I needed them anymore...I had horrible side effects from stopping antiseizure medications which are truly the only treatment available for neuropathic pain...I am a nervous wreck because my brain has been stripped of all the neurochemicals that protect it.....
I had a horrible injury with agonizing pain...it lasted over a year......I wanted desperately to go to the er...I went once...the nurses all gave me the look...back pain...rigghtt...I never went back
I suffered because of nursing judgement and crappy attitudes...
why nurses think they have any right to judge another human beings pain is beyond me...I think it is disgusting........just a nice moral superiority moment...well....it can happen to you just like it happened to me...turned that patient just a little wrong... and you will get to be at the other end of the look at the junkie speech
what is interesting...I never had a doctor hand down that morally superior judgement.....just nurses.
If you have a problem with pain management and you think your patient is a liar and the treating physician is a fool maybe you need to stop and have a look at yourself....I know people want to vent...but nursing and pain control has been a never ending nasty problem and I think nurses need to cut it out....give the patient the medication ordered...if they continue to complain call the doctor and address it...save your look at the dumb junkie moral superiority ...it's hard enough to endure pain but to have to endure some snotty nurse calling you a liar is just too much.
I refuse to give nurses the right to judge pain and I thank GOD every day I didn't have to rely on a nurse for access to pain control... despite continuous education this attitude prevails...that is why doctors prescribe...if we left it to nurses everyone would get a tylenol and gravol only if they vomit with three witnesses.
before this happened I was a big pain control advocate...all my patients got pain services if the standings failed...I worked with nurses who gave NOTHING in 12 hours to open heart patients and whined that they wouldn't cough and their sats were terrible....it never occurred to them the patient was in agony...they were too scared to ask for relief because they were told by the doctor the nurse will give you pain relief....they didn't want to challenge the nurse...what a terrible thing that in 2004 nurses still behave this way.
I don't care if you think 125mg of demerol is way too much......it's not your business...your business is to assess and evaluate and watch for side effects and address those...
Pain control is not a power issue...nurses act like it is...pain control is a compassion issue and it's time to start thinking what if it was ME in this bed? What if I had abdominal pain and nausea that came and went with a terrifying force and NOONE could figure out why?
I had an emergency appy after a 6 months of that....the appy was a disgusting dessicated pus filled mess.....i was told i had stress and perimenopause...see I didn't have a temp or much of a white count...it was only until an er doc thought things were just a little too weird that he called in a surgeon and he opened me up to look around and was shocked at the mess...I had ultrasounds and a ct that showed nothing...
so some poor schmuck is lying in a hospital bed because they FEEL sick...please don't tell me someone spent 8 hours waiting to be seen in an er on a whim...you can get drugs a lot easier than that...treat them with some dignity...it could be you.
Stop using pain and pain medication to feel superior...yes you are really lucky...you don't have pain...feel grateful..... but when you begin to think that your patient is a liar and a junkie..stop and remind yourself...that could be me..or my child or my loved one...
Cynicism is incompatible with compassionate nursing....believing your patient is a liar and a con artist means you are NOT giving good care...you may think just because I do everything ordered I am doing my job...the patient knows you think they are a liar...you are not hiding your disgust..it's coming off you like cheap perfume and as a patient I have had more than enough.
I understand nurses want to vent but for me this is not a venting issue...it is a power and superiority issue...it is belittling and degrading.

Dear heavens, this post made me want to cry. I am so sorry for what you went through! (((((HUG)))))

leslie :-D · Jul 10, 2004

moia,

Dear Lord, i so feel your anguish, and you do have my heartfelt sorrow for you having to endure this painful sequelae of events.

and i do pray that you have begun some healing in the obvious abandonment of your individual needs.

leslie

moia · Jul 10, 2004

I want to thank those that offered concern and I want to say I am not calling people names or asking them to defend themselves because a patient drove them crazy for 12 hours.

I believe as a nurse it can make a nurse crazy when our patients complain of unelenting pain despite the pain meds we give...it makes us anxious and upset because for alot of us we are thinking the worst...some horrible complication that we are missing and will kill our patient...I know I have felt more and more frantic as a shift went on when I have had a patient that appears to never be out of pain despite the gallons of morphine I am pumping in....

I will try to offer some more perspective...when I first began this journey the doc started me on celebrex...it made me sick...and did nothing for the pain..so..vioxx...which was worse...so tylenol 3 which I ate like M&M's...then percocet...which made me sick and horribly anxious and out of control...so back to tylenol 3...added amitryptilline...stopped being able to pee...at all....clonazepam...so sedated I drooled..literally all the time...so then oxycontin...with neurontin....sedated...couldn't speak without a terrible stutter..anxious and comatose..drooling and crazy..unable to pee or move my bowels....on to morphine..off clonazepam......on to muscle relaxants and ativan......back to codeine...off all sedation...codeine and neurontin...finally...surgery ....at present...off all meds except occassional tylenol......take St Johns wort for generalized anxiety from withdrawal of neurontin..hopefully will be able to be drug free very soon.

So...I am not a strange case....the majority of patients are going to need experimentation in meds to find something that gives some relief without destroying the person.....the doc and the nurse and the patient should be working together...if you are spending a 12 hour shift with a patient who gets no relief alarm bells should be ringing...the immediate "junkie" response should NOT be what you reach for...what you should be saying is wow ...this med doesn't work for this patient at all...

I think it's time to stop pushing this drug and try something else because this is not working...

Instead ...we get venting posts that scream my patient is a lying junkie that is manipulating everyone.....why? Why get into such a competitive attitude with a patient? You are demanding that the patient prove their pain to you...how? what do you want the patient to do? They cry and complain and beg and whine and curse you out for relief...what else can they do?

If i could somehow understand what nurses are looking for I would have done my best to give them that...I would have cried and begged and kissed your feet if the nurse would have held my hand and told me it was going to be okay and she was going to get me some help....

This subject is horribly distressing to me because I know that nurses were thinking this about me...I know they were thinking it can't be that bad...she doesn't need those drugs...only cancer patients should be getting morphine...

The thing is this... venting here within our communtity is one thing...but too many nurses actually believe that they are only venting here....

I said before and I say again...you aren't fooling anyone......that patient who asked for more meds? they KNOW you think they are a liar and a junkie....you made them feel powerless...and ofcourse the more waves of disapproval you drown them in the more they act out and got angrier and more disgusted with you......

It seems to me that nurses disapprove of pain medication...why? why do you care?

Why such crazy disgust over drug use? Why so much disgust over someone asking for drugs? Is this person taking something from you?

Why can't you just give them what is ordered without saying in your head...wow what a junkie...they cannot possibly need all those drugs and I would know this because I am a nurse and I am an expert in rating other peoples pain...I just loved that "Iam a good judge of pain."..oh yes you are.....aren't you..judge..jury...you will be the one to decide if the patient needs pain relief right...because it's YOUR judgement that matters.......still you don't get it....nurses are NOT judges of pain...it's not your job to judge if the patient is having pain and how much ...your job is to RESPOND to the patients needs....without judgement....you don't like it I get that...some patients can make you feel like you are not doing your best...pain makes everyone involved anxious and defensive but there are ways to address that.....

What if you had told that patient I am really sorry for this situation, I feel awful about it, I have tried every way I know to help...is there anything else we can try? hot shower...cold,walking ,sitting in a chair.....the patient would have felt that they had a friend and the desperation and fear would have lessened...and to some extent the pain...the biggest fear I had was someone was going to stop my meds...I lived in terror at the thought...what would happen to me if this pain got out of control...would I have to kill myself?

FEAR is what is motivating a lot of pain patients...the thought that someone somewhere will decide that they can't have any relief and they will somehow have to try to survive the pain...knowing full well they won't be able to.

All I am asking is that before you decide that the patient is a manipulative lying junkie you try some compassion...treat their feelings despite your own...reassure them that you are there and that they will have access to relief...tell them that you won't let their pain get out of control...you may be happily surprised.

My apologies to those that got their feelings hurt..I do understand the frustration of feeling like you spent a lot of time with a patient and never could meet their needs...I just really feel that pain should never be an issue of such condemnation and judgement.