Overuse of opiates?? Opinions? - page 8

would like to know what your opinion is on an issue that has bothered me for quite a while. patients being admitted to medical/surgical units with various diagnosis, for instance "abd. pain, nausea,... Read More

  1. by   leslie :-D
    Quote from xmaxiex
    No arguement here just wanted to share something I have been thinking about . I work in LTC and often I wonder about pain meds in the elderly . We have some pts known as clock watchers. I don't judge but oftentimes I worry about the effect some pain meds have on the healing process ( some pts are so "relaxed" they rather sleep than attend therapy) Also I worry about the cognitive effects pain meds have on an unstable elderly resident or those suffering with dementia . I would welcome more education on pain and its management , particularly in the elderly .
    elderly and children are the 2 populations that are typically underserved in terms of pain mgmt.
    i've worked w/elderly and have seldom met a clock watcher. most are stoic, deny it and refuse it. that's the way their generation was. and it takes much education and 1:1 to get them to try even tylenol sometimes.

    besides, they're elderly. my only concern is their risk for falling if sedated. other than that, with the typical dxs of op, oa, ra, compression fxs, djd....they certainly need and deserve something.

    leslie
  2. by   jennifer0223
    Quote from niteshiftnut
    would like to know what your opinion is on an issue that has bothered me for quite a while. patients being admitted to medical/surgical units with various diagnosis, for instance "abd. pain, nausea, vomitting, " you know the type, frequent flyers who come in every other week with some imaginary ailment, and they always get a bed, and then get obscene doses of narcotics. i mean, 100mg of demerol every hour? or 25 of phenergen on top of the 4mg of dilaudid they are getting every hour via pca pump. is it me, or is there an epidemic of narcotic addicted junkies floating around the healthcare system? and does anyone else feel that the doctors are part of the problem? i'm growing more and more intolerant of this whole horse and pony show. after a night like last night it really makes me think about my career choice.
    i do not know you. i am new here but i will have to say that alot of the problem are nurses that assume a person is getting to much narcotic or they are addicted. i have a rare bone disease that causes me so much pain i can barely walk. but if i wear 200mcg of fentanyl changed every 3 days plus oxycodone 15mg prn i can walk and move around. now i have been admitted to the hospital 3 times in the last year. once i collapsed from pain and exhaustion, 2nd was surgery, 3rd was a severe eye infection. even with my medical record there showing i do not absorb medication the "normal" way that my body metabolizes it way to fast that the effect is not felt sitting in front of them the doctors would not give me the 'normal" for me doseage. once they finally were told to do so by my specialist the nurse was terrified of giving me what was ordered. which was dilaudid 6mg iv push every 15min until out of pain then every hour prn. now that may seem like alot it does to me even. i have yet to have a pain free day in the past 2 years. i went 8 months without any pain medication while they tried to figure out what was wrong. then started pain meds and they didn't work. finally found the problem so we changed routes. 200mcgs of fent is alot i know this....but guess what i stilll have pain severe pain that wakes me up in themiddle of the night crying.

    i guess i learned from spending a month in the hospital the other side of the issue. i found that if a patient says they are in pain 9/10 they are. if they ask you for pain meds and they are ordered you shouldn't think about are they addicted let the doctor. the patient needs us to not judge them. the patient needs to know if they need something for pain they will get it not a look from a nurse thinking god she is a pill junkie. one day it might be you on that bed crying from pain and the nurse saying i already gave you 5mg of such and such. or there is no way you are hurting or no way you are nauseated. visit pain clinic, hospice places where people are using large amounts of pain medication you may find you have a different view.

    i do see your point if you are talking about a true needle track junkie or what not. but if i go into the hospital every week for the next 10 weeks for pain and get a bed i surely hope i do not get a fellow nurse that takes the outlook that i am "making things up" or coming up with some misc. ailment etc. i am not writing this as an insult to the originator of this post or anyone else merely giving the "large dose" of drugs prospective. most people that were on 200mcg of fent would be out cold. i still hurt on this amount go figure. this was a very interesting thought brought up and i thank you for the opportunity of sharing my viewpoint.
  3. by   jennifer0223
    Sorry,
    xmaxiex,
    i did not see your post. But if you want to view more about pain in the elderly read about hospice and palliative medicine even though it is about death and dying etc it does have alot to talk about medicating the elderly for pain. Here are a few short articles I found.

    http://www.seniors-connection.com/03011999a.html
    http://www.stat.washington.edu/TALARIA/LS7.2.html
    http://www.painbooks.org/elderly.html
    good luck
  4. by   xmaxiex
    Thanks Jennifer , I am always trying to learn and find new ways to help my pt's great info !
  5. by   LittledebX2
    [quote=niteshiftnut]would like to know what your opinion is on an issue that has bothered me for quite a while. patients being admitted to medical/surgical units with various diagnosis, for instance "abd. pain, nausea, vomitting, " you know the type, frequent flyers who come in every other week with some imaginary ailment, and they always get a bed, and then get obscene doses of narcotics. i mean, 100mg of demerol every hour? or 25 of phenergen on top of the 4mg of dilaudid they are getting every hour via pca pump. is it me, or is there an epidemic of narcotic addicted junkies floating around the healthcare system? and does anyone else feel that the doctors are part of the problem? i'm growing more and more intolerant of this whole horse and pony show. after a night like last night it really makes me think about my career choice. [/quote
    it is so sad to know that there are nurses out there that think anyone who takes a higher than normal dose of a narcotic is just a "narcotic addicted junkie". i pray that you never have a chronic illness that causes you pain, because i think your opinion of these "frequent flyers" is very biased. one thing "abd pain, nausea and vomitting" is not a diagnosis it is a symptom, and doctors are getting a hard time from insurance companies:angryfire for using that terminology.
    but just maybe this person really does have pain?:uhoh21: what do you do then when you have already made a decision to label them. to me it seems alot of nurses are backwards in there thinking about narcs and pain. they assume they are guilty (of being an addict) before they assume they are not. there are many studies and surveys out there to show that in fact, nurses and doctors are undermedicating patients , not the other way around. undermedicating causes more problems in the long run, (longer stays in the hospital, more complications-like pneumonia because the patients don't want to tcdb, dvt's due to the patient's resistance to get up and move around, ect.)
    my suggestion to you about this frequent flyer is to get the doctor involved with your concern, and tell:chuckle them what you are witnessing with this patient, and see if this is cause for the doctor to assess what they are doing with this patient.
    i am a chronic pain patient who takes narcotics everyday, and because my illness is not something you can see it does not mean that i don't have very real pain. and if i came to the hospital as a patient, i would need more pain meds than the average patient to get relief, does that make me an addict, absolutely not. so don't be so quick to assume and always treat that person as if were somebody you love and care for dearly.
  6. by   cazza
    I wonder if anyone could help ? I am a recovery nurse and over the years have come across drug addicts who are in extreme pain following surgery, some are trying to withdraw from their drugs, and I am concerned that the pain relief I give is just not adequate, that I may be perpetuating their addiction, and that perhaps different painkilling drugs may be more effective dependant on the patient's drug addiction. I realise that some people are just acting to get the drugs, but post-op many patients have pain and I feel my job is not to judge people but provide the best care I can give. So if anyone has any knowledge/experience they can share I would much appreiciate it.
  7. by   Traveler
    I have been reading some interesting and differing opinions on pain here. I think lately we have come a long way in understanding and treating pain. There area more sustained release medications than ever. Unfortunately as many have pointed out, it is the very few that make it hard for the rest of the people who genuinely hurt. There are several things that I want to point out. One is that if someone is hurting with a chronic condition, they are not going to present as someone who is in acute pain. They may be sitting calmly and smiling, their vitals may be normal, etc. We must always remember that it is the patient's perception and report that we need to listen to. Another thing is that patients who have chronic pain that is not treated appropriately, they may seem like drug seeking patients. They just want to not hurt. If pain is controlled before it becomes intense, not as much medication is needed. I work in home health in a rural area. Many of our patients worked very hard physically in their youth and have severe osteo- their joints are worn out and they hurt. Many don't want to take meds because it's "dope", but if they can improve their quality of life, then we need to provide education. There are great pain management clinics out there. Opiates are used as well as other interventions. As many people pointed out before, it is a trial and error thing with each individual. I also do hospice. Some of our patients take a dose of morphine that is off the charts. We had one lady revoke hospice because she wanted more treatment at the hospital. Despite the fact that I called and faxed her medication regimen, she was given less meds at the hospital than she had been comfortable on at home. I too have had issues with chronic pain. I know what it is like to wake up in the morning and cry because I actually slept through the night and didn't have pain incorporated in my dreams because I was hurting in my sleep. It has only served to make me a better patient advocate for my patients. If there are one or two that slip by and aren't what they claim, I figure that's all right since I have helped so many others whose whole lives have been turned upside down because of the pain.
  8. by   stbernardclub
    People have different reactions to medications, and pain med is no different!
  9. by   xmaxiex
    cazza , pain is an issue that I have been learning more about and have come across many articles that state that many of those who are/were chemically dependant require more pain meds to relieve their pain . Many articles cite that their threshold is much higher than average .
  10. by   Canadian_Gal
    "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."

    AMEN to that Moia! I totally and completey agree with you. I work in LTC (as an Nurse's Aide) and when a Resident states that he/she is having pain the Nurse's will not address the issue. All I hear is, "Tell Bob he is fine..." Many times I have reported on a Residents discomfort, and am told that the Resident is NOT in pain and that they are just seeking attention. I think that there is a fine line between comfort from pain, and over-sedation though. I have seen some Residents zonked out on meds, just to keep them from complaining! Complaining about pain, or just plain old "complaining"!

    Goodness knows that when I was in Emerg with a bile leak after gallbladder surgery, morphine was my best friend and I thank the Doc that did the ordering and the RN that did the administering of it (without question)!
  11. by   Fiona59
    Pain is subjective and its not up to us to judge its severity. Having said that with a few of the elderly I've worked with repositioning often works if they have been in a wheelchair sometimes transferring them to a recliner worked.

    Having said that if they ask for their prns they would get them. Worked with a new grad once who had a thing about prns, she just wouldn't use them on her shifts because "they've had their usual tylenol, motrin," whatever. I actually had to get our nurse manager to talk to her about what prn meds were for. I 've always wondered if she would withhold breakthrough meds in acute care? Because the way I've looked at prn's in LTC are basically breakthrough meds...
  12. by   akcarmean
    Just my


    I have severe migraines, since I was 14 yrs. old. I usually try my Imitrex and sleep, darkness, quiet, I have some 800 mg tylenol. I will try. I also have Torodol for them if that doesn't work. If I have suffered for 3 or more days maybe 2 and the medicine doesn't work I will go to the ER and tell the Dr. that at this point the only thing that will help is the demerol and phenergan. I know that the Dr's and nurses have made commits about me coming in but I only go in when nothing else will work. I have a 20 mth old, school, family and life I can't afford to be down and debilitated with a migraine. I always go in with a typed list of my medication, DX, no allergies, surgeries which they photocopy. I also let it be know that I am an LPN. If my BP is higher than normal then I tell them. For being over wt. my BP ususally runs top in onehundren teens and bottom in the 80's.Some times I have had a dr. give me Torodol after I have already told them that I had been taking that and it didnt work. so next day I am back out at ER. Now with the shots of demerol and phenergan I come home go to sleep for the next 24-36 hours migraine completly gone and fully functional.

    I also have chronic back pain. I have 50mg Ultram, and Vicodin 500/5 mg. I have had to use them quite frequently the last few months but I have been trying not to take the medicine unless the pain is more than I can stand b/c I don't want to become addicted.

    I can understand both points of view. Just wanted to explain my story so you could get an idea from a nurse who is also a pt.

    Angie
  13. by   z's playa
    Quote from akcarmean
    Just my


    I have severe migraines, since I was 14 yrs. old. I usually try my Imitrex and sleep, darkness, quiet, I have some 800 mg tylenol. I will try. I also have Torodol for them if that doesn't work. If I have suffered for 3 or more days maybe 2 and the medicine doesn't work I will go to the ER and tell the Dr. that at this point the only thing that will help is the demerol and phenergan. I know that the Dr's and nurses have made commits about me coming in but I only go in when nothing else will work. I have a 20 mth old, school, family and life I can't afford to be down and debilitated with a migraine. I always go in with a typed list of my medication, DX, no allergies, surgeries which they photocopy. I also let it be know that I am an LPN. If my BP is higher than normal then I tell them. For being over wt. my BP ususally runs top in onehundren teens and bottom in the 80's.Some times I have had a dr. give me Torodol after I have already told them that I had been taking that and it didnt work. so next day I am back out at ER. Now with the shots of demerol and phenergan I come home go to sleep for the next 24-36 hours migraine completly gone and fully functional.

    I also have chronic back pain. I have 50mg Ultram, and Vicodin 500/5 mg. I have had to use them quite frequently the last few months but I have been trying not to take the medicine unless the pain is more than I can stand b/c I don't want to become addicted.

    I can understand both points of view. Just wanted to explain my story so you could get an idea from a nurse who is also a pt.

    Angie
    Angie:

    It's like reading one of my own posts!
    Smae treatment...same lists...same meds..same everything. Even sounds like we have the same doctor. :chuckle

    My BP once went up to 176/103 and the doctor was trying to tell me it was white coat syndrome. Loser.

    Z

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