Overuse of opiates?? Opinions?

cazza · Nov 25, 2004

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.

Traveler · Jan 25, 2005

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.

Traveler · Jan 25, 2005

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.

stbernardclub · Jan 25, 2005

People have different reactions to medications, and pain med is no different!

stbernardclub · Jan 25, 2005

People have different reactions to medications, and pain med is no different!

xmaxiex · Jan 25, 2005

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 .

xmaxiex · Jan 25, 2005

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 .

Canadian_Gal · Jan 25, 2005

"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)!

Canadian_Gal · Jan 25, 2005

"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)!

Fiona59 · Jan 30, 2005

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...

akcarmean, LPN · Jan 30, 2005

Just my :twocents:

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

z's playa · Jan 30, 2005

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