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- May 14, '12 by OCNRN63my comment, as a cancer patient who is receiving opioids for pain: sorry i'm not dying fast enough for you to qualify for narcotics. but don't worry, i have a 35% chance of surviving to 5 years, so it's entirely likely i will die soon. thanks to my onc., i'll have spent whatever time i have left not crying and confined to my home because of cancer pain.
that, and i hate to use it, but the good old, "glad that a lot of you aren't involved in my care."
- May 14, '12 by whichone'spinkTo those who have been burnt by jaded nurses and doctors who didn't take your pain seriously, I say I am deeply sorry. But the anger should not be towards the nurses and doctors, but rather towards the a-hole drug seekers who manipulate, lie and cheat to get their way. A-holes that our current system helped to create. Dealing with people like them is not easy, and unfortunately too many caregivers end up shutting off their compassion for patients who are truly in pain.
- May 14, '12 by aknottedyarnQuote from whichone'spinkTo those who have been burnt by jaded nurses and doctors who didn't take your pain seriously, I say I am deeply sorry. But the anger should not be towards the nurses and doctors, but rather towards the a-hole drug seekers who manipulate, lie and cheat to get their way. A-holes that our current system helped to create. Dealing with people like them is not easy, and unfortunately too many caregivers end up shutting off their compassion for patients who are truly in pain.
One of the gifts of a great nurse is to be able to put aside these judgments about patients. Unless you are a recovering person I doubt if you know much about the pain addicts face.
Of course there are drug seekers. There are also people who swim in a public pool with open sores, smokers who have heart disease, those who exercise when injured. Many youing people get STDs. I don't see the rabid discussions about these people. Why not? They are either hurting themselves or others. Addicts do dumb things also. Most hurt themselves and their families. They are hurting in ways you probably can't even imagine.
I have had the privilege of dealing with great doctors who understand addiction and treat addicts like other humans. They don't feel the need to speak so badly about such a horrible disease as addiction and call those unfortunates who have this disease nasty names. I have worked with great nurses who were able to do the same things.
We know that the pharma industry has pushed drugs to many who never would have been in a position to become addicts. Some of these have become addicted. They are just as much victims in this as the burn victims, the MVA victims, and in many cases they are the same victims.
Addiction can happen to probably 15% of the population. In special populations the number is astronomically higher.
I know these patients are the PITA patients for all nurses. One thing that really separates the great nurse from the one who does the job is the gift of non-judgmental care.
Be that great nurse. Hold the pharma industry accountable for their actions. Watch who has been bought out by them. But stop bad mouthing your patients. It makes you much more miserable than it does them. You cannot inflict the depth of pain they already have. Actually you are more like the pimple on the underarm to them. A nuisance, nothing more.
But you diminish yourself with each nasty comment.
Great nurses are few and getting fewer as we deal with the changing health care system.
Become the great nurse.
- May 14, '12 by Bklyn_RNWhichone'spink, you have such clarity. Nurses can become fatigued by so many narc seekers rating their pain at 10/10 that we can inadvertently become indifferent. But there are cases where based on the individual scenario and diagnosis, like burns, MVA, cancer, status post surgery, visible trauma, fractures, sickle cell anemia... and the list goes on. That we temporarily forget about the ever present drug addict nipping at our heels. We put professional judgement to use based on empirical evidence and will advocate for that pt get, "something stronger." I know I have, on many occasions harassed the doctor on my pt's behalf. So please don't get it twisted. No one is attacking people with legitimate pain.
- May 15, '12 by Eric CartmanThe pain rating scale is great and terrible at the same time. Pain is subjective! It is what the patient states it is. It's just hard to believe a patient when he/ she states their pain as a 10/10 and exhibits no other physical signs that might indicate pain (elevated blood pressure, stammering speech, sweating, guarding, elevated pulse, ect.). Painkillers are not candy; however, sometimes it seems like doctors prescribe them like it's "Trick or Treat!"
- May 15, '12 by heronInteresting how an article on the unethical marketing of commercial opioids turns into a discussion of who's pain is legitimate enough to merit treatment with opioid drugs.
Oxycontin was not originally marketed as a treatment for severe end-stage cancer pain. It was marketed as an alternative to the highly profitable long-acting morphine, MS Contin. Apparently, concerns about addiction and abuse led to the leveling off of revenues for the manufacturer. The claim to superiority was based on the assertion that oxycontin had little or no euphoric effect and was thus less likely to be abused. Comes to find out that oxycodone (Percs, oxycontin) is much more high-making than morphine ... and hydrocodone (Vicodin and Lortab) is just as bad. The manufacturer knew it and had to pay a big fine a few years ago for telling that little lie.
Meanwhile, what are the first-line, go-to narcs for pain unrelieved by tylenol or nsaids?
Bingo - classic market manipulation! GrnTea is spot on.
The industry goes through these cycles of being busted for its role in our society's drug addiction. Back in the 70's it was speed - aka diet drugs. I remember reading articles pointing out that far more amphetamine was being manufactured and sold than could be accounted for by legitimate prescription records. The manufacturers were coining money. It was quite the scandal for a minute. The dark side of supply and demand, I guess.
- May 15, '12 by dirtyhippiegirlQuote from aknottedyarnAwesome, never felt more talked down to than this.I know there are few easy answers for your questions. I wish some of the current nurses had made an attempt to give some concrete answers for you.
1. Recognition of those who have been fighting the battle of addiction by attendance in NA/AA. Support this by encouraging visits by 12th steppers.
2. identify those who you can already see will have difficulty going home with bottles filled with narcs. Get honest with them. Why can we be honest about the effects of the burns but hesitate to say "dependent, developed tolerance".
3. Advocate for use of a detox prior to leaving. I once had a pt. who had done well post addiction treatment until he was badly burned. He was receiving narcs via needle up until day of discharge. What did anyone expect to happen? He relapsed into heroin quickly. Fortunately he got himself back into treatment. I don't recall if he contracted hep or HIV before coming back. That would have been common in that area at that time. This relapse would have been prevented with appropriate detox following burn treatment.
4. Use the time of dressing changes to establish a positive relationship with your patients. Encourage them to use this experience as an added push for them to get help.
5. Get yourself educated about local help for addicts. Keep a list of NA meetings at your finger tips. Connect with some local NA members and ask their help with this problem.
Thank you for your recognition that there has to be a better way. Accept my pat on your back for a difficult job you are doing.
In fact, hell, next time I do a major dressing change on a full thickness 75%+er who has come in positive for meth, opiates, etc., I'll make certain to use calm, non-threatening tones to establish a positive relationship with him. And while he's crying, shrieking, desat'ing, hyperventilating, etc., I'll make certain to push that 400 mcg of fent.
- May 16, '12 by kcmylornI'm not against giving patient's appropriate pain medication for thier disease process. I was an Onc nurse for 18 yrs an gave plenty of narcs. And can remember back in the day when some patients were still given Demerol gtts., and the standard post op combo was Demerol and Visteral. I remember when PCA's first came into being.
What I don't condone are these crack pot patients who come into to the hospital with the ever so popular"abdominal pain". They have had every test under the sun is done on them each and every time they come in and no one can find one thing wrong with them- and believe me- I have seen more than my share of these patients. And some of them come in 2-3 times /month!! Had one put their call bell on for more Dilaudid, was told it wasn't time yet, so the goof left the floor in their patient gown( no underwear, flapping in the breeze) and tried to get re admitted to Hospital through the ED. We got a call from a very amused ED nurse asking us to come down and collect our patient!!.
There is no reason for most of these post op's to be on IV Morphine for days on end in the hospital. At some point early on in their post op period- they need to be switched to purely po analgesics. But their surgeons keep renewing the IV Morphine along with ordering the po. The nurse can go in give the po and 20 min later they're on the blasted bell for the IV morphine and it's day 3 or day 4 post op. And these patients get their IV meds. Had one in MRSA isolation storming out of the room down to the nursing desk bellowing for more IV Dilaudid- this one was 1 week post op and had a drug abuse hx the reason for their cardiac issues. So why wasn't more attention paid to the patient's past medical hx. when managing post op pain control???? This happens alot on cardiac units- drug hx's and cardiac sequela. I guess it's a nice thing to read in print but ignore in practice.
The nurses, and I supposed the docs also, give it to them out of fear of being reported or sued because of this new founded pain scale and patient satisfaction survey. Pain is pain- it hasn't changed over the years. Pt's did very well on the PCA's. Now post ops can lay around in bed, refuse their PT post CABG get their pain meds round the clock, make another trip( another scenenic tour on this Disney express) to the MICU for pneumonia and return to the hospital 1 week post discharge in CHF; all in the name of pains scales, patient satisfation surveys, and the magic of the admistration's idea of hospital visit = Disney. It's time to take the administration's 2 cents out of patient care. Let the professional healthcare staff manage the patients and stop interferring.
To address the burn patient issue- I've never been a burn nurse, maybe there needs to be a lengthening of their stay to get them off the hefty IV narc prior to discharge, but then again, there's another money influenced decision in patient care- insurance. Not evidence based practice, nursing critical thinking or sound medical judgement but MONEY and administration salary/profit.
- May 16, '12 by Bklyn_RNKcmylorn I also had a pt demand dilaudid and elope to the ER to when it was refused by the MD. But mine had took the time to get dressed before leaving.
- May 18, '12 by EmTheNewRNQuote from apocatastasisPerfectly expressed... Couldn't agree more.Pain is not pain is not pain - there are different kinds of pain that need to be approached differently depending on the situation. The current research, which is what we should all be looking at, is that chronic, daily use of opioids for non-terminal chronic pain is not only inappropriate but INEFFECTIVE for the majority of patients and creates significant detriment to daily functioning. These patients are more appropriately served with drugs such as NSAIDs, tricyclics, GABA analogues, physical therapy, and psychotherapy (particularly cognitive-behavioral therapy).
HOWEVER, under-treatment of ACUTE pain (e.g. by someone who isn't even a nurse yet but who has ALREADY(?!) decided that she has a vendetta against opioids across the board for the "benefit" of her patients) leads to establishment of pain pathways in the nervous system within the first several weeks after the initial injury. If unchecked, the establishment of these pathways leads to a patient who now has CHRONIC pain rather than ACUTE pain.
Acute pain should ALWAYS be treated swiftly and appropriately, and this includes use of narcotics if necessary and appropriate to the patient (e.g. no history of addiction), so that pain does not become a chronic issue, with attendant psychiatric comorbidities.