Pain Medication addicts - page 2

As a new nurse I have already encountered many patients who ask for pain medication non stop. I have even seen them place timers on their phones to remind them when the dose is due. Does anyone have... Read More

  1. by   rhudo
    I have a couple of thoughts.

    First and foremost- pain is what the patient says it is. It is completely a subjective symptom. That does not mean, however, nurses should administer medication without caution. If you feel the regimen is insufficient, talk with the prescribing provider. Also, watch for dependency s/s as well as cardiac/respiratory issues.
    Secondly- I am recovering from ankle reconstruction as we speak. It is not fun being on this end. I was timing a triad of meds post op. If the schedule was deviated, bringing the pain to even painfully tolerable was almost impossible. When I had my baby, a nurse kept me waiting for 1.25 hours for Vicodin, a very long time after a C-section. Hence, personal experience gives a new perception and appreciation for pain.
    Lastly-my dog, Colby, also takes Ultram for his ACL pain. Another participant mentioned their dog did the same. Needless to say warm milk and analgesics are a way of life around here for owner and dog lately. 😊
  2. by   SaoirseRN
    Quote from monkeybug
    She said that she had come in earlier but I was "asleep" so she just left the room. That really irritated me. I had just had general anesthesia, I was drowsy. This has nothing to do with my pain. You can sleep even when you have pain. Also, a lot of the time, I had my eyes shut in attempt to get control of myself. The more I hurt, the quieter I get. It doesn't hurt nurses to give meds. They don't deduct that morphine from our pay, so why do so many nurses act like it's personally costing them something?
    We aren't mind readers, though. If you want to shut your eyes to help that's fine, but there's a call button there for a reason, and if you need pain meds, ask for them. You should know it's easier to control the pain before it gets bad, so ask. Don't blame the nurses if you didn't tell them you had that much pain.
  3. by   leslie :-D
    Quote from Orange Tree
    It irritates me that so many nurses do not want to give pain medication for various reasons. They think the patient is lying, watching the clock, drug-seeking, not acting like they're in pain, etc. It seems to be a control issue for at least some nurses.
    Quote from MunoRN
    If patients are constantly having to initiate this assessment then there's a problem.
    the most evident, glaring problem i see, is evidenced by the title where the op outright calls the clock-watchers "addicts".
    even more unfortunate is i know she is not alone in her thoughts.
    it's too, too bad this is such a problem amongst nurses...it really is.
    pain advocates should be requesting to drs, that all pain meds should be scheduled and atc for the first 24 hours.
    otherwise, this "prn" stuff is for the birds.
    gawd help those who are in pain.

    leslie
  4. by   morte
    yup, in nursing school, many moons ago, we were taught that post up meds should at least be offered atc for the 1' 24'......of course that was before PCAs...
  5. by   LadyFree28
    I am an advocate for treating pain. I give medicine for "breakthrough" pain as well. I find that pain control is essential to being able to recover.

    In my experience as a post-OP pt, I had to enlighten my assigned PACU nurse who thought that my pain was sufficient for my pain, however I had a headache, and the morphine was not touching it. When I ran down a couple if meds, she still looked unsure, she got the anesthesiologist, who stated "all you have to do is push the button." My reply was "DUH!! I am a NURSE employed at ----- and graduated from ---(the school was affiliated with the hospital and I used name clout, lol...) I am VERY aware of how to use if. My post-OP pain is controlled. I have a headache, I suffer from migraines. I still need a break through medicine to treat THIS new pain." VERY Grateful for a nursing who had NO PROBLEM administering Toradol IV ( and was an alumni from the school )...headache was gone in 5 mins!!!!

    I'm still and advocate on treating break through pain...if the person has a high tolerance level, we still have to tailor to their needs, and start having a plan on tweaking their pain plan, and for the pt to be actively involved. I'be had pts who had in the past taken illicit drugs, and their pain could never be satisfied because their pain receptors were covered in the drugs they frequently took. I tried alternative methods along with the pharmacological methods. I had to explain to them the WHY...some were able to eventually get their pain resolved, some still had trouble, but found a way to tolerate their pain-but used heat/ice, were willing to try deep breathing and guided imagery, and they felt it helped them cope. Some didn't feel it was enough, and U made sure they had resources to go into a pain management program.

    I think it takes a balance assessment wise and patient reporting to come to a decision on pain. If there are concerns about done of the physiological effects, there are too many alternatives that can be arranged to allow a pt to sit there in pain, IMHO.
  6. by   monkeybug
    Quote from SaoirseRN
    We aren't mind readers, though. If you want to shut your eyes to help that's fine, but there's a call button there for a reason, and if you need pain meds, ask for them. You should know it's easier to control the pain before it gets bad, so ask. Don't blame the nurses if you didn't tell them you had that much pain.
    I wasn't given a call bell. I was in a recovery situation. I don't know if they didn't have them or I just wasn't given mine. My point was that sleep is not the opposite of pain, and that nurses never should, but often do, assume that just because a patient is asleep, they are pain free. And I've spent a lot of my career recovering surgery patients (usually c-sections and tubals) and assessment is key. I have no qualms about waking up a patient to assess for bleeding, vital signs, OR pain. It's not the same thing as waking up someone at 3 am to ask them if they'd like a sleeping pill.
  7. by   PunkBenRN
    The patient gets pain meds when they ask for them. Period. I would rather overmedicate a junkie than undermedicate someone in legitimate pain. Most patients that are believed to be junkies are in fact not. Sometimes its an issue of poor pain management, other times its because the person is very sensitive to pain or has high expectations from the hospital (such as first surgery or childbirth). It is incredibly subjective to assign this title and dictate plan of care accordingly without all the facts present, and I've found calling people 'med-seekers' will only be a detriment to their care. Once the health care team's mind is made up, they stop investigating route causes, they stop treating, and they blame the patient for the problem. Don't get me wrong, they are out there. They are very cumbersome and annoying, I will give you that. But research suggests that number of legitimate med seekers is much lower than what health care professionals estimate it to be.

    Besides, even junkies have pain. Treat it.


    Edit: I guess I should have read through the thread first, I suppose a lot of people agree with me. Great to see, thank you all
  8. by   SaoirseRN
    Quote from monkeybug

    I wasn't given a call bell. I was in a recovery situation. I don't know if they didn't have them or I just wasn't given mine. My point was that sleep is not the opposite of pain, and that nurses never should, but often do, assume that just because a patient is asleep, they are pain free. And I've spent a lot of my career recovering surgery patients (usually c-sections and tubals) and assessment is key. I have no qualms about waking up a patient to assess for bleeding, vital signs, OR pain. It's not the same thing as waking up someone at 3 am to ask them if they'd like a sleeping pill.
    I didn't realize your situation occurred in the recovery room, my apologies. And I agree with your points as well. I have, though, seen too many times when patients (on the ward) just don't say anything, let the pain get bad. My point was if someone wakes up in pain (say at 0200 vitals they had no pain, but awoke at 0330 in pain and didn't say anything until I did my 0400 round) they need to let someone know, because I can't tell from my charting station that they are awake and in pain.

    Did not mean to offend -- sorry if I did
  9. by   monkeybug
    Quote from SaoirseRN
    I didn't realize your situation occurred in the recovery room, my apologies. And I agree with your points as well. I have, though, seen too many times when patients (on the ward) just don't say anything, let the pain get bad. My point was if someone wakes up in pain (say at 0200 vitals they had no pain, but awoke at 0330 in pain and didn't say anything until I did my 0400 round) they need to let someone know, because I can't tell from my charting station that they are awake and in pain.

    Did not mean to offend -- sorry if I did
    Not at all, and you are correct about patients speaking up.
  10. by   teeroze201069
    The patient that is 7 days post-op ( to be discharged in the AM), walking independently down the hall, talking on their cell phones and passing me by talking about "My Dilaudid is due, can you bring it? I'm at a 10/10 pain level." Or the patient who watches the clock or sets their cell phone alarm so it can WAKE THEM FROM A SOUND SLEEP, so they can also claim a 10/10 pain are the ones I have issue with. Pain is what the patient's say it is but I think cell phones and any devices that act as alarm clocks should be banned. If the patient is sleeping, more times than not, they are not 10/10 pain level. We use whiteboards in the room to write the time it is given and time next dose due. If they sleep 2 hours past when it can be given, they obviously didn't need it at that time. I also know something is up when patient's get VERY angry when I dilute their IV morphine or dilaudid or if I administer it slowly per protocol. They want me to slam it in. I try to educate them but they don't want to hear it. I follow policy and procedure all the time anyway but then the patient complains about poor pain management on HCAPPS and the hospital gets stiffed for the bill. I wish there were stricter criteria for pain assessment. Like the patient must exhibit specific behavior for 10/10 pain and, short of that, nurse's should be empowered to be able withhold the strongest pain med and give the lower med. using sound nursing judgement.
  11. by   KIMMIEKAY11868
    I worked in pain management for 18 months. There are many patients who have severe pain and are dependent on their opioid. There is a big difference between dependent and addicted! Many pain patients have real pain and there are those who abuse it. More difficult to tell than you would think! It is hard to manage period. We need new treatment options.
  12. by   jdub6
    Quote from LadyFree28
    I had a headache, and the morphine was not touching it. When I ran down a couple if meds, she still looked unsure, she got the anesthesiologist, who stated "all you have to do is push the button."... My post-OP pain is controlled. I have a headache, I suffer from migraines. I still need a break through medicine to treat THIS new pain."...

    I'm still and advocate on treating break through pain...if the person has a high tolerance level, we still have to tailor to their needs, and start having a plan on tweaking their pain plan, and for the pt to be actively involved. I'be had pts who had in the past taken illicit drugs, and their pain could never be satisfied because their pain receptors were covered in the drugs they frequently took. I tried alternative methods along with the pharmacological methods. I had to explain to them the WHY...some were able to eventually get their pain resolved, some still had trouble, but found a way to tolerate their pain-but used heat/ice, were willing to try deep breathing and guided imagery, and they felt it helped them cope. Some didn't feel it was enough, and U made sure they had resources to go into a pain management program.

    LadyFree, I apologize in advance for using your post to illustrate something that may not have applied to you/yourself...I recently have had several patients requesting breakthrough narcotics because their acute pain was "still there, not bad but it's just annoying." A certain percentage of these folks (along with anyone else getting narcotics esp morphine) are surprised when an hour later they notice a headache. In my experience as a pt and nurse morphine in some patients causes or worsens headaches. Sure, "pain is what the patient says..." but I do try to educate my patients that the goal with acute pain is not generally for them to be pain-free. When they (or their well-intentioned family) use their pain meds with the goal of no pain their expectations have been so heightened that they are legit surprised to find the side effects often are worse than tolerable level of pain. I believe in treating pain but also managing expectations.

    As someone whose very real acute pain (with real radiology findings and all) led to a nasty addiction which spun out of control when I began to confuse withdrawal symptoms with pain in need of treatment I find myself struggling sometimes when patients or their families make comments like "he's in the hospital, might as well take the Big Guns [morphine] while they're available" "I think I need more meds. I still feel a little pain, not even a 1/10 but it's still there somewhere" etc. The clock-watching in my case was at first about pain treated with Dilaudid that hit hard, then wore off in 2 or 3 hours but was ordered q6. After awhile, the clock watching was also about me avoiding withdrawal. I wouldn't put my worst enemy through the hell my addiction caused me and while I don't advocate for people suffering, I do recognize that addiction strikes well over 1 in 15 people, can happen to anyone (even those who request meds as ordered for "real pain"!!) and has devastating consequences in the lives of those who still HAVE their lives.

    We need to understand that using narcotics as our sole treatment method is biologically unsound and leads to clock watching and similar behavior. Not just for addicts with impossible tolerance levels but for anyone. The fact is that a not-insignificant percentage of us will become addicted, and many more suffer severe side effects. Alternative methods, non-narcotic meds, and realistic patient expectations are crucial for ALL patients, not just those already addicted or displaying signs of possible addiction.

    To the poster who described narcotics as a "control issue" for nurses...I'm sure I'm one of the nurses you speak of but that's actually not my motivation. So many here describe themselves as primarily concerned with relieving or preventing pain. I am too...I just know first hand that opiates bring a serious risk of addiction and that addiction brings extreme physical/metal/social pain.

    People speak of giving meds as requested unless unsafe because they believe we cannot cure addiction during an acute hospital stay-and that may be true-but in my case it STARTED during a hospital stay and while at that time I loved my nurses who treated my pain and withdrawal symptoms, I do wish now that i would have been encouraged to minimize use of narcotics early. I don't blame my nurses or doctors for my problem...but to say it couldn't have been helped while I was hospitalized is just naive.
  13. by   hppygr8ful
    Quote from jdub6
    LadyFree, I apologize in advance for using your post to illustrate something that may not have applied to you/yourself...I recently have had several patients requesting breakthrough narcotics because their acute pain was "still there, not bad but it's just annoying." A certain percentage of these folks (along with anyone else getting narcotics esp morphine) are surprised when an hour later they notice a headache. In my experience as a pt and nurse morphine in some patients causes or worsens headaches. Sure, "pain is what the patient says..." but I do try to educate my patients that the goal with acute pain is not generally for them to be pain-free. When they (or their well-intentioned family) use their pain meds with the goal of no pain their expectations have been so heightened that they are legit surprised to find the side effects often are worse than tolerable level of pain. I believe in treating pain but also managing expectations.

    As someone whose very real acute pain (with real radiology findings and all) led to a nasty addiction which spun out of control when I began to confuse withdrawal symptoms with pain in need of treatment I find myself struggling sometimes when patients or their families make comments like "he's in the hospital, might as well take the Big Guns [morphine] while they're available" "I think I need more meds. I still feel a little pain, not even a 1/10 but it's still there somewhere" etc. The clock-watching in my case was at first about pain treated with Dilaudid that hit hard, then wore off in 2 or 3 hours but was ordered q6. After awhile, the clock watching was also about me avoiding withdrawal. I wouldn't put my worst enemy through the hell my addiction caused me and while I don't advocate for people suffering, I do recognize that addiction strikes well over 1 in 15 people, can happen to anyone (even those who request meds as ordered for "real pain"!!) and has devastating consequences in the lives of those who still HAVE their lives.

    We need to understand that using narcotics as our sole treatment method is biologically unsound and leads to clock watching and similar behavior. Not just for addicts with impossible tolerance levels but for anyone. The fact is that a not-insignificant percentage of us will become addicted, and many more suffer severe side effects. Alternative methods, non-narcotic meds, and realistic patient expectations are crucial for ALL patients, not just those already addicted or displaying signs of possible addiction.

    To the poster who described narcotics as a "control issue" for nurses...I'm sure I'm one of the nurses you speak of but that's actually not my motivation. So many here describe themselves as primarily concerned with relieving or preventing pain. I am too...I just know first hand that opiates bring a serious risk of addiction and that addiction brings extreme physical/metal/social pain.

    People speak of giving meds as requested unless unsafe because they believe we cannot cure addiction during an acute hospital stay-and that may be true-but in my case it STARTED during a hospital stay and while at that time I loved my nurses who treated my pain and withdrawal symptoms, I do wish now that i would have been encouraged to minimize use of narcotics early. I don't blame my nurses or doctors for my problem...but to say it couldn't have been helped while I was hospitalized is just naive.
    While I respect your personal experience I challenge the idea that all patients treated with opioids are at significant risk of becoming addicted to those medications. With the completion of the Human Genome Project certain genes have been identified in less than 10 percent of the population that are strong predictor's of the risk for addiction.

    Genes and Addiction

    While each patient cannot be realistically tested for this tendency all persons should not be treated in a one size fits all attitude. I do see value in educating patients new to opioids about the risks for dependence/addiction I must defer to the patient's need for pain control so that they can rest, recover and participate in the PT.

    In my experience detoxing hundreds of opioid addicts only a very small number state they started using after surgery. Many in fact obtain their first doses from street venders in high school and college to get high this is also true of the current Xanax epidemic in high schools across the nation.

    I posted this article under another topic but it is an interesting read as it is the current position statement on pain management from the American Society of Pain Management Nurses and the International Nurses Society on Addiction.

    http://www.aspmn.org/Documents/PainM...orders_JPN.pdf

    Pain is often the most under treated symptom in the hospital setting especially in the psych and elderly populations. We must have more non biased discussions on this topic.

    Hppy

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