Pain Medication addicts - page 3

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   jdub6
    Quote from hppygr8ful
    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....
    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
    Obviously not everyone is susceptible to addiction like i obviously was/am. The reason I share this is that I see a bias in the other direction often. Patients and nurses are given/giving unrealistic expectations and dangerous advice that opiates should be used with the goal of no pain, that opiates are the main and best method of treating any pain (in fact opiates are generally not effective in chronic pain) and that you do not have to worry about addiction/dependence if treating "real pain" with prescribed meds.

    As you said pain should be treated with many methods including PT, massage, psychotherapy/coping skills/stress management, acupuncture, meditation, NSAIDS, steroid injections, stretching and opiates. Unfortunately opiates often are the cheapest/easiest/quickest solution and nurses and patients alike tend to reach for the Percocet (in my state Medicaid covers p.o. narcotics for chronic pain but not Lidoderm or PT.)

    We need to have a balanced perspective and share it with our patients. Pain should be treated but people should have realistic goals (often that means pain will be present but at a tolerable level-not gone) and they should know that 10% or more are at risk of addiction when taking opiates even as prescribed and nearly everyone who takes them medium or long term will have to deal with withdrawal. They should know if applicable to their situation that opiates do NOT improve function/increase employment levels/improve subjective quality of life in studies of chronic pain. They should know if having GI pain that opiates decrease motility, and about narcotic bowel syndrome. If rapidly increasing dose they should know about opiate hyperalgesia. Athletes with sports injuries should not use opiates to mask pain and continue playing as this worsens their injury and is a setup for addiction (overdoses are now the leading cause of accidental death among middle and high school ages as well as adults.)

    In short opiates are one tool and they are not magic, and a significant minority of the population is susceptible to addiction even if they feel they are not criminals/wouldn't do things like that/addiction is something that only happens to others. The view that morphine or Percocet is "the only thing that works" is dangerous-they should be used in conjunction with other tools and not as a lone magic solution. Nurses need to encourage compliance with PT and coping skills and not just grab the meds because it's easier.
  2. by   hppygr8ful
    Quote from jdub6
    Obviously not everyone is susceptible to addiction like i obviously was/am. The reason I share this is that I see a bias in the other direction often. Patients and nurses are given/giving unrealistic expectations and dangerous advice that opiates should be used with the goal of no pain, that opiates are the main and best method of treating any pain (in fact opiates are generally not effective in chronic pain) and that you do not have to worry about addiction/dependence if treating "real pain" with prescribed meds.

    As you said pain should be treated with many methods including PT, massage, psychotherapy/coping skills/stress management, acupuncture, meditation, NSAIDS, steroid injections, stretching and opiates. Unfortunately opiates often are the cheapest/easiest/quickest solution and nurses and patients alike tend to reach for the Percocet (in my state Medicaid covers p.o. narcotics for chronic pain but not Lidoderm or PT.)

    We need to have a balanced perspective and share it with our patients. Pain should be treated but people should have realistic goals (often that means pain will be present but at a tolerable level-not gone) and they should know that 10% or more are at risk of addiction when taking opiates even as prescribed and nearly everyone who takes them medium or long term will have to deal with withdrawal. They should know if applicable to their situation that opiates do NOT improve function/increase employment levels/improve subjective quality of life in studies of chronic pain. They should know if having GI pain that opiates decrease motility, and about narcotic bowel syndrome. If rapidly increasing dose they should know about opiate hyperalgesia. Athletes with sports injuries should not use opiates to mask pain and continue playing as this worsens their injury and is a setup for addiction (overdoses are now the leading cause of accidental death among middle and high school ages as well as adults.)

    In short opiates are one tool and they are not magic, and a significant minority of the population is susceptible to addiction even if they feel they are not criminals/wouldn't do things like that/addiction is something that only happens to others. The view that morphine or Percocet is "the only thing that works" is dangerous-they should be used in conjunction with other tools and not as a lone magic solution. Nurses need to encourage compliance with PT and coping skills and not just grab the meds because it's easier.
    You make some very good points and as a recovering alcoholic sober 15 years I have had many fears when I had to have several surgeries in 2012. During that time I had 18 inches of my colon removed for a cancer I didn't have (long story). A wound that wouldn't heal and am unrelated rotator cuff tear that still pains me to this day.

    In all my experiences I never remember any nurse, doctor, therapist stating to me that the goal of pain management was to be pain free. In fact as the name implies pain is to be managed to a level that allows rest, recuperation and recovery! That's what I was told and that's what I have conveyed over the year to patients before I started doing psych. I was not really education by any of them on the danger's of addiction except that they noted my history and suggested I stop taking the medication as soon as reasonably possible. They never cut me off though.

    I stay very active in the recovery community and once had a conversation with a past president of the National Association of Addiction Treatment Providers and he told me this about the predilection for addiction.

    There are essentially two kinds of people addicts (and those waiting to happen) and non addicts. the non-addict breaks a leg skiing and when he/she follows up with ortho tells the doctor "I don't like the way these meds make me feel. Can I just get some Tylenol or Aleve?" The addict or potential addict says "This stuff is great can I get some more?"

    Again I can see where your own experience has shaped your views and I totally respect your stand. I also respect that you have said that you would not deny someone in pain
  3. by   RestlessHeart
    Quote from 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
    If ever given the chance, the need or the opportunity I would wish you could be my Nurse. I would be proud to take direction / education from you as My Nurse.

    I have horrible horrible pain issues and have had them form more than 20 years. Ive taken, almost literally every pain med out there. Morphine, dilaudid, fentanyl, nubain, demerol, codeine, oxy, vicodin et al. Nubain was the best for migraine. Morphine and dilaudid and fentanyl damn near killed me because the Nurse would not believe I was allergic. Oxy never did a thing. I could literally take a handful and go shopping. Codeine and Vicodin are the best, they dont kill the pain but they do make it tolerable so that I have some quality of life.

    I take vic now with a phenergan chaser (LOL kinda) and havent changed the dose in probably close to 10 years. It works....I dont question what works.

    What I do question is how some nurses treat "us". I had shoulder reconstruction twice and a torn and repaired ACL and Im tellin ya...nothing much touches that pain. Of all the surgeries Ive ever had...those were the worst. I had a nurse encounter each freaking time that was enough to land me in jail (jk) According to her anything more than Tylenol was not needed the 2nd post op. She would make me wait 5 or even 6 hours before giving me the pain med ordered. Back then they were almost always IM.

    We're not all junkies. I'll be the first to fess up....I have no pain tolerance to speak of. A hangnail for you is a surgery for me. IF I was a junkie, you denying me a pain med after surgery isnt going to change that, it wont make it worse or better. When we are denied adequate pain control OF COURSE WE act as what you call a junkie, we start clock watching, we may get demanding, angry or weepy. ALL we want is the hurt to let up. We know, those of us with Chronic Pain, RCPS et al that we will never not be in pain on some level. We just want it to be a little less, a little more tolerable.

    Please dont look down your nose at me / us. Dont be condescending, dont judge my pain according to your pain.

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