Drug seeking or real pain? How do you tell? - page 11

I'm a new nurse on the list so please pardon my ignorance. I was quite interested in the pain links and explored several and probably will use some for staff training. I did not see any mention of... Read More

  1. Visit  twotrees2 profile page
    0
    [QUOTE=KarenGeorgeBSRN;2685965][SIZE=3]Whoever here can say they did not write an article that they wrote needs to either change a password (please people you have a sign on if someone else is playing with your pc you need to take responsibility), and or open a new account and get this one closed down.

    [SIZE=3]

    i apologize- i looked back and this was on my name- do not know how - will be cahnging my password- in my dfense- the 2 previous posts before the one i questioned were as i felt - showing i do feel we need to listen to pain and people who have it. previous posts before the one i questioned were as follows - and i know i posted morethat were along the same lines that i agree with you that we need to believe and treat pain. in flowing with the questionable post id go another step and say - as for questioning docs orders- its not just double dosages- itis lack of orders- ( pain? why not pain meds? and we have documented vigourously against the current doc i work with does routyinely neglect pain on our inmates and we dont like it) thank you for bringing this to my attention- i thought perhas that my name got attached to another when they ran together sometimes i cut and paste and it hjas happend when i have cut and paste to accidently cut the wrong section) . i aqpologize if i sounded rude in regards to the post i did not paost- i amglad it was noted and i know to change my passwprd- didnt know anyone could get on it...
    <
    living with chronic pain i disagree with you on the "if you have to shake em to wak em or thier snoring" etc comments- - when my body gets in the best position i can zonk out quite soundly - not really sleeping but my body wore out type sleep - but when i awake i am in so much pain it isnt even funny - i snore even when i am not sound asleep with sleep apnea - dont assume i am sleeping just cause i am snoring. also during a acute pain episode i was given demerol - it took care of the edge of the pain allowing me to sleep between spasms of pain- teh spasms of pain would wake me right up screaming - -

    =============================

    people who have chronic pain can have acute pain also - i dont see any reason they should NOT go to the er if they end up with other pain - one because with our chronic pain we know whats causing it and what fixes it - i sure am not gonna have severe abd pain and just medicate myself with my pain meds and perhaps have a ruptured appendix opr whatever -

    oh and i have seen somone who ran out of the pills ( not thinking to refill them as they werent scheduled )- and he tried hard to not take em - and he let it go so far he went toget some and had only a few pills left - not enough to get through the weekend to get to doc on mon. it happens.
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  3. Visit  krisssy profile page
    1
    Quote from KarenGeorgeBSRN
    Dear Krissy,

    You would do the profession a "justice" to work with PM clients; you could with all your years of experience get involved within your profession now (don't retire we need nurses like you!!!) on that level. The empathy you exhibit is something we cannot teach in our profession, or in the medical profession--it is a gift you were born with (from God many will say), and with this a "beginning" not an end to a wonderful career of truly helping. You have seen thousands of clients in the "trenches" and your value to our profession is inestimable.

    Keep it up my friend you are well needed!

    Thanks,

    Karen G
    Hi Karen,

    It has been such a pleasure to chat with you and learn from your posts. Thanks again.

    Krisssy RN MA
    tsalagicara likes this.
  4. Visit  krisssy profile page
    3
    Quote from KarenGeorgeBSRN
    Dear VA Medic 4,

    I've been looking back on those who really want to know; who can't understand for either they have lost compassion, or worked with physicians who also "just do not care" and what is sad truly is that a tolerant, pain client does not get "high or dopey" they get relief. Bottom line they want to be "just like a normal" meaning not laying in bed crying, unable to walk, think or move. Imagine taking a client into the OR for an appendectomy and "not medicating" just hit them with curare so they are paralyzed, then "bring them up" and watch the "show begin..." My God the thought of it makes me sick...

    Ya'll I have burned out on this speciality and for years have done pro bono pain support and been an "advocate" as "Krissy" notes she would like to be. Each of us have that capacity now. We cannot wish that "another suffer" even what some here hatefully term an "addict."

    An addict suffers in incurable disease and this too must be treated with love, compassion, and kindness. Where else but in nursing can we truly address in our assessments "the client's response to medical intervention."

    Today I choose to step back (or did I am laughing here) from this specialty and call myself a "generalist" and thank God I am. Let me never end a "work day" wondering if the man down the hall died suffering, or the older woman with severe RA or OA did not have anything to help her in the morning when she awoke unable to take a deep breath for her swollen gnarled hands were like hot pokers, let me NOT be that kind of a nurse.

    Yes I work Administration, yes I must always be a "teacher" and no I can't ever stop either (Krissy) and won't. We have this obligation to never question our role in our profession when we hang our hat upon the door and go home..We are caregivers, indeed!

    Hell if they are eating chips, ice cream, or gagging over the "crapper" because they are in withdrawal they are in PAIN folks. Get off the throne and get down on the floors see their true pain, empathize!!

    Karen G.
    Hi Again Karen,

    This post should be hung in every ED in this country.

    Krisssy RN MA
  5. Visit  Josh L.Ac. profile page
    1
    So is it being advocated on this thread that we should give narcotics to patients that are going through withdrawals because they are suffering?
    canoehead likes this.
  6. Visit  krisssy profile page
    3
    Quote from Josh L.Ac.
    So is it being advocated on this thread that we should give narcotics to patients that are going through withdrawals because they are suffering?
    Our job as professional nurses is of course to do what we can to help any patient who is suffering for any reason. If the reason is narcotic withdrawal OF COURSE we need to give our patient narcotics. As we should all know, abrupt cessation of narcotics does not just cause suffering and pain, it can cause DEATH. In an ED, I would hope the doctor would give the patient narcotics to stop the withdrawal, thereby stopping the suffering and pain and preventing the possibility of death. A consult with a psychiatrist would lead to a determination of what is going on in the particular situation with the particular patient. Has the patient become tolerant to narcotics? Why does he take narcotics? Is he in pain? Does he have the DISEASE of addiction? Or has he just developed a tolerance? If he has the DISEASE of addiction, he needs to be detoxed SAFELY at a rehab. There will be trained people there to help the patient with their particular DISEASE. If he takes the narcotics for pain and has developed a tolerance, he may need Pain Management. WHATEVER, the reason, how can anyone of us advocate for just leaving our patient in pain and suffering and perhaps even letting them die?

    The narcotics is to relieve pain and suffering and prevent death. Then the professional team uses their critical thinking skills, their knowledge and their compassion to diagnose what is wrong with the WHOLE person physically, emotionally, mentally and spiritually. Then a treatment plan is made INDIVIDUAL to every patient.

    Krisssy RN MA
  7. Visit  KarenGeorgeBSRN profile page
    4
    POSTED TO REAL PAIN OR ADDICTION HOPE ALL CAN APPRECIATE!

    Dear "Professionals,"

    The patient is.... "in pain" and is suffering. Pain can and does kill. Even with properly utilized opioids the organ systems within the body react as if in fight or flight response; wearing away over time the entire person's ability to do simple ADLs, have restorative healing, and to intentionally live.

    Those not in pain just do what others in pain must think to do. (Please reread that sentence and think it out several times before continuing.) A person afflicted with pain who has been functional is no longer able to react physically as their mind and body are overtaxed with negative reinforcers. If they bend their knees, pain tells the brain "stop" and when they force it pain spreads and or has a "referred response." It causes such exhaustion and overload that over time there is depression further depleting the brain of endorphins (natural substances endogenically produced to soothe pain), and a cycle of negative consequence occurs.

    Many in chronic pain look great; if they are again reinforced by support list(s) such as mine; they do not lay in bed, they get up and out of the house (fight isolation) and do to their best capacity what they can to realign their inability to do what is normal. For those with catastrophic pain who have lost everything; job, family, and friends an entire reorganization of life must occur starting with "who am I now" (new role), and the constant reminder that the "pain" has a persona so powerful it is as if "satan" is there sabotaging their every move.

    Whatever pain it is; terminal or nonmalignant it must be relieved, and to chase acute pain in a chronic, means large doses of IV push medications in a humane environment; this post shows me that many here this or chase the physician for he or she to do this. Prevention of those rapid cycles is the true way to treat the pain; hopefully with a good LA or two good LA's and a BT medication for short acting results.

    Put yourself in their shoes; recall that time when you had a sudden event; a renal stone; bad appendicts, MI...Remember that pain, and when a patient states he or she has pain, gives it a number on a scale of 1 to 10 (0 being none and 10 the worst imagined pain) do something about it. Do not forgo your normal nursing assessment at all; for indeed there could be an acute cause in one with NIP; but do not degrade your client by doing less than he or she warrants.

    Humane, professional treatment. Ladies and gentlemen you are not opening your own vault of "morphine" to allow a client relief for 2 to 3 hours here; this is a chemical used to treat pain; does not matter which medication is given, only that there is a response. We all know what works best; we also must assess tolerance in those who have NIP, and honestly share their normal medications et al. We want our client to be open and helpful so that we in turn, may provide interventions to relieve their pain, to help this plague on sanity (body and mind) that can truly take them to a point of such destruction that suicide (over time) is the only outcome!

    Those with terminal pain are lucky on one level; the DEA truly does not care if they are medicated. What about those who live; who have families, and want to work and continue with heads held high? How may nurses do you know who are in NIP and working on PM? Not many perhaps but more than you are likely to know; it is far harder to convince a nurse that his or her NIP needs proper treatment for "we" tend to think we are above this nonsense but sadly we are not. Those who do work on PM, may be cautiously "silent" to avoid the very prejudicial statements we have all witnessed on this and other posts, bedside in the setting that those in "pain" unjustly receive.

    If it makes a nurse in these days of high demand and high technology a functioning member of our profession; a good wife or husband, and an able member of society so be it. Remember, tolerance disallows getting high; that those in pain can suffer profound withdrawal IF they are suddenly removed from medications, but addiction is another serious deadly disease where the person suffering takes all he or she can get to the point of overdose and death. Such a difference needs to be pointed out early on in training. Many of us have not had the benefit of training, and should be throughout our careers and lives open and able to learn, to absorb new information, and also to pass it along to those in need. We must be advocates; there are family members to educate, physicians, CNA's all about us.

    Let us put our energy to good use; not to negative and judgmental rage.

    Thank you all!

    Karen G.


    Originally Posted by wannabeenurse1
    The PT is dying of cancer, why are you so concern with him becoming addicted to drugs. At this point in his life he just needs to be comfortable.

    sharpeimom, tsalagicara, amygooch, and 1 other like this.
  8. Visit  NEC1970 profile page
    2
    Greetings. Not sure if this post is still active so I'll be brief.

    Yesterday, I worked per diem at an Out Patient Surgical Center. We had several quick cases to recover for epidural steroid injections. All chronic pain pts. This one lady, about 40 y/o, came out miserable. Pain numeric #8. Looked very sad and flat. During the case she rec'd 60mg Toradol, 100 mcg Fentanyl, 2mg Versed. She is otherwise healthy.

    Well, I assessed her post-op and she was miserable. This particular surgeon does not write post-op pain orders. I was told this is how we do it here. Get em in and out quickly. "We cannot fix their pain." I was getting frustrated. I approached the surgeon and requested something for this pt's pain. I was told, how high is it? Ok an 8. "let's wait a while and see if it goes down. She got a lot during the case." I said with all due respect, I am advocating for this pt who is in pain. May I have an order for Dilaudid please. Not only was I shot down, this MD spoke to my charge and said she was offended that I implied she wasn't an advocate. Well, I was close to asking her if her mama was in that bed would she deny her pain control and simply wait and hope it got better?

    What really frustrated me was the fact that this pt was being fully monitored, was completely awake, VSS, and they were making a big deal about giving her narcotics. I finally got an order for one time 0.5mg Morphine. I held my composure barely. This surgeon was a joke. When the pt first came out, I asked if she wanted me to check a sugar as the pt was DMII. The surgeon says why, she isn't a diabetic. The pt responds, yes I am. I wanted to scream, you dumb***, don't you even know your pt's H&P.

    I also got into a discussion with the charge as he sided with the surgeon. He said we give these pt's a Percocet and send them home. I said the pt was in pain and we did not treat it. He says, "she wasn't in pain." I immediately responded, that is not for you to say! Of course, he tells me, "it is for him to say...." I think it is said that many medical professionals & out-pt surgical centers do not really care about their pts. I researched for 1 hr today and could not locate anything to the contrary about a pt's pain rating is what they say it is. This was like day one nursing school.
    tsalagicara and nanacarol like this.
  9. Visit  psalm profile page
    1
    ...as the patient Tuesday at my dentist's, I am here to tell you that my pain was/is very real! I forget how debilitating tooth pain can be until I need another root canal, oh my, I am suffering! My last root canal was 20 years ago and I am dreading my next appt. I cannot take codeine, or NSAIDs and the tylenol doesn't help the inflammation much. Darvocet q 4 hours and at 2.5 hours I need more. I would think the antibiotic would have helped by now, as it zaps the germs...

    This experience has humbled me to the needs of my patients. I have tried all the diversions and repositioning I have suggested to my patients and not too many work! or work for long. So pain is pain is pain.
    tsalagicara likes this.
  10. Visit  nanacarol profile page
    3
    I applaud you for your persistent advocacy. You are correct, if the patient says her pain is #8 it is #8 and should be treated. Both the charge and the doc are in error. I believe this is an ethics committee issue and if there isn't such a group I would report this to the clinic's licensing board. If we don't stand up as professionals we will always be ignored by physicians and other less than competent nurse leader (your charge). Nanacarol
    tsalagicara, NEC1970, and krisssy like this.
  11. Visit  twotrees2 profile page
    1
    negating a patients pain is out there - i had to get a new GP as mine left after 15 yrs i had hjim- this new one that came into the clinic inplace of him- told me straight out she would not give me my painmeds for my fibromyalgia- it is not a real disease and the only thing that can be done for it is exercise. oy vey. yeah- she called me "histrionic" ( looking it up means "acting") in regards to that and my heart troubles ( cardiologist is not happy as i started to doubt myself "maybe it is all in my head" and did not schedule tests he had ordered- he caleed to tell me " you cant fake decreased cardiac output and a carotid bruit - get those tests " - ) anyhow- there are judgemental docs out there and i can onl;y hope theyone day end up with some serious pain or whatever they tell patients that they are faking about so that they can experience it and i hope they too are told its all in thier head. its disgusting. hang in there and just keep advocating.



    Quote from NEC1970
    Greetings. Not sure if this post is still active so I'll be brief.

    Yesterday, I worked per diem at an Out Patient Surgical Center. We had several quick cases to recover for epidural steroid injections. All chronic pain pts. This one lady, about 40 y/o, came out miserable. Pain numeric #8. Looked very sad and flat. During the case she rec'd 60mg Toradol, 100 mcg Fentanyl, 2mg Versed. She is otherwise healthy.

    Well, I assessed her post-op and she was miserable. This particular surgeon does not write post-op pain orders. I was told this is how we do it here. Get em in and out quickly. "We cannot fix their pain." I was getting frustrated. I approached the surgeon and requested something for this pt's pain. I was told, how high is it? Ok an 8. "let's wait a while and see if it goes down. She got a lot during the case." I said with all due respect, I am advocating for this pt who is in pain. May I have an order for Dilaudid please. Not only was I shot down, this MD spoke to my charge and said she was offended that I implied she wasn't an advocate. Well, I was close to asking her if her mama was in that bed would she deny her pain control and simply wait and hope it got better?

    What really frustrated me was the fact that this pt was being fully monitored, was completely awake, VSS, and they were making a big deal about giving her narcotics. I finally got an order for one time 0.5mg Morphine. I held my composure barely. This surgeon was a joke. When the pt first came out, I asked if she wanted me to check a sugar as the pt was DMII. The surgeon says why, she isn't a diabetic. The pt responds, yes I am. I wanted to scream, you dumb***, don't you even know your pt's H&P.

    I also got into a discussion with the charge as he sided with the surgeon. He said we give these pt's a Percocet and send them home. I said the pt was in pain and we did not treat it. He says, "she wasn't in pain." I immediately responded, that is not for you to say! Of course, he tells me, "it is for him to say...." I think it is said that many medical professionals & out-pt surgical centers do not really care about their pts. I researched for 1 hr today and could not locate anything to the contrary about a pt's pain rating is what they say it is. This was like day one nursing school.
    tsalagicara likes this.
  12. Visit  jtoney profile page
    2
    I don't like how you call the patient a "manipulator". More people die every year from Obesity and Cigarettes in the millions. Of the 4 million Americans who use pain medicine, only a couple hundred die from over dose. You don't deny obesity food, or cigarettes to smokers. Why should you deny Morphine to a pain addict? Just makes no sense at all.

    I have a herniated disc, c4/c5...with nerve damage in my back. I have spent countless nights in pain because a doctor wouldn't prescribe the right amount of pain medication.
    tsalagicara and Templedoll like this.
  13. Visit  Dragonnurse1 profile page
    0
    1 How long have you been a nurse?
    2 How long have you been a triage nurse?
    3 How many times have patients come in and ask how is the doc on and leave
    4 How many time have patients seen you sitting in triage and leave.

    Don't quote pain problems unless you are ready to fix it I was found on a Monday to have C3,4,&5 Herniated well wedged into foramen on right side did not have much use of right arm. The nerve in my right are is permentaly damaged, they even tried to move ulnur nerve. I had C5&C6 fused and plated 2 years ago and it still hurts and I have stenosis at L1,2,herniated diskl3 and l4.

    If your pain is that bad why do you not have surgery? Quick fix 2-4 weeks at home all better. Nerve damage in back you would have to explain.:typing

    One other tidbit - Normal bp. normal heartrate, normal breating, not needing emesis basin and being able to tell the staff exactly what to give how much to give and that they are allergic or had problems with every other oain med except dilauid or mso4
    something ain't right.

    Post scriptone of our regulars (Sickle Cell) was caught selling her pain med on street.She on course fainted and they brought her back to er. no more meds, no passing go, nocollecting 200.00
    Remember it is the Doctors that order the meds not the nurses.
  14. Visit  nanacarol profile page
    0
    We are not the pain police nor have been ordained to be the judges. I often ask nurses and physicians who show judgmental and indignant attitudes, what there is in the unspoken vault of their individual unspoken self that allowing the patient's spoken truth about pain violated. If one says "I have pain", then take it at face value. Let go of the need to control and dictate to others. As for the patient with sickle cell selling her pain med, the selling does not negate her having pain and requiring meds, it merely indicates her priorities have changed. Neither you nor you prescribing doc have the right to say no the next time that patient comes in and reports pain. nanacarol


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