Drug seeking or real pain? How do you tell?

[JudyPRN]

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 dealing with chemically dependant people who may or may not be having pain. I work in a mental health facility which also serves chemically dependant people. We have a constant struggle with determining who is in pain and who is drug-seeking. We have isolated a few cues, but over-all are probably treating the wrong patients. Does anyone on this list have ideas on this subject, who can steer me to a few resources? I appreciate all the help offered.

[CapeCodMermaid, RN]

I called the nursing supervisor and asked her to let the instructor know what a kind thing the student had done.

[luvmykids1123]

Thank you for these posts. I am a nursing student and have already encountered nurses who label patients as drug seeking. In school we have of course learned as you, that a patients pain is what he says it is. In practice I have seen a very different world. Reading your posts have assured me that I can treat the patient with the drugs that have been ordered for them without feeling like it is somehow my job to decide if they need them or not.

[sharpeimom]

i have sustained several sports injuries over my lifetime, was attacked by a psych patient who was nearly 7 feet tall and weighed over 400#, and i was accidentally bumped off the back of a london bus. i have arthritis as a result and am now dealing with a 7.5 cm tear in my right rotator cuff. i don't want to get into taking opiates yet. i take an nsaid, use a tens unit several times per day, go to a vigorous pt program 3x per week, use the same heat and ice packs i use at pt at home, take extra strength tylenol prn and usually it works for me. my average daily pain level is about 4/10, on a good day. i wish it were lower but it isn't and won't be. i have not had the shoulder repair yet because i'm a chicken. it will have to be an open repair and i'm just afraid either the pain med won't work and/or the ortho won't order enough. irrational maybe, but maybe not. when my shoulder and knee were dislocated and injured by the psych patient, the er doc kept telling me i was not in pain and to quit being a baby. yes, there are addicts and pain med seekers, but don't forget to order alternative remedies in conjunction with or instead of heavy duty meds to start out with. it's when no alternatives are presented that we get hyper and off-the-wall about pain relief. also, believe us when we say we hurt. don't assume. my vitals don't change much unless my pain is truly unbearable, so that isn't a reliable sign.

kathy

shar pei mom:paw::paw:

[Footballnut]

I am amazed that nurses always seem to get so fired up over this topic. Pain is one of the primary reasons people seek medical attention. One of my skills as a nurse is in relieving pain and I have a wide range of pain medications and pain management skills to choose from. Sometimes opiates are the best and sometimes they are not. Why should I let fear of drug seeking be a big enough issue to interfere with the good that I can do? I have the skill to safely monitor and assess my patients as I go.

I am at peace with addiction. A certain group of people is going to struggle with addiction whether I give them pain medications or not. They are all the more to be pitied and respected. Since I work in an ED addiction is usually a beginning conversation, a referral and a topic for another day. (Unless you put yourself into the ICU or mental health unit with your addiction.) There are limits. If someone has been getting outrageous prescriptions it is pretty easy to check out. For patient safety reasons our MDs are unlikely to give another 30 opiate tablets to someone who has already managed to get multiple recent large prescriptions from various sources. And the MDs expect patients to follow up so their illness and pain issues can be managed by one practitioner on an ongoing basis.

More than addiction, I worry about missing someone with pain that I could have helped. I help with beginning long term therapies and with short term opiates. I talk little old ladies into a pill or two for their pain when they are worried about getting "addicted." I give addicts opiates when they are in the storm of crisis and pain while withdrawing. I work to assess pain for my nonverbal patients. I like asking directly about pain as part of my assessment because it gives me information that I could not have guessed otherwise. Everyone is a candidate for pain, even addicts. Think of how badly you might feel withholding treatment from someone who has pain because of your fear of drug seeking.

[tewdles, RN]

I love your post footballnut...

I wish all ED nurses had your attitude about pain and pain relief.

[AtomicWoman]

This is one of the subjects I am most passionate about! There seems to be a terror of a patient "getting one over on me" among many physicians and nurses, even those that treat pain all day long. A recent article/editorial in the New York Times expressed my sentiments exactly: It's gonna happen! Oh, well! Some people will fool us. Better to take everyone's complaints of pain seriously than risk NOT treating the pain of someone who is in pain. Here's the article:

Mind - Fooling the Doctors, Some of the Time - NYTimes.com

[pggrn]

I agree totally. We, as a society, tend to be stingy with drugs that someone might also "enjoy" in addition to treating their symptoms. As an example I would point to the very limited research that has been done with marijuana and the right wing frenzy to stop the use of it.

[classicdame, MSN, EdD]

is it really part of your job to determine if the patient "deserves" the medication? Document activity, responses, etc. and let MD decide. Even if it is emotional pain, treat it

[Kezef76]

I just accept that for a portion of the time I am being fooled. It isn't a reflection on me though. I got into this to help people and if not missing the ones that are in real pain mean I get bamboozeled by some con artists, then so be it.

I do worry though that we jump straight to dilaudid too often though in the ED. Toradol works wonders for many patients when patients are willing to give it a try. But my main job is to not only relieve their pain but to protect the rest of us on the road by making sure these people don't kill somebody by driving off while altered. As long as they are in the bed and can get a ride, they're going to get relief from me.

[funnypharm]

Since I believe that people own their own bodies and it is not my job to play God of morality, if a client says they are in pain... Then they are in pain!

Obviously, if someone is already under the influence then that is a game changer but if a person is AOX3 and states that they are in pain then I take them at their word.

[MacSusan]

I'm in a chaplain residency program at a large urban hospital, and one of the floors where I visit patients is Ortho/Medical. I hope to do my ministry specialty project on something related to nurse's perspectives on patients they feel are "drug-seeking" post-operatively, and the patients' perspectives on how their requests for pain relief are handled and responded to and their overall satisfaction with quality of care they received. An additional and recent insight received from conversations with nurses on this floor suggest that at least some portion of their reported "burnout" with their job in general is related to the stress of responding to patients' complaints of inadequate pain relief, and the nurses' perceptions that a fair or high number of patients are drug seeking. And then, where in the mix of all this is the stress, perhaps, of nurses having to be in the middle between patient needing/wanting pain meds and the doctors who must be contacted to approve a higher dose or frequency? I have heard LOTS about the strains between doctors and nurses re: primary care issues!!!

So... why do some nurses feel so strongly against providing whatever pain relief is needed to keep a post surgical patient comfortable, so long as respiration is ok, etc.? Their hospital stay will be short presumably, their meds will be controlled after discharge by their own doctors, and if they are physically more comfortable they will participate in PT, get up and move around, and be far more likely to participate willingly in whatever they need to do to get back to their pre-surgery lives. Why so much worry about addiction, when the research and data is available in copious quantity to show that this is simply not an issue for the majority of patients?

I would love and so appreciate hearing from nurses and from those who've been patients in these circumstances! I have dealt with chronic pain for over 30 years from college years gymnastics injuries, so I know chronic pain and the impact it has had on my life. so I willingly acknowledge a bias towards treating the pain, since I lived the first twenty years after these injuries without consistent pain relief. And, pain DOES lead to depression, and, apparently, vice versa. Why in the world, when pain management as a medical practice has become so well established, are there still so many who fear everyone who takes pain meds is, or will become, an addict, a drug- seeker, etc.

Thank you!!

[Dragonnurse1, ASN, RN]

Too many nurses (and patients) do not understand pain control. I was a nurse in the ER and I suffered with migraines and since I was intimately familiar with migraines I was often called to exam rooms of patients requesting narcotics for migraines. Yes many of the patients were chronic migrainers but more than half were drug seeking. Nurses in the Emergency Rooms deal with more true drug seeking. This is a true problem for most ERs but not, I'm sure, in post-op. I have spent many hours instructing patients that not taking prescribed pain meds was detrimental to their recovery. Many patients are afraid of becoming "drug-addicts". I believe that pain-control should be taught as a subject in all nursing schools.

As a side note: I had one patient that bluffed even me - she got an INT and IV phenergan and demerol and she left (with INT intact) got in her car and drove away. Try doing the paperwork on something like that.