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

by JudyPRN 146,860 Views | 202 Comments

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... Read More


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    I have read all the responses and still say that the fact the individual has a drug problem does not negate her having pain. Nor does it mean the nurse has been duped. She perceived her pain to be 10/10 for her that is what it was. Who are we to say a drug addict does not have legitimate pain. We should educate as best we can, advocate always for the identified needs of the patient and Stop being "Pain Police. Nanacarol
    tsalagicara and KarenGeorgeBSRN like this.
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    Quote from Rapheal
    I always have my suspicions about some patients. But to keep things simple- and to perform my duties without value judgements I just accept the concept that pain is what the patient states it is and treat it according to what medications are ordered.

    It is sad however when I see people come in for bowel obstructions and need surgery and the main suspect of the bowel obstruction is constipation related to narcotic use. That is a sad consequence of narcotic use in some patients as well as other consequences. The best I am able to do is to perform teaching that people d/c'd with narcotics add fiber and extra water to their diets.
    I have worked with opiod addicted pts. We advised them to take OTC Colace. It works very well, and is cheap- and easy to shoplift- or so my addicted pts have told me.
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    Quote from mittels
    one of the first things you learn is if the pt says their in pain, tx them. is it your problem that they are chemically dependant? do you have to be the savior? im sure you dont want to be sitting in a court room with 12 jurors and answering the lawyers when they ask you, how did you come to the conclussion this person was not in pain? then end up paying megga bucks because you didn't tx. would you with hold pain meds to a chemically dependant person after mayjor trauma? no! then whats to say this person does not have pain. it always upsets me to see nurses who with hold pain meds to pt's when their in pain. weather true or not, we should not judge! tx them!

    what is tx?? i am a student and am new at this website
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    tx = treat. Reminder: Pain is what the Patient says it is.
    KarenGeorgeBSRN likes this.
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    Quote from scarlet
    tx = treat. Reminder: Pain is what the Patient says it is.
    Even if they c/o pain of 10 out of 10 on abd pain while smiling and eating potatoe chips. It is whatever they say.
    KarenGeorgeBSRN likes this.
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    deleted because accidentally posted 2x
    Last edit by lalalady on Dec 28, '07 : Reason: deleted
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    Here's a fun (not funny) story appropriate for the subject, but not really in response to the origional question...
    I was a patient in an ER in 2003. I was 23 then, mother of two and living with roomates whom I didn't know very well while I was going through a divorce and trying to get established in a new city and new job. I had an abscessed tooth. I had one or two before (once it was the same tooth) while I was pregnant, so I knew that if I kept it clean and I self-medicated, the pain might subside for a year or so. If I'd land in the ER, they would give me vicodin, antibiotics and novicaine to hold me over till I got an emergency appointment with a dentist (which I didn't keep before because the pain went away - I know, not smart). This particular time, I had been dealing with it for several days by combining tylenol and 3 or 4 ibuprofen and eventually (in the middle of my work-week) I was having to combine dayquil with 4 or 5 ibuprofen just to take one or two of the several "edges off." I called a dentist that would accept my lousy insurance and was prescribed vicodin over the phone to hold me over for a week till I could get seen. So I was crying and could barely think at all when my roomate drove me to the ER one night when the pain woke me from a vicodin/ibuprofen sleep. I knew one thing for sure: I could get some novicaine. The problem was my doctor treated me like I was "seeking" or whatever you call it. He treated me like I was a fool, less than human, like I was a pest or a parasite to humanity. I felt disgusting. He left me in the room in severe pain to call the dentist who prescribed the vicodin. Now I have had children. In my experience, I know that an abscessed tooth can be worse than the pain of child-birth if left untreated. The funny thing is, in retrospect, my dentist failed to get me an antibiotic, which is the only thing that can really make the pain subside...Anyways, this ER doctor came back to tell me he and my dentist are not sure, but they think I might be going through my vicodin too fast...??? I didn't ask for vicodin! I told him it made me nothing but nauseous and it wasn't working! I NEEDED Novicaine! Now I have NEVER felt sedated or drunk or "fun" from novicaine in my entire life. I felt like he was getting a kick out of stalling while I had tears comming out the corners of my eyes! Like he enjoyed it! I felt like he was torturing me. So after an hour or so of him making "phone calls" and "judgement calls" he finally gave up and gave me one shot of novicaine. Not enough to make a dent in the pain. NOT A DENT. I told him I needed more, so guess what he did? He told me that there was no possible way I could still be in pain. He accused me of lying. Horrified, I said I most certainly did NOT feel like the novicaine was working AT ALL. So guess what he did next? He told me to open my mouth and close my eyes. I felt his fingers pushing on my gums and he asked me if I could feel "that" and "that," which I could. Obviously frustrated with my ability to guess when he was touching me, he used a Q-tip instead and tried to "trick" me by not actually pressing on me sometimes...no, I did not feel "that..." What a jerk! And after all that nonsense, he says he can't give me more anyway, he gave me the max allowed by law or some crappy excuse. I told him I have had novicaine before in an ER when I was pregnant and have been administered up to 4 or 5 shots for an abscessed tooth. Then he actually ACTED like he was ACTING (totally and completely insulting my intellegence) when he opened his eyes real big and said he could not believe that I would have ever been administered THAT much novicaine at an ER. He proceeded to give me one more injection, "TWICE the maximum limit," which barely, you guessed it, took the edge off. I hadn't gotten real sleep for days and that night was no exception. The next day I went to a clinic and got a surprise! A nice healthy dose of sumthin' shot into my butt cheek by a no-nonsense nurse who made my roomate all but carry me out of the building. I vomited before we got in the car and I felt like eating for the first time in days. I slept like a baby when I got home and was better able to manage my pain after a solid meal and good sleep until I got to the dentist. Woo hoo! Had I not been going through so much as it was I would have sued the pants off that doctor. I'd love to see the look on his face if he saw me all dressed up for court without the bags under my eyes and smeared make-up...ah, well...my tooth is gone now and that's all that matters.

    After all that, before you think that my doc was smart to try his Q-tip method, how do you think you would look in court when you describe the tactic in which you decided you COULD 'tell' the pain was not 'real', as my doctor would have surely been embarrassed by his Q-tip antics. Especially after it proved the pain was 'real' after all. lol
    nanacarol likes this.
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    Quote from Kanani_Ikike
    And I am saying that if more people trusted in God, (Jehovah) or whomever they claim as their deity, life isn't so hard to handle. Man, and his coping mechanisms, shouldn't be the answer. People put too much faith in worldly things.
    ~~~~~~~~~~~~~
    [mouse]
    In my limited experience, some patients tend to ask for less pain meds when their pain is validated and met with belief, with the nurse offering not just pharmaceuticals, but also elevation, hot or cold compresses, validation of their pain, acknowledgements of what they have that is good...both for those patients who believe in God and those who don't. Religion does not offer a rose garden without the thorns; it just offers paradise after the fact.
    Some of our patients' life styles often contribute to their pain and suffering; it does not make it any less real nor can we judge what they are going through, lest we be judged likewise...some people are not as strong as others in dealing with life and its myriad hills and valleys...
    [/mouse]
    Nurse_Diane and lalalady like this.
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    You are right, religionand or faith do not negate the reality of pain. It is unfortunate that some encourage others to feel it is the lack of faith and trust in God that hinders pain relief or healing. Pain is real and should be treated, faith is an adjunct to treatment and has a place in refocusingaway from self, but Pain is very, very real. nanacarol
    tsalagicara and KarenGeorgeBSRN like this.
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    My specialty has been in subtance abuse for 8yrs and whether they are seekers or not they are in pain, withdraw does cause a patient to go into immediate pain as soon as the pain med wears off so yes now they are seeking, intentionnally or not, the patient may not be aware that they have developed a problem or that they are developing a problem, I have to say that it is up to the M.D. to determine what the patient needs are all we can do is continue to educate ourselves in the field we specialize in, so that we can educate our patients, and pray for the patients we work for, there are alot of excellent sites you can look up in regards to addictions and recognizing withdraw Sx, in order to differentiate the seeker from a new patient, who can be taught other ways of pain management, because once addicted to pills, I have learned that it is a long road to freedom. Some withdraw symptoms are chills, dialated pupils, muscle aches, their back and leg hurt the most, sweats, yawning, teary eyes, runny nose and difficulty sleeping, but most commonly you will find the patient over medicating or switching doctors alot, some patient frequent the E.R. so they can get an immediate script for pain medication these are definite tell tail signs. But they are still patients none the less and they still have a sickness that needs to be treated.
    nanacarol likes this.


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