Drug seeking or real pain? How do you tell?

KarenGeorgeBSRN · Feb 27, 2008

Dear Krissy,

Thank you for your kind words, but more so for being another "nurse" who can advocate, and treat those in pain as a human being. My speciality today is being a "generalist" in short; for homeostasis to occur; one cannot focus on one part of the whole, for all parts of that "being" biologically, physically, spiritually, emotionally, and mentally entail one person.

You could (any nurse) be the one professional who makes a difference in a patient's life; you could in fact "save a life." The toll of NIP is death; a body can shut down over time to long-standing "treated" pain meaning organ failure and death. They have found in some studies that naturally occurring chemical hormones (endorphins) do not have normal production in those with NIP; it may or may not be a genetic basis, but "pain" is still today recognized as a disorder (it took us many years to do so), and also as a "symptom."

As several nurses here have mentioned; we must observe objectively the signs and symptoms of pain, but our biggest capability is "listening" to the subjective descriptor from the client. Many in NIP look absolutely normal; if they have been blessed with pain support networks such as mine; they are taught not to lay in bed, to ambulate as long as medical indications support, to get up and shower, do hair and makeup and leave the "bed" for sleep time.

AD's are typically prescribed by good PM specialists; the AD's are needed to treat the depression caused by years of insomnia due to pain, and they also accentuate and increase the capacity of the opioids in the cerebral cortex.

Many of you are aware that giving a placebo is medical malpractice. That is unless, you tell the client "I am pushing 3 cc's of NS not morphine, meperidine, or hydromorphone." Indeed medical malpractice is issued for a nurse who supports verbal slander such as a physician stating in an ER without proof "you are a drug addict" and the nurse who silently obeys due to his statement is also committing malpractice.

For those of you who are "opioid phobic" why not find work outside the scope of med-surg or clinical arenas where you might have to give a client a narcotic? If this is so against your inner beliefs then work in another area. Would any of you not start an IV of gentamicin saying or growling to yourself "I'm not giving the patient this he may go hard of hearing!" Think of how you sound, what you feel inside that is triggering your inability to treat pain which needs to be treated!

I remember a patient who had a bad root canal done. The dentist was against giving her more Percocet yet she came in on a Friday and he had to open the canal up and she was in terrible pain on Saturday. He did call her in 3 "lone" Percocet to get her through the weekend. She was due in on Monday to be checked, and when she arrived was greeted by his wife, also a dentist in the practice. She told the client he was out because he had a tooth go bad over the weekend. An oral surgeon literally came in and extracted it over the weekend. She proceeded to check the client's root canal and saw her exhaustion and flinching. As she pressed on the gum she saw pus ooze out (infection), and got out her pad and wrote two prescriptions. The patient knew she would get an antibiotic and just was praying it would work she was in terrible pain. The dentist handed her two prescriptions; the one was for Ciprofloxin the other for Percocet 60 count. The patient literally said "why are you giving me this much medication." The female dentist smiled and said "my husband told me this weekend about your situation and how he would have never known this kind of pain unless his tooth went bad, I never have a problem giving a patient pain pills but he's always been that way. He told me to tell you he learned the hard way!"

It is wise to truly ask yourself "what am I doing" in a profession if I cannot treat pain in a client without adverse judgement.

Thanks!

Karen G.

Karen George I really support,with great humility and respect, everything you say. I couldn't begin to express it as beautifully as you did.
When a patient is in pain, we as nurses need to use our critical thinking skills, read the doc's diagnosis, read the labs and other test results and figure out what is going on here. One writer at the very beginning of this thread wrote that bowel obstructions are caused by constipation due to narcs. That may be true for SOME, but for a nurse to decide that that is the problem is cruel. I had two emergency surgeries for bowel obstructions due to adhesions, from a previous surgery, wrapping themselves around my colon causing the blood supply to my colon to be cut off. The pain was excrutiating, and I would have died without surgery. Imagine if a nurse said to herself, "this is just a drug seeker constipated and on narcotics?" The ED treated me with IV narcotics, but the floor nurse would not give me my pain meds before the surgery. My husband went to the DON and nearly got her fired. The surgeon had written an order for narcotics, and she refused to give it to me??????????????? How could a nurse think I was a drug seeker in the condition I was in? She obviolusly didn't read my chart and didn't even know what was going on with me? As a patient and a nurse I was shocked.
I also agree, Karen, that drug addiction is a DISEASE. When blood levels drop on a narcotic user, they are in real PAIN. They have a disease, and they have the right to medical care. Addiction and alcoholism are recognized by the AMA as a DISEASE. There are detox centers, rehabs, and all sorts of places that social services can get for patients with a DISEASE who are withdrawing emotionally, mentally and physically and need help. Why is it that some nurses still don't get it? You can turn away a person in withdrawal and they can get their narcotic off the street and overdose. It does not matter and it is not up to us to judge why they use these pain killers. It is our job to help our patients with compassion and understanding and not judge them by what kind of disease they have.
Sorry if I am ranting, but like Karen the words "drug seeker" makes me very angry.
Krisssy RN MA

twotrees2 · Feb 28, 2008

Dear ?
This is not about you but is about what is medically ordered.
How would you know what happens? Have you mainlined please
give yourself some dignity when you reply in regards to a proper
medical order. A client can be responding normally and be in pain
this is not a judgement call.
I am frequently amazed at nurses who "know it all" but really are
just thinking or replaying what they do know. Substance abuse
is high in medical professionals and the tone of this post makes
me wonder!
Karen G.

i do not know how my name got on this post but i did NOT post it- i do believe that it is our duty to ask about any questionable orders however i would not consider a person in pain automatically a drug seeker. i am a chronic pain sufferer myself and know all about living in pain and not being taken seriously - just wanted to clear this up and make it known this was NOT my post :) ( qouted again below for refresher of memory - i don otknow how my name got on it ) and for the records i dont even know what mainlines is but i assume it means sometyhing about the iv - as the person who did write this said something about an iv - ??? so do not understand what you or the original poster meant here.

Originally Posted by twotrees2

no , we do NOT have to give what a dr ordered if we have valid issues and proof at hand- if i suspected strongly ( not just whimsica) that i had a drug seeker r i would before giving anything call my supervisoer or tell the doc to give it himself then. ourlicense is on the line - it is our responsibility to question an unnacceptable order - if we dont in the court we are held as responsible as the doc.

as for speeding up the narcs then those patients are idiots as its more than likely in there- it isnt like the dose is in the bag- and if your doing over 4 min the amount you wuld give diluted would be already run into the vein.

krisssy · Feb 28, 2008

Good Morning!
One of the most difficult concepts for a nursing professional who is brainwashed into thinking of "drug seeking" as a medical term is the differentiation between "tolerance" and "addiction." The physical symptoms are the same for either person; yes they are both viable clients with overtly different diagnoses and outcomes!!
Over and over I read posts on this topic in the year 2008 where modern research has shown that "tolerance" and "addiction" appear the same physically, when indeed the only similarity is the symptoms physically that occur between a person who is legally prescribed medication for pain, and someone with a serious disorder which is entirely different; this disorder is termed "addiction."
Physical withdrawal can occur between the "pain patient" and "the addict" with the same result; an uneducated physician or nurse can infer by value system (not by the subjective verbal report of the client) that a person is in fact "drug seeking" and one of the top pain specialists in the United States told me "at some point a patient not treated for his or her pain will be RIGHTFULLY drug-seeking at some point if not treated, for he or she cannot tolerate the suicidal level of pain they experience."
Nursing professionals are in the role of advocate by the nature of our profession; with or without a value system in place; putting ourselves as "God" does nothing for the client in need, makes us look like idiots, and furthermore negates the value of our very comprehensive education. I do not care whether you are a LVN, two year or diploma RN, or four year RN--you know through clinical experience if not through text book knowledge the truth.
Reply after reply show nurses who have years "in the trenches" learning from their own misconceptions about the term "drug seeking." When I tell you that stating such in an ER with a client in true need is malpractive for a physician and the nurse involved I mean this. If any of you who use this term freely or believe somehow that you know better than the client experiencing pain "his experience" then you are wrong. Lack of objectivity will keep you miserable in your role as a potential advocate, and then when someone you know and love, even yourself falls through the cracks, and is attacked or mistreated in thousands of ER's (in particular) throughout the United States you might change.
We have an obligation to continue the learning process throughout our lifetime. I know of no other profession where it is encouraged, applauded, and complimented. Our profession can make a difference in the lives of many; this particular concept of "drug seeking" needs to be trashed along with foul language, abuse, and a thousand other crimes of a medical nature that occur with frequency today.
I ask all of you in disbelief to further educate yourself; get your nurse managers or DON's (such as myself) to arrange inservices, really make yourself an open book when you approach any new client, and "stop the violence." One day it might be you so labeled and suffering, please do this for your client's and for yourself.
There is no "seeker" this is a disgusting judgement. An addict is also suffering a serious disease process; one that is incurable, but a psychiatrist is in the role to truly determine if a person fits into that diagnostic criteria; not a one shot five minute analysis rendered by a value statement.
Thank you,
Karen G.

Dear Krissy,
Thank you for your kind words, but more so for being another "nurse" who can advocate, and treat those in pain as a human being. My speciality today is being a "generalist" in short; for homeostasis to occur; one cannot focus on one part of the whole, for all parts of that "being" biologically, physically, spiritually, emotionally, and mentally entail one person.
You could (any nurse) be the one professional who makes a difference in a patient's life; you could in fact "save a life." The toll of NIP is death; a body can shut down over time to long-standing "treated" pain meaning organ failure and death. They have found in some studies that naturally occurring chemical hormones (endorphins) do not have normal production in those with NIP; it may or may not be a genetic basis, but "pain" is still today recognized as a disorder (it took us many years to do so), and also as a "symptom."
As several nurses here have mentioned; we must observe objectively the signs and symptoms of pain, but our biggest capability is "listening" to the subjective descriptor from the client. Many in NIP look absolutely normal; if they have been blessed with pain support networks such as mine; they are taught not to lay in bed, to ambulate as long as medical indications support, to get up and shower, do hair and makeup and leave the "bed" for sleep time.
AD's are typically prescribed by good PM specialists; the AD's are needed to treat the depression caused by years of insomnia due to pain, and they also accentuate and increase the capacity of the opioids in the cerebral cortex.
Many of you are aware that giving a placebo is medical malpractice. That is unless, you tell the client "I am pushing 3 cc's of NS not morphine, meperidine, or hydromorphone." Indeed medical malpractice is issued for a nurse who supports verbal slander such as a physician stating in an ER without proof "you are a drug addict" and the nurse who silently obeys due to his statement is also committing malpractice.
For those of you who are "opioid phobic" why not find work outside the scope of med-surg or clinical arenas where you might have to give a client a narcotic? If this is so against your inner beliefs then work in another area. Would any of you not start an IV of gentamicin saying or growling to yourself "I'm not giving the patient this he may go hard of hearing!" Think of how you sound, what you feel inside that is triggering your inability to treat pain which needs to be treated!
I remember a patient who had a bad root canal done. The dentist was against giving her more Percocet yet she came in on a Friday and he had to open the canal up and she was in terrible pain on Saturday. He did call her in 3 "lone" Percocet to get her through the weekend. She was due in on Monday to be checked, and when she arrived was greeted by his wife, also a dentist in the practice. She told the client he was out because he had a tooth go bad over the weekend. An oral surgeon literally came in and extracted it over the weekend. She proceeded to check the client's root canal and saw her exhaustion and flinching. As she pressed on the gum she saw pus ooze out (infection), and got out her pad and wrote two prescriptions. The patient knew she would get an antibiotic and just was praying it would work she was in terrible pain. The dentist handed her two prescriptions; the one was for Ciprofloxin the other for Percocet 60 count. The patient literally said "why are you giving me this much medication." The female dentist smiled and said "my husband told me this weekend about your situation and how he would have never known this kind of pain unless his tooth went bad, I never have a problem giving a patient pain pills but he's always been that way. He told me to tell you he learned the hard way!"
It is wise to truly ask yourself "what am I doing" in a profession if I cannot treat pain in a client without adverse judgement.
Thanks!
Karen G.

Thanks again Karen for your wise words. I grew up with a mother suffering her entire adult life from a disease process called Somatization. She was always having pain in some part of her body, but tests always showed no sign of disease. She is now 83 and in perfect health EXCEPT she is having head pains, which she has had many times over the years, with no organic cause. She refuses narcotics, because she says she is afraid of getting addicted. No one has ever been able to help her. I did notice that Pamelar seems to help, but she refuses to take it. I am getting off topic a little, but my point is that I am very interested in pain management having lived with a very ill mom for my whole life. Although there is no organic cause that we can identify, the woman is very sick. She has lived her entire life in terrible pain. People make fun of her-so sad. We cannot judge anyone's pain whether it be someone who somatizes or an addict or a person who has built up a tolerance to pain killers. Our job is NOT to judge people but to help them. Karen, I know you agree, but some nurses just don't want to get it, and I don't understand what they are thinking.

I have a friend who after surgery became addicted to Percoset that she was given for post surgical pain that lasted for two years. A pain clinic was prescribing it after seeing her CT scan etc. She ended up in the ED with severe vomiting and abdominal pain. The nurses thought she was a "drug seeker" and left her in the ED crying and screaming in pain. My friend had decided to just stop taking the Percoset not knowing the consequences of abrupt narcotic withdrawal. She wasn't a "drug seeker" (a non word in my book). She was in withdrawal not even knowing what was going on. She asked for her surgeon thinking the pain was from the surgery. He immediately diagnosed her situation and put her on narcotics admitting her. When she was made comfortable, she was sent to a hospital specializing in addiction and eventually entered a rehab. She has been off narcotics for a year, is going to AA meetings and doing very well. What a wonderful doctor that was-a surgeon who cared about his patient and saw her as a whole person-not just looking at the area of her body that he operated on. He gave my friend back her life. I am appaled that those ED nurses left her lying in the ED alone in a room vomiting and screaming in pain for at least an hour not even entering the room to talk to her or hold her hand-just ignoring her. Each person is an individual and there are a million different scenerios for each and every patient. A patient could be an addict, could be somatizing, could have a disease process, could have a low tolerance for pain-I could go on and on. We are professionals who are there to be compassionate and to help other human beings not judge them. For goodness sakes, anyone who enters an ED has some problem. It could be med/surg or psychiatric or yes an addict who needs help. Addicts are not criminals. They are sick, and we have taken an oath to help all sick people. We do not have the right to judge anyone, and I hear too many instances where this does go on. Karen, as a nurse I would love to work with a DON like you, and as a pt., I would feel safe in your hospital. Thanks again for your highly intelligent and thoughtfull posts. Krisssy RN MA

krisssy · Feb 28, 2008

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.

There are many reasons why a person with chronic pain, who attends a pain clinic, may end up in an ED. Sometimes pain centers are closed or the doctors cannot be reached fast enough or the patient becomes hysterical and needs immediate help. Maybe the pain doctor missed something that is going on with your pt. Maybe the pain killers are just not working. Maybe the person has an allergic reaction to the pills. Perhaps the patient didn't take the pain killers as prescribed. Maybe she didn't understand the directions and got confused and took the incorrect dosage. Maybe the patient took too many pills because they weren't controlling the pain. Maybe the pain developed into a new dimension over the weekend-perhaps an infection. Maybe the patient has developed a tolerance to the pills and they stopped working or she or he took too many because the dosage stopped working and the clinic is closed. Maybe the patient has become addicted to the pills, and took too many. Yes, that IS a reason to go to the ED. When the blood level drops a narcotic user (and I don't care what the reason is) is a sick person who needs help. Look, I could go on and on and give you scenerio after scenerio of WHY a chronic pain pt. may show up in an emergency room. If you work in an ED, it is your job to work with the doc and find out what is going on with your patient and help them to the best of your ability. I have been an RN for 37 years, and I may become a pt. advocate when I retire! Krisssy RN MA

Sorry, the top of the quote where the writer said he doesn't understand why chronic pain pts. go to EDS was cut off.

krisssy · Feb 28, 2008

no , we do NOT have to give what a dr ordered if we have valid issues and proof at hand- if i suspected strongly ( not just whimsica) that i had a drug seeker r i would before giving anything call my supervisoer or tell the doc to give it himself then. ourlicense is on the line - it is our responsibility to question an unnacceptable order - if we dont in the court we are held as responsible as the doc.
as for speeding up the narcs then those patients are idiots as its more than likely in there- it isnt like the dose is in the bag- and if your doing over 4 min the amount you wuld give diluted would be already run into the vein.

It is our job to question an order if twice the normal amt. of medication is prescribed. It is NOT our job to judge a patient's pain. Your license is on the line if you leave a patient untreated, no matter what the problem is. If you wouldn't give your patient pain meds because you have "proof that he is a drug seeker", what WOULD you do for your patient? If he is an addict, what would YOU do to help your patient? Krisssy RN MA

KarenGeorgeBSRN · Feb 28, 2008

Good Morning Krissy all,

The woman on "Percocet" was tolerant; the withdrawal was the same withdrawal we speak of when a heroin addict is "dopesick" which is not a medical term but a street drug term.

A heroin addict who steals Percs and shoots "downside" is in withdrawal; either he or she can't get a "bump" and puts anything in his or her vein they can find, and keeps shooting and that habit increases regardless of the "result" or suffers withdrawals.

A patient given Percocet, Oxycontin, Tylox, Percodan, MS Contin, Methadone (also used as a LA for pain, the list goes on) who stops abruptly can literally die from his or her tolerance to the drug if he or she stops suddenly. They are NOT taking the medication to the excess; they are taking it and may not as another writer mentions have a clue if given by a surgeon (who is not a PM specialist) or even some GP's (who are in today's world more astute overall for they in their practice are generalists) that the client is merely "tolerant" and needs to be referred (or should have been) for pain management. The nurses busting their "cans' in the ER were likely doing that every night regardless of the poor woman in withdrawal who now has been convinced she is just like the dopesick heroin addict; this because in her hour of need there was no one medically qualified to help her.

Due to the "DEA" madness medicine is being practiced as a police state; just about six years ago the research findings showed that managing chronic pain with opioids is the safest method of return to QOL; that meant less cost to society as a whole, less cost to insurers, less loss of family, friends, et al. We have lost close to 24,000 PM's and the AMA is telling physicians not to go into this specialty due to the outcomes; physicians and clients going to prison. It has given a renewed heyday to those in our profession who were prejudicial in their treatment of clients who were unjustly treated in the first place.

A few years ago a young man with AIDS who was managed by a NP (back in Virginia) was found unconscious on the street; it was known by ER upon admission that he was HIV+ and yes I see many of you sighing in relief, however, no one knew for sure his PM status for he was severely cachetic and wasting, he was well under 225 and on his way out. He had evolved into one of the cancers the unfortunate with HIV may get and was full blown AIDS. His normal managing NP had not heard from him for a week; he was regularly managed with Oxycontin and Percocet for BT, and when found on the street unconscious he had NOT taken his normal medications for close to 72 hours and was severely ill (now from withdrawal as well God bless his heart).

We got him on the unit and (stepdown Telemetry CCU) and he was in pain, we were pushing MS IVP up to 10 mg. q 3 h prn and it would help a bit and he was still not well enough to explain his status or that he was off his medication. I took a call from his NP an hour later asking me specifically "is he on his Oxycontin and Percocet in addition to the new order for pain" and I about dropped the phone and ran. Within 15 minutes he was being brought up to his normal baseline, and within 2 hours he was able to speak clearly, and tell us the event where he had been literally robbed and left for dead on the tough Richmond, Virginia streets...

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.

The bottom line is we are responsible. Furthermore your "tolerant" client upon admission might have an order for double or triple the amount if the ordering physician knows his or her history; now yes you should question this order if the client is "new" and you have no clue; but make sure when you give report and pass him off to the next shift you speak of his true condition so that the next shift is kind, "tolerant, loving and patient" as good nurses are known to be, and that he is not left miserable due to his "orders" and his condition.

Again thanks to all the nurses here who are willing to learn, to practice our profession with dignity and respect, and treat those with NIP with the respect they deserve. Depending on what state you are in you might be termed an "addict" if it is a dry state. Not one here would want to be a part of such a network for then we must truly question what we are doing with that license of which we are so proud.

Thanks again!

Karen G.

It is our job to question an order if twice the normal amt. of medication is prescribed. It is NOT our job to judge a patient's pain. Your license is on the line if you leave a patient untreated, no matter what the problem is. If you wouldn't give your patient pain meds because you have "proof that he is a drug seeker", what WOULD you do for your patient? If he is an addict, what would YOU do to help your patient? Krisssy RN MA

KarenGeorgeBSRN · Feb 28, 2008

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

KarenGeorgeBSRN · Feb 28, 2008

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.

Karen you really should post more!! Those two posts were some of the best I've read on pain management. It is truly appalling the ignorance that pervades the medical and nursing professions on the topic of pain management. Too afraid of making their patients addicted, I suppose. Perhaps they don't realize the negative quality of life that those who suffer from chronic pain endure on a day to day basis.
What's sad is that so many people know just how to work the system. Like teeituptom says - they could be sitting there eating potato chips (or, in the case of my facility- fries and a coke), and tell us their pain is a 5/5. Do the fries make it better? :nuke: These are the people who make providers jaded, the ones who make us doubt their claim because we can't feel what's going on inside their bodies. Because they "look" fine, they "sound" fine. It's a shame people just can't be honest...but that would be too much to ask.
vamedic4

KarenGeorgeBSRN · Feb 28, 2008

Dear Loricatus,

I was speaking of "burn out" helping those in NIP; what you did not leave out if the judgement made in this post--what could have been left out regarding a determination that this patient is "drug seeking and an addict" there is such vindication in this story, such deep sadness--sometimes we do not know it's time to change to another area, and not be around folks with this attitude.

A very well known PM told me "at some point if their (NIPer) pain is not treated they will become drug-seeking, indeed they should they need pain medications in order they not die from it (the pain)..."

"But for the grace of God go I...."

Thanks,

Karen G.

There is a certain manipulative behavior, very similar to that seen in some mental illness, that a drug seeker will demonstrate.
While in the ER, they know they don't have time to play the game slowly, so in the course of a couple of hours you may see: try to befriend you while complaining about everyone else's insensitivity; whine, cry, scream in pain at eardrum shattering levels; report you; play helpless and needy; play the misunderstood one; educate you; become verbally abusive & occasionally physically abusive; have a tantrum or two; apologize and state that they really didn't mean to be [whatever]; try a few attention getting stunts [accidently pull out the IV, wet the bed, get tangled in the sheet, fall, etc]; try to turn staff against you; enlist the help of a codependent friend or family member; set the days record for the amount of time the word 'nnnuuuurrrrrse' was yelled out ...
I do have to admit that sometimes I find the inept manipulator amusing and have fun with it. It's probably a survival thing.
For instance: I have an allergy to dilaudid IV and PO, demerol and po morphine. The only thing I can take is IV Morphine and anything less than 6 mg doesn't help my 15/10 back pain.
What happens to you when you have morphine pills?
I get hives and my throat swells up.
Well, the doctor has ordered the Morphine injected into your muscle.
I can tell you now that it's not going to work, I'm just going to be allergic to it.
How do you know for sure?
I just know
Post IM injection, pt seen rubbing the site and hitting it under the sheets
NNNNUUUURRRRSSSSE
What is it?
See, I'm having an allergic reaction?
Are you sure?
Yes I'm sure!
Do you want me to document it as an allergic reaction?
Yes. Now can I get the Morphine IV?
Don't think so because you are probably allergic to all opiods and I don't think the doctor's going to order something going into your vein that you are now saying caused you an allergic reaction. I'll go tell the doctor.
Nurse, wait, you know what, I don't think I'm allergic to what you gave me, I was lying down on it and I think it just fell asleep, see, see how better it is looking.
Sorry, we can't take a chance that you'll have an bad reaction-I'm going to get the doctor and let him decide.
Talk to doc & he comes to bedside: I see here on the chart that you said to the nurse to report the redness where you got the injection of morphine as an allergic reaction, is that the way it was?
No, the nurse must have misunderstood me.
Pt on other side of curtain yells out : everyone here heard her yell at the nurse to report it as an allergic reaction, she hasn't shut up for over a half hour now.
Doc: Sorry, but we can't give you anything that you might have an allergic reaction to.
I'm leaving, nobody listens to me, nobody cares about all the pain I'm in and how I can't walk (while standing up, putting clothes on over the gown and trying to storm out)
THIS IS A TRUE STORY (I left out some things and changed /deleted medications that might be too specific to the patient).

twotrees2 · Feb 28, 2008

There are many reasons why a person with chronic pain, who attends a pain clinic, may end up in an ED. Sometimes pain centers are closed or the doctors cannot be reached fast enough or the patient becomes hysterical and needs immediate help. Maybe the pain doctor missed something that is going on with your pt. Maybe the pain killers are just not working. Maybe the person has an allergic reaction to the pills. Perhaps the patient didn't take the pain killers as prescribed. Maybe she didn't understand the directions and got confused and took the incorrect dosage. Maybe the patient took too many pills because they weren't controlling the pain. Maybe the pain developed into a new dimension over the weekend-perhaps an infection. Maybe the patient has developed a tolerance to the pills and they stopped working or she or he took too many because the dosage stopped working and the clinic is closed. Maybe the patient has become addicted to the pills, and took too many. Yes, that IS a reason to go to the ED. When the blood level drops a narcotic user (and I don't care what the reason is) is a sick person who needs help. Look, I could go on and on and give you scenerio after scenerio of WHY a chronic pain pt. may show up in an emergency room. If you work in an ED, it is your job to work with the doc and find out what is going on with your patient and help them to the best of your ability. I have been an RN for 37 years, and I may become a pt. advocate when I retire! Krisssy RN MA
Sorry, the top of the quote where the writer said he doesn't understand why chronic pain pts. go to EDS was cut off.

i totally agree- dont know what the previous post was but as my post here shows i totally agree with you - pain needs to be adressed- be it at the ED or whatever. i do not think anyone needs to suffer ever -

twotrees2 · Feb 28, 2008

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.

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 - -

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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.

krisssy · Feb 29, 2008

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