Drug seeking or real pain? How do you tell?

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.

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.

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.

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

so you are saying that we - the entire medical community should and has a obloigation to suppport drug dealing and by the legal suppliers of rx. meds?
Get over it. I speak from both sides of the situtiation. I suffered with "migraines" for 10 years.
Trips to the ER the looks from the nurses and doctors. Hell when I walked in Sue, one of my regular nurses would ask did I need the usual dose? Yes I would answer 100 mg of demerol, 50 mg phenergan ande 100 mg of pentobarbitol. I got shots so often that they would let me drive home and then it took about 30 to 45 min. for the reliefto set in.
Then one night one of the ER docs went just a little further with his H&H. The next week I had an MRI and was sent from my reg Mds office to the neurosurgeon. 10 years of pain meds, that now have no effect on me, given to me for migraines - herniated discs.

In 9+years I never personally treated anyone who complained of pain with any thing other than respect and concern for their pain. After 1 year ALL nurses in the ER can do that. It just was the waste of time and medication and trying to tackle patients in the parking lot to keep them from leaving with their INT before they got meds. It was just a sterile access for a time.

Having had 2 neck surgeries, spinal stenosis, permenant ulnar nurve damage, knee surgery, and a few true migraines, joints injected, broken kneecap, broken toes and now living with L1-L4 problems, if someone is truly in pain and the MD said stand on your head and the pain will go away, they will try it. People in real pain do not walk out signing an AMA form if their pain scale states 10 on a 0 to 10 scale.

the original question was how do you tell if a patient is really in pain. As nurses in the
ER on the night shift know real from fake. I thought this was a forum for trading experiances and knowledge not to launch an assult on anyone writing here.

On by the way our sicle celler had an infuse a port but wanted drugs for home to keep from coming in so often - when she was brought in that night she had sold her pain meds and bought crack.

As the author of the original post, I , too, was unsure where this discussion ended up. There were many excellent responses that emphasized true advocacy and best practice. thanks.

andrew

i guess each of us has our own wayof deciding on real pain or drug seeking. The bits about normal bp, normal hr, normal breathing, no nausea, and they tell you that they can only get relief is mso4 or diluidid I would be on guard.
And we have have those that did fake by triage that got an int started and when we would go to get the meds the patient would bolt for the door. Talk about safe iv drug use!!!!!You will figure it out as you go. Medicine is a practice not an absolute.
If you do not learn something every day then you are not doing your job.

Dragonnurse, now, now, you and I both know that I said, nor did I imply that we should support drug dealers. My goodness the melodrama is emerging. I did say that as nurses we are to accept our patient's assessment of what is pain. I said, we were not deputized as drug police and if I did not I should have said that National Patient Safety Goal indicates we DO poorly in assessing, evaluating and managing our patients pain. I believe it is because we are so entwined in judging and less so in ministering to our patients. Now before the board blows up, I KNOW this is not true of every nurse! But to be real, there are a great many who feel as you describe. Our assessments should probe deeper into what is causing the diversion and make recommendations for the patient. nanacarol

Nanacarol, this is the last post I will make on this subject. The "tone" of your post pointed to a big problem in the medical field in general. We know that hospitals are forming "Pain assessment teams" trying to set goals to address pain needs. That is not what we are discussing - in the walk in triage setting how do you assess the pain level of the patient. Your complaint note states what they say 0 - 10 example 10. You note ten on your paperwork that will be forwarded to the doctors in the treatment area. But everyone of the people I worked with all formed dx with each patient. Now you have 10 people all claiming to have pain of 10. You have one bed in the back. How do you decide which one goes back first.

Your vital signs and the location of the pain. Now is it the 21 yo chest pain with a bp of 110/68,72,16, O2 sat 99% talking on the cell phone or the 35 yo chest pain with a bp of 166/99,89,24 O2 sat 96,holding his chest and sweating? The 21 yo came in first and both are males - who goes first?

the 35 yo is the one you choose - why. Because his appearance and vital signs indicate that he is possibly having an MI and he looks like he is in distress. You cannot be a good triage nurse if all you do is note the pain level and do not assess the patient for pain indicators. That is why we had a policy that no nurse with less than one year experiance could work triage.

That having been said and having worked in the ER like I did I can truly say that I never denied or "judged" people as to whether they were drug seekers or not because I had had that same Judgement leveled at me before I became a nurse. I mean when I would have to go and my "standing orders" were 100mg Demerol 50 mg phenergan and 100 mg pentobarbitol and I could tell by the burn of the injection if they had given me the correct med. and called the ER doc on it several times - than I an not going to do the same to my patients. If anything I was guilty of pushing the MD for more or different (stronger) pain meds depending on my patient. And when I was on at night I was sent to assess each migrainer when such was presented to see if they were "for real". 8 out of 10 times I would have seen the patient, found out what med worked best for them, drawn the meds from the pyxis, taken the chart put it in front of the MD and told him what I was going to give and how much. I can remember only one time I was vetoed and we ended up giving the patient my choice of meds and having to admit for intractable pain due the the slowness of receiving proper pain med.

Sometimes only someone who has the experiance of intractable pain and mutiple medical problems all requiring pain meds can truly understand a patient with pain that cannot be "visualized".

This is my last response as well, if you do what you describe, then all of your patients will have been served well and you will really rank as an advocate. Kudos to you. nanacaroly

Yeehah dragonnurse! I work in a county jail now. I used to work hospice and pride myself at knowing how to help someone control their pain and other symptoms. I have a mildly herniated disk at L-5 and S-1. When it flares up...man, I am dying. Before we knew what was causing my pain, my FP made me an appt with an Ortho. It took 3 months to get in. I called and begged "Please, I'm in so much pain, squeeze me in" The secretary or bulldog I should say says, " Well I can get you in on this date", It was a month later than what I already had. My FP did not want to order an MRI, she wanted the ortho to order it. They all kept telling me Just go to the ER. We'll, yes I was suffering but the ER is for emergencies. This just needed Temporary TX until my 3 month down the road orth appt. I knew what worked in the past. I said, just give me 4 days worth of Naproxen and Flexeril and I'll be good to go. No NO NO from everyone. I gobbled 3 times the NAD of over the counters, Did stretching exercises, ice packs hot packs and went to work. How could I get time off? No doctor's note, no diagnosis etc. By the time my 3 months later appt rolled around, the flare up was over. I was in significant pain for 5 months. Waited 2 months before going to FP in the first place. So I went to my ortho appt and told them exactly what I thought of them and how I had drug dealers in my jail who were being treated by the same outfit with no Dx but "chronic pain". These addicts were selling their meds as well as playing with them. they got caught. So.. I was ****ed. The Doctor felt really bad about what happened to me and ordered a stat MRI. He read it right away. Even though I was not currently haveing a flare up, he rx'd me for naproxen and flexeril with 3 rflls. If I learned anything from an inmate, it was this....stock up on drugs. I'll never get stuck waiting 3 months without any relief again. that was 2 yrs ago. I kept those pills and when I have a flare up, if I treat it right away, at the first twinge, I can nip it in the bud. It takes one or 2 days of meds, ice and strething and I'm good to go. Any doctor today can plug your name and address inot a nationwide pharmacy system and see what you've been up to. It will list every doctor, every med that doctor prescribed, and every pharmacy you've been to. there is no reason any more for nurses and doctors to wonder if the patient is legit. Imagine yourself in a courtroom and the lawyer is asking you to explain why you continued to give rx to a known drug addict who ended up overdosing and died. Tx the cause and not the symptom.