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| Advertisement Sponsored Links | | | | No. 151 | 
Apr 23, 2008, 10:53 PM
 Re: Drug seeking or real pain? How do you tell?
Just came across this info yesterday and added to pain mgmt links
From: American Society for Pain Management Nursing Pain Management in Patients with Addictive Disease (pdf) Summary Patients with addictive disease have the right to be treated with respect and to receive the same quality of pain management as all other patients. Providing this care addresses the potential for increased drug use or relapse associated with unrelieved pain. Nurses are in an ideal position to advocate and intervene for these patients across all treatment setting... ** Visit the ASPMN Web site (www.aspmn.org) for assessment tools for withdrawal, protocols for treatment of withdrawal, risks of unrelieved pain, treatment options for addictive disease, and therapeutic plans for relapse.  | | No. 153 |
Apr 30, 2008, 08:49 PM
Re: Drug seeking or real pain? How do you tell? Originally Posted by NRSKarenRN  Just came across this info yesterday and added to pain mgmt links
From: American Society for Pain Management Nursing Pain Management in Patients with Addictive Disease (pdf) Summary Patients with addictive disease have the right to be treated with respect and to receive the same quality of pain management as all other patients. Providing this care addresses the potential for increased drug use or relapse associated with unrelieved pain. Nurses are in an ideal position to advocate and intervene for these patients across all treatment setting... ** Visit the ASPMN Web site (www.aspmn.org) for assessment tools for withdrawal, protocols for treatment of withdrawal, risks of unrelieved pain, treatment options for addictive disease, and therapeutic plans for relapse.
This sounds great in theory for an inpatient setting but how do you safely give a chronic pain patient that is addicted to narcotics more narcotics in the outpatient setting? Both the doctors I work with have narcotic contracts that the patients are required to sign. One of the stipulations is that they take their medications as prescribed and absolutely do not get more narcotics from other physicians. Obviously, the addicted chronic pain patients have problems with this and eventually their UA comes up dirty.
So what are we supposed to do? If they are addicted, they will often take too many narcotics and develop hyperalgesia, which leads them to take even more narcotics without permission...which leads to more side effects.
As a patient advocate, how do you give the chronic pain addicted patient more meds without endangering their health? Plus if they violate their narcotic contract, do you continue to write them scripts?
| | No. 154 |
Apr 30, 2008, 10:30 PM
Re: Drug seeking or real pain? How do you tell?
My response may seem like a copout, but adequately treating pain begins when the patient first presents, not after they have had to resort to inappropriately medicating themselves with whatever they can get legally and otherwise. The problem becomes a major challenge once the person is dependent and or addicted. And you are correct, contracts don't work, dependent and/or addicted individuals will do whatever is necessary to be medicated. I really don't have an answer other than to advise us to take the patient seriously when they first present in our health arenas. nanacarol
| | No. 155 |
May 03, 2008, 11:09 AM
Re: Drug seeking or real pain? How do you tell? Originally Posted by nanacarol My response may seem like a copout, but adequately treating pain begins when the patient first presents, not after they have had to resort to inappropriately medicating themselves with whatever they can get legally and otherwise. The problem becomes a major challenge once the person is dependent and or addicted. And you are correct, contracts don't work, dependent and/or addicted individuals will do whatever is necessary to be medicated. I really don't have an answer other than to advise us to take the patient seriously when they first present in our health arenas. nanacarol
I am going to have to disagree a bit on your first point - I think there is a difference between a drug addicted patient and a patient that is receiving ineffective pain control.
One of the questions we ask new patients is if they have ever been treated for alcoholism, because an addict is an addict.
Let's say I go to the beer store and buy a case of my favorite stout [North Coast's Old Rasputin Imperial Stout]. Now there is zero chance I am going to go home and drink more than a few of them. One of my childhood friends, on the other hand, is a recovering alcoholic. There is a very good chance that once he starts with one he is going to continue until he is unable to drink anymore. My friend and I are pretty much in the same cohort - middle class upbringing, divorced parents that remarried, advanced degrees, BLAH BLAH BLAH. The major difference is that he is an addict for some reason, and I am not [for some reason].
I occasionally have neck and back pain with radicular symptoms. If I were to be put on narcotics for the pain, I would have no problem taking the ordered dose. If I was not getting enough pain relief, I would contact my pain doc and discuss increasing the dose, changing meds, or getting a procedural intervention. My friend, on the other hand, would probably start taking more meds even if he was not in excessive pain because he is an addict. That's the difference. Even if he got to the point where he was developing hyperalgesia, meaning he was in more pain with more meds, he would continue to take more meds.
I think the docs I work with would argue that inadequate pain relief will not turn a "normal" person into an addict, but inadequate pain relief will stress a patient with an addictive nature to the point where their addictive nature surfaces. But in those cases, the primary disease is addiction, not inadequate pain relief. If you switch meds or perform procedural interventions [to alleviate the pain] without addressing the addiction, then they are still in trouble.
| | No. 156 |
May 03, 2008, 03:10 PM
Re: Drug seeking or real pain? How do you tell? Originally Posted by Josh L.Ac. I think the docs I work with would argue that inadequate pain relief will not turn a "normal" person into an addict, but inadequate pain relief will stress a patient with an addictive nature to the point where their addictive nature surfaces. But in those cases, the primary disease is addiction, not inadequate pain relief. If you switch meds or perform procedural interventions [to alleviate the pain] without addressing the addiction, then they are still in trouble.
I think inadequate pain relief will turn a "normal" person into one that appears to be an addict.
The description of this has been labeled PSEUDO ADDICTION. Here is a brief article describing the behaviors. Pseudoaddictions
From the article:
Signs and symptoms of a person diagnosed with pseudo-addiction are usually associated with the behaviours displayed by drug addicts seeking to receive superfluous analgesia.
Typical behaviours include the constant request for pain relief, knowing exactly when pain relief is due or can be taken, even causing clock-watching and knowing in-depth information about different types of pain relief. These patients often moan, groan and overtly verbalise their pain in an effort to receive further pain relief. In the case of pseudo-addiction, the patient is actually experiencing high levels of pain, but due to their behaviours, staff are often reluctant to administer pain relief as they do not want to encourage drug use by what they believe to be an addict, often exacerbating the situation.
| | No. 157 |
May 05, 2008, 08:22 AM
Updated
May 05, 2008 at 08:23 AM by nanacarol
Re: Drug seeking or real pain? How do you tell?
Josh, You took the initial assessment piece to its basic beginning. Thanks. I agree with you completely. nanacarol
| | No. 158 |
May 05, 2008, 12:57 PM
Re: Drug seeking or real pain? How do you tell?
, Yes, my hubbie Big Joe Paramedic, Deep Sea Diver Dude, RN MAN, had a Cervical herniated disc and went through the same thing. He could not believe the pain. Now his thought process has totally changed. He never NEVER uttered the words "suicide and I understand why people do it", untill he had this amount of pain. I was IN SHOCK when I heard that come out of his mouth. He said he knows why people seek drugs now if they have THAT MUCH PAIN,l GIVE THEM THE DRUGS! Needless to say, this was a 180 turnaround.
Lortab made him have night terrors. Flexeril made him INSANE..... Robaxin was like drinking a glass of water, untill I shoved a 5yr old Soma saved from pulling my back out gardening, he did not get relief. Had to get an RX stat for him too because of the drug testing they do @ his work. Doctors were soooo leary at first. Getting past the front desk BULLDOG is impossible. If you are in pain pray you have a stash, hoard meds because you won't get em when you need em and save your bottles with your name on them for when you get the P test. Surgery was a success, no meds except for nsaids. I am sure there is a law somewhere how long I can have my narcotics. Where do you go though, dental pain, chronic pain, mental pain, ..........THE ER.......then all these people DRIVE all over the place on all these drugs... HOLY COW.
| | No. 159 |
May 05, 2008, 06:22 PM
Re: Drug seeking or real pain? How do you tell?
10MG-IV 6 months before I found out that I had C3-4-5 discs herniated I could to to the ER get the following, 100mg Demerol, 50 mg, phenergan and 100 mg of pentobarbitol; then drive home try to find something to feed my 4 kids and approx 1 - 1 1/2 hours post injection finally pass out. MD thought I was haveing really severe migraines (hx of same) but pain was not the same. Now I have plates holding c 5-6 together, neuro guy will not touch neck again, too many allergies  Today I find out that L1,2,3,4,5 and S1 are all ***** and collapsing Here I go again for the pain problems. 
Dragonnurse
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