Drug seeking or real pain? How do you tell?

Your response supports my contention that documantation and communication between the doctor and nurseis critical in establishing a united front and valid treatment plan for this particular patient presentation. KUDOs to you and your team. nanacarol

Doctor and pharmacy shopping are the objective tip offs. Also, when the pain mgt practice tells them they are no longer welcome for noncompliance. That's objective. The rest I suppose is nursing intuition. Now I work in the ER where all the addicts end up eventually with "chest pain" when they have exhausted all legal and illegal sources and they're really jonesing. So, that is the population I see.

Just another aside,
I know alot of people who are in recovery for alcohol/drug addiction. I wonder what their take on this thread would be? I have heard a number of stories about going from doc to doc, er to er using complaints of pain to get pain meds and using them to get high or selling them to get money for their "drug of choice" When are we going to quit medicating for pain for these people and treat them with honesty and true respect-sit them down and say,"you have a disease-lets talk about that and get you into treatment and on the road to recovery-not just keep writing out scripts. Ok, I don't think it is goodto generalize, but many of us who work in the ER have seen the addicts in action-its time to get honest

When we fire a patient, we do offer to taper them off for six days and also encourage them to do an inpatient detox.



There is always a choice.

"Vital signs will always show some reaction to pain."

Not necessarily. I've been a chronic pain patient for a few years, and in addition to opiate therapy I use self-hypnosis to keep me out of the hospital. I've seen too many nurses look cross-eyed at me and heard too many snarky comments to ever willingly set foot in a hospital.

Self-hypnosis actually works during a pain crisis, but it took me years to reach this point. My pulse and BP decrease to nearly normal when I'm in "a state." It doesn't help that my underlying condition is pretty much invisible. I have abdominal adhesions out the wazoo and live with pretty constant SBO, and as you know they don't generally show up on imaging studies. It makes no difference if I show up with 10 years of medical records proving my condition, some nurse or doctor will always believe I'm a drug seeker. No, I would rather die than go to a hospital - and probably will some day. At least then I won't have to deal with pain any longer - or doubting, second-guessing medical staff.

I didn't see this thread before I posted my pet peeve regarding pain issues. I've always treated patients who ask for pain meds as the expert on their pain, no matter what the reason they are in the facility for. I work in a LTC facility, we have alot of short rehab patients for hip fx, etc. Some of these people do have a hx of ETOH abuse, drug use in the past. I look at it this way, they are with us for treatment of their current problem, if we don't manage the pain for the hip fx or whatever, they are not going to rehab to home as quickly as possible which is our goal. We are not a drug rehab. facility, we only look at their main diagnosis and treat it accordingly.
Thanks,
Jerenemarie

RANT: I resent the 1-10 pain scale. we have to "ASK" which in my opinion is a "PROMPT" " on a scale of 1-10, 10 being the worst pain you ever have experienced, what is your pain now?" Of course the answer is 10/10. NOW I don't ask..... I chart what I see. I went to 4 years of school and have 30 years of critical care, I THINK I KNOW HOW to assess PAIN. SO,I chart what I see or hear, "none stated by "client" no facial grimace, skin w/d, watching TV talking on phone, no resp distress, chewing gum, eating chips, drinking coke,playing gameboy, listening to I-Pod, no vomiting, etc. you get the picture... and record the vitals which we trend. and I trend EVERYONE q 15 min I want them to get their $$$'s worth. HA HA HA now, I know my Patient Demographics are different than yours and I have been selective on my rant. Not all Patients in pain are this way... THESE make me crazy, that is why it is a rant.....

@ Triage is insane! CHEST PAIN w/ back pain w/SORE THROATx3wks .. 10/10 THEY are talking on the cell, chewing chips,gum, drinking cola no obvious distress, no difficulty w/sitting standing,smooth steady gait. PAIN??? oh its a 10 yeah 10.(the day before the rock concert) Since they c/o CHEST PAIN....We do a "TIMI RISK card" boot them back to the waiting room ACCORDINGLY.

now the Acute MI, presents with SYMPTOMS nausea, diaphoretic, ashen, anxious,shallow or labored respirations, syncope, but they are in DENIAL BUT THEY tell me it is a dull ache, 3 or 4 "I think it's indigestion that burger I ate" GET THEM BACK NOW.... OH all the rooms are full of sore throats and back pains.......GO FIGURE!!!!!

Become a real EMERGENCY ROOM NOT A CLINIC.

MY OPINION..& vent..NOT A HUMBLE ONE EITHER....