Drug seeking or real pain? How do you tell?

I have chronic pain (FM etc...) when I am in a lot of pain I am either very very quite or angry. I dont know why but that is how I react unfortunately because I am known to have chronic pain I am terrified of ER due to judgementalness. I think just as all nurses should have to work as an aid at leaste for a short time It would probably be benificial (not being mean here) for all nurses to have pain that is not treated promptly and effectively at leaste once in their lives. Not that I want anyone to hurt it is just that it is very hard for people to understand something they have not experienced. Jumping down off of soap box.

While you certainly want to consider your patients compalints of pain seriously, I think what you were looking for was how you might be able to spot a patient with a drug problem. That is a very legitimate concern and a huge problem we are faced with as nurses.

This link has some good information and in particular points out behaviors of drug seeking individuals.

http://nsweb.nursingspectrum.com/ce/ce210.htm

well, when you see the same patients days in a row, it is kind of a clue. when you give them take home packs and scripts for narcs and they come in hours later or the very day and say that they lost the script or the pills fell in hte toilet or the pain was sooooo bad that they took them all..... well, you know the farmiliar stories. one time shame on them, two times shame on us!

And it is important to note that in ALL of those cases, we're looking at a patient who needs to be evaluated for PSUEDO Addiction.

Again, and I seem to be a broken record here.
It is not our job to JUDGE THEM. We are to treat pain based on the patients report.

Dave

I'm a little consfursed as to what you are saying. Of course, we don't judge, but we do need to assess what is happening with the patient. Whether the patient has pseudoaddiction or not we still need to respond appropriately. It is not OK to keep giving narcotic pain meds in the case such as MAGIK GIRL is describing. Or do you disagree with that?

I would have to assess each case individually. In some cases I would give additional medication, and in some I would consult an Addiction Specialist before making decision.

If they were stolen, ofcourse we'll need a police report. Lost in the potty? Well, this is harder to say. If they patient is in pain, then I will ofcourse treat it. Lost scripts. We'll, a "Fill only at" on the script. I can call the pharmacy that was selected and see if it is filled.

I'm not about feeding addiction, I am about adquately treating people who are truely in pain.

Dave

OK, Dave. I agree with you. Thanks for clearing my confusion!

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!

I have been in both positions I have pancreatitis which causes me a great deal of pain and I am also Dr Rx addicted to oxycontin. So when I have had an attack I never got the pain relief I needed because I was labled "Drug Seeking" When you go to an ER and a Doctor tells you he will not medicate you because everytime I was seen in his ER it was for a painful condition and he also said I had used two different names with my correct info. One why would I go to an ER unless I was in pain. Two I had gotten married hence the two names. To top it off one year later I had a attack the Same ER different doctor said the same exact thing word for word. Now I am on MMT I could not get pain medication if I was dying. It is wrong but I am glad to see that many of you opt for treating anyones pain. Because people do not always Dr shop because they are addicted sometimes because of idiots like the ER doc that will not medicate or under medicate.

Very interesting topic. As someone who lives in chronic pain and happens to be a nurse and a student, I find it educational to hear what others have to say about whether or not they think somebody is in real pain or drug seeking. Unfortunately, I have dealt with many physicians and nurses who have made it very difficult for me. When somebody puts down in ones chart, "drug-seeking".........."drug-seeking behavior" etc.......I wonder if they know what they are doing to that patient. Was I drug-seeking? I suppose that you can say yes. I was in severe daily pain and was let go by my surgeon when I told him, "No More Surgeries"....I have had many tmjd surgeries including implants and have had nothing but more pain since. I'm not going to get into all of my medical junk, but I was cut off from pain meds, just like that. I was not weaned off or given a name of another doctor and/or pain clinic. Back in the 80's, there weren't many pain clinics as there are now, so I was left just like that. So, yes, I was not only very angry, but I was in so much pain and in the beginning stages of withdrawel. I went to another doctor, waited forever to see him, and when I did, right off the bat I was told, "we do not give out narcotic pain meds here"........At that point, I didn't even get to what meds I was on. I was in tears, shaking, upset etc...........and most importantly I was in pain!!
So, now when I assess a patient, I believe that I do a pretty good job. I really hate it when a pt comes in to the office for their scripts and one of my peers says something like, "oh here she comes, she needs her drugs" or if a pt calls, it is often assumed that they are calling for meds. I try very hard not to prejudge anyone. don't get me wrong, I do see some pts who definately just want the pills and don't need them. I know that they are out there and I know that we can't just turn a blind eye to them. These are the people who are making it difficult for those of us who are really in severe pain and need pain control/treatment. Just like with Oxycontin............all the bad press about this med. Who died from it, who turned into a junkie blah, blah, blah.....Well, excuse me, but those who are really in chronic pain, like a friend of mine who is dying from cancer is not the one who is taking oxycontin and crushing it and snorting/shooting it. My friend finally has a med that helps her pain and now she worries that with all the bad publicity and lawsuits that they may stop making it or stop having it readily available. That's just not fair!!
I don't know what the answer is, but please, don't assume that because a pt is on narcotics that they are abusing them. I know that most of us understand this but there are some that really can make life miserable for those in chronic pain. So, let's continue to educate and learn how pain affects just about everything in the person who is suffering.

LOL, ok, I will stop now...As you can tell, this is a sensitive subject for me, lol............sorry if I ranted on here.

JUDE