Drug seeking or real pain? How do you tell? - page 20

by JudyPRN 147,256 Views | 202 Comments

I'm a new nurse on the list so please pardon my ignorance. I was quite interested in the pain links and explored several and probably will use some for staff training. I did not see any mention of dealing with chemically... Read More


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    I'm in a chaplain residency program at a large urban hospital, and one of the floors where I visit patients is Ortho/Medical. I hope to do my ministry specialty project on something related to nurse's perspectives on patients they feel are "drug-seeking" post-operatively, and the patients' perspectives on how their requests for pain relief are handled and responded to and their overall satisfaction with quality of care they received. An additional and recent insight received from conversations with nurses on this floor suggest that at least some portion of their reported "burnout" with their job in general is related to the stress of responding to patients' complaints of inadequate pain relief, and the nurses' perceptions that a fair or high number of patients are drug seeking. And then, where in the mix of all this is the stress, perhaps, of nurses having to be in the middle between patient needing/wanting pain meds and the doctors who must be contacted to approve a higher dose or frequency? I have heard LOTS about the strains between doctors and nurses re: primary care issues!!!

    So... why do some nurses feel so strongly against providing whatever pain relief is needed to keep a post surgical patient comfortable, so long as respiration is ok, etc.? Their hospital stay will be short presumably, their meds will be controlled after discharge by their own doctors, and if they are physically more comfortable they will participate in PT, get up and move around, and be far more likely to participate willingly in whatever they need to do to get back to their pre-surgery lives. Why so much worry about addiction, when the research and data is available in copious quantity to show that this is simply not an issue for the majority of patients?

    I would love and so appreciate hearing from nurses and from those who've been patients in these circumstances! I have dealt with chronic pain for over 30 years from college years gymnastics injuries, so I know chronic pain and the impact it has had on my life. so I willingly acknowledge a bias towards treating the pain, since I lived the first twenty years after these injuries without consistent pain relief. And, pain DOES lead to depression, and, apparently, vice versa. Why in the world, when pain management as a medical practice has become so well established, are there still so many who fear everyone who takes pain meds is, or will become, an addict, a drug- seeker, etc.

    Thank you!!
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    Too many nurses (and patients) do not understand pain control. I was a nurse in the ER and I suffered with migraines and since I was intimately familiar with migraines I was often called to exam rooms of patients requesting narcotics for migraines. Yes many of the patients were chronic migrainers but more than half were drug seeking. Nurses in the Emergency Rooms deal with more true drug seeking. This is a true problem for most ERs but not, I'm sure, in post-op. I have spent many hours instructing patients that not taking prescribed pain meds was detrimental to their recovery. Many patients are afraid of becoming "drug-addicts". I believe that pain-control should be taught as a subject in all nursing schools.
    As a side note: I had one patient that bluffed even me - she got an INT and IV phenergan and demerol and she left (with INT intact) got in her car and drove away. Try doing the paperwork on something like that.
    AtomicWoman likes this.
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    Macsusan, I couldn't agree with you more! But as I mentioned a few posts ago, it is my opinion that people, including nurses, hate feeling like someone has gotten over on them; no one likes to feel fooled. And then there's anger that a drug-seeker uses valuable healthcare resources, including nursing time. Plus the fact that relatively few people have any sympathy for addicts in the first place. But I will restate: I would rather give 9 drugseekers pain medication they don't need than risk not relieving the pain of 1 person who is truly in pain. And while I'm at it, I have heard nurses express the opinion that drug users can't feel pain any more. What the hey?
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    Quote from Dragonnurse1
    Too many nurses (and patients) do not understand pain control. I was a nurse in the ER and I suffered with migraines and since I was intimately familiar with migraines I was often called to exam rooms of patients requesting narcotics for migraines. Yes many of the patients were chronic migrainers but more than half were drug seeking. Nurses in the Emergency Rooms deal with more true drug seeking. This is a true problem for most ERs but not, I'm sure, in post-op. I have spent many hours instructing patients that not taking prescribed pain meds was detrimental to their recovery. Many patients are afraid of becoming "drug-addicts". I believe that pain-control should be taught as a subject in all nursing schools.
    As a side note: I had one patient that bluffed even me - she got an INT and IV phenergan and demerol and she left (with INT intact) got in her car and drove away. Try doing the paperwork on something like that.
    I am too a ER/trauma RN, charge nurse, but now disabled with chronic pain was treated horrible in the ER last night. I had 4 fusions neck and back,neurogenic bladder,bowel, quada equina syndrome. Anyway went to er for severe neck and occipital pain and a xray not meds because the pain was so bad i wanted to make sure my plate was not shifting. Anyway the DR comes in and he says "what do you want" with the look, negative body language, negative tone in his voice and i said! "not pain meds"! he replied "what then" i said how about an x-ray i pretty much had to beg for it, when he left the room i felt just so unwelcomed and ashamed of how patients are treated especialy RN's as patients. I am tired everytime i go to the er or pharmacy i get that look."another Drug Seeker" I even worked at the hospital for 6 years where i was treated like a piece of crap! Not once was i asked my pain level, neuro checks, examination of my neck, offered anything for the pain. I feel like writing a complaint about that DR, but what good would it be nice if all the er staff knew that true chronic pains patients addiction rate is only 1%, but treated more like 99% anyway i know how you feel, and feel for you.
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    thanks for the responses to my post everyone. Fascinating info for me. We have such a long way to go with this whole pain management thing. Seems that those patients in ICU units and more and more often those on palliative care wil receive adequate pain management. But those who are suffering frompost surgical pain, from chronic pain conditions etc are assumed to have "low pain tolerance," are drug seeking, whiners, etc. The impact of untreated pain on quality of life is SO huge -- I often wonder, and not happily, how my life might have been different in many respects if chronic pain had not become the "jello" within which I had to live my life for so many years. It is exhausting.
    Nurses supposedly learn about pain management right? Doctors too. Why is there still so much misinformation and prejudice directing their actions?
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    I am sorry about the way you were teated by your own peers. I have had the misfortune to be treated the same way since I became disabled. I, too, have fusions in my neck now supported by plates and screws. Hang in there - you are not alone.
    traumasurfrn likes this.
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    I am a migrainer in nursing school and we are discussing how to control patient pain. As a migrainer, I've been labeled a drug seeker in the ER and have been treated rudely so many times. I do see a neurologist regularly, do have a preventative med (Topamax) that I take daily, along with an 'emergency' stash of Vicodin and Phenergan. But for some reason, there are times when the Topamax won't work and if I can't get to my emergency stash in time, I start vomiting. By that point, I know that my stash won't work since I'll vomit whatever I put into my mouth so a trip to the ER is necessary. I know exactly what works for me.....1-2mg of IV Dilaudid and 4-8mg of Zofran. But as soon as I mention the 'D' word, all hell breaks loose. I get an attitude from everyone involved in my care...right down to the guy who mops the floors. It's ridiculous! I have a legit medical problem and I take meds but because Dilaudid works best for me, I get labeled as a drug seeker. Can I help it if it works so well? I didn't manufacuter the freakin' drug, for crying out loud! IIt's a pain med and I'm in pain so give it to me! That's why it's in your pyxis! In school, we learned that "pain is whatever the patient says it is." Um, yea. Tell that to most ER nurses. I hope i will be a more understanding nurse than some of the nurses I have had. It's interesting that this is such a hot button topic...at least I'm not alone.
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    The best reference for pain management information is a book by Chris Pasero and Margo McCaffery called "Pain Assessment and Pharmoacologic Management". It is what I call the bible of pain management. You have identified a real issue - pain vs drug seeking. When the person has addictive disease that complicates the issue. There is no sure method of weeding out the drug seeking from real pain. The addictive disease patient may have real pain and then it is even harder to treat often as their tolerance is even higher. Try looking in this book under chapter 2, page 32. The other thing you can do it go to the American Society for Pain Management Nursing site (www.aspmn.org ) and click on "The Organization" then look on the right hand side for a shaded area with a list of topics. Toward the bottom you will find "position papers". That may be of help. Finally, the ASPMN list serve is a wonderful tool and I don't believe that it is limited to members - join that (directions on that site) and ask this same question of the pain management professionals on that list serve. Good luck.
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    I have a question about this. I broke my ankle over a year ago and it still hurts a lot. Also is a delayed union fracture. But I wonder if it is real pain at this point. I call to ask my doctor for a refill on my pain meds. Because I have been going months now in so much pain I feel I'd rather die then have to be in so much pain anymore. The doctor is refusing the refill the meds. Could the pain be fake? I've almost went to the ER for said pain several times because of how badly I hurt. I am not sure if the pain is real. I don't want to be addicted to the pain meds. I just need relief very badly.
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    Quote from LuciaNix20
    I have a question about this. I broke my ankle over a year ago and it still hurts a lot. Also is a delayed union fracture. But I wonder if it is real pain at this point. I call to ask my doctor for a refill on my pain meds. Because I have been going months now in so much pain I feel I'd rather die then have to be in so much pain anymore. The doctor is refusing the refill the meds. Could the pain be fake? I've almost went to the ER for said pain several times because of how badly I hurt. I am not sure if the pain is real. I don't want to be addicted to the pain meds. I just need relief very badly.
    Call your MD
    We can't give medical advice here


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