Drug seeking or real pain? How do you tell? - page 21

All doctors/PA's/NP's are completely different when it comes to pain management. In April I had a crani for trigenimal neuralgia. After I got out of the OR they put me in a PCA but the dosing was very low and the PCA only had a bolus rate and not a basal rate. The dosage was .3mgs of dilaudid with an 8 minute lockout. A few weeks later I was having complications from the surgery(dizziness, extreme pain in the surgery spot and shooting down my neck, feeling lightheaded and a few other symptoms). But my worst symptom was pain, not to mention I am a chronic pain patient. So when the doctor came over to examine me he ordered me a CT scan and said I "could have whatever I want for pain." He let me name the medication that I wanted. So spent 24 hours in the ER getting 2mgs of dilaudid IV push(I was admitted but it took a day to get a bed). The doctor made sure I got my dilaudid and he also gave me IV ativan(I didn't even ask for it). Then when I was on the floor they ordered me a PCA this time it was .6mgs of dilaudid every 6 minutes with 2mgs of dilaudid(put in saline solution)every 2 hours for break through pain. Same hospital, different doctors. Also another time I was brought to the ER(this was a couple of years before the surgery and a different hospital) for falling down the subway stairs(gross I know and it hurt a lot). I decided to wait it out a couple of days before going to the ER but my neck and back were in such excruciating pain/spasms my mom took me to the ER. The doctor didn't do a darn thing, just gave me some tylenol and gave me a prescription for motrin.

Every time I went to the hospital with my mother and she tried to advocate for me. It's amazing how one doctor said "name your pain medication" while another doctor gave my tylenol.

I advocate for pain management for my patients. Many are drug addicts, alcoholics and drug dependent. Because I snap, crackle and pop when I walk. Because I have experienced chronic pain. Because I am a caring, compassionate nurse. I prefer to believe my patients when they report pain. I educate about long term narcotic use. I chart patients behavior as well as their statements about pain. I sometimes have conflict with MD's who want patients to stop narcotics and take Tylenol for pain. I believe we have a long way to go and so much more to learn about pain management. But we must put our prejudices and suspicions aside - and treat the patient. And provide relief. There are so many good ways to soothe pain and provide relief. Like offering a hot pack or cold pack, positioning for comfort. But one of the best ways is just acknowledging the patients and their pain. Working as team to find relief.

If in any doubt, the senior nurses I've worked with call the APS (Acute Pain Service).
Of course we get drug seekers - despite what people think, these people are chronic drug seekers as most have chronic pain. Also everyone's pain is very different. My brother cannot stand any pain at all - he is never ill - but any pain he can't handle. My Dad can handle lots of pain and narcs don't usually work on him (I've seen this with my own eyes in an ED). So we are all different.
I nursed a woman in a large ED once. She had had back pain for about 20 years I think. She had diabetes, hypertension, God knows what else. She was hugely overweight. She wouldn't even move off the bed to use a bedpan. She wailed & moaned in pain. She had had pain relief (can't remember what). She would have defecated in the bed, but I made her use the bedpan. We were incredibly busy that night & she took up a lot of our time; I think she was a frequent flyer, probably hadn't visited her pain specialist or whatever.
The whole point is some patients WILL have pain, but if they've had something for it, they still need to move as much as they can. If they don't their muscles & joints lock up, blood flow is decreased, etc & they can't then do anything at all. We still need to encourage them to move around at least a little.
I get horrid pain from long-standing endometriosis. Some days I get pelvic pain, pain going to the toilet, back aches etc from scar tissue. I have miserable, heavy periods. But I still make myself do things after taking some pain killers - I HAVE to or I will eventually wither up and die. I keep thinking positive thoughts and do positive things. On really bad days, I have to call in sick for work & just basically rest and look after myself.
Yes we are all judgemental it's human nature. But it does get wearying when u know who the drug seekers are. They also take up A LOT of time in any department you work in, whether it's ED or the wards. And they are never satisfied with the treatment they are given, they also get lazy.
As a RN I think it IS up to us to question these patients, and to r/v pain meds with the doc when we get hold of them. In the end, you don't do patients a favour by piling more meds onto them as it leads to more complications and problems.
Having worked with pain doctors & nurses, I can also tell you that when patients DO stop their meds - maybe in a trial or something - they have as much pain as when they're on their meds. Some also found better relief with OTC pain medicine too and using other methods, ie: stretching, gentle walking, water aerobics is fantastic for pain pts, yoga/pilates, and being referred to a pain clinic can help (though most pts don't go for follow up t/ment). If you can suggest these things, these may help chronic pain patients as well.
I also nursed MH pt with long standing neck pain, think she'd had 2 or 1 disc removed?? (can't remember). No pain killer had helped her except narcs but I noticed that the physio & doc thought it was psychosomatic. When I went in to assess her, I noticed she was holding her head to the side at an odd angle; this was how she 'coped' with the pain. I explained that the muscles on that side had probably tightened up & the pain would/had got worse. She kept insisting that how she held her head HELPED the pain, but I was trying to reiterate that yes it would for a while, but when she went to straighten her neck, the pain would get worse, due to tight muscles being stretched. She refused any help, just wanted the narcs. I think this is sad in a way as she (and the doc etc had written this) she would not do anything to help herself. Being scared is a big factor too.
So yes it is very, very difficult to help people sometimes. We have to accept their right to refuse t/ment as well.