Drug seeking or real pain? How do you tell? - page 4

by JudyPRN 146,899 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


  1. 0
    Well Laura"put them to sleep" thats novel
    I am not going to defend those in legitimate pain, thats not what is behind this thread, I am not going to defend drug seekers, yes I used that bad and judgemental term.
    All a pt has to do is tell me they are hurting, then if the doctor chooses to medicate them, then I will. I no longer question their motives or needs for pain control. I am not going to fight with them or argue with them in the least, I just say discuss that with your doctor. He is the one paid to make those decisions and I will abide by whatever he decides. I used to argue about it in the old days when I was younger, but now Ive chosen the path of least resistance. No more stab wounds in the back for arguing with patients, those that abuse it will pay in their own way.
    They end up loosing their families, their jobs, their respect from others. Who am I to judge. Judge Not Lest thou Shall be Judged. Or something like that anyway.
    I feel for people who hurt, My back has been killing me for over 12 years now. I take my ASA and thats it. I have decided that if I ever wake up pain free, then I must have died. Meantime I keep working, I keep Golfing, what else is there. I certainly dont need anymore grey hair from battling. And trust me, I have seen how drug seekers end up by loosing everything worthwhile in their lives. Why should I fight it.
  2. 0
    Tom,
    You are truely a wonderful nurse! I would be privilaged to work with you.

    Dave, humbled by Tom's awareness of Pain Mgmt.
  3. 0
    Chris what a powerful post! Thank you.
  4. 0
    Quote from JudyPRN
    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 dependant people who may or may not be having pain. I work in a mental health facility which also serves chemically dependant people. We have a constant struggle with determining who is in pain and who is drug-seeking. We have isolated a few cues, but over-all are probably treating the wrong patients. Does anyone on this list have ideas on this subject, who can steer me to a few resources? I appreciate all the help offered.
    hi, a really great site I came upon is PAIN.com,Great stuff about addiction vs. chronic pain sufferers who use oploids, a lot of great articles,studies on differentiating and identifying drug abusers(even those with chronic pain issues who need proper pain management).today's view on pain management,I could go on and on,just check the site out, you won't be dissappointed.Our society;Law makers, the medical establishment,we all need to educate ourselves.....people in pain should not have to suffer needlessly,we can not hide behind the door's of ignorance any longer! you can also just type in pain management, and a lot of useful sites will come up,it can be overwhelming,but our education has to start somewhere right! good luck and God Bless, mar
  5. 0
    I too understand and feel your post, Tom.
    Keep on the green, Tom.
  6. 0
    Here's what's confusing to me about people who have genuine chronic pain conditions for which they are under the care of a chronic pain specialist, and have an agreed to (often signed) treatment plan, including a narcotic or two.

    Why would they ever have to go to an ER (particularly to get refills of those prescribed narcotics) in the FIRST place? Just like diabetics or asthmatics or any other patient with a chronic disease, they HAVE (or SHOULD have, if they are willing partners in their own health care) a physician managing their treament plan and prescribing their narcotics according to a fixed schedule. Why should they ever be caught in a position where they have run out, and have to go to an ER where people don't even know them, their hx, or how their pain has been managed, since they have no access to their outpatient charts?

    I mean--if you have chronic back pain, or chronic migraines, you have a doc managing that chronic pain; a chronic pain specialist, if you've gone to the trouble to seek one out and have worked out a mutually agreed to treatment plan and are compliant with it--and that means keeping your scheduled appointments and getting your narcotic prescription refills as ordered and as agreed to in your treatment plan.

    If you've done that, then you have the meds you need and should be using them as prescribed. Why would you ever be caught in a situation where you have run out and have to visit an ER, essentially behind your doctor's back, for more of the same meds, or the same meds, but in IM or IV form? To me, that's non-compliance and in violation of your agreed to treament plan.

    I am anything but judgemental, and I, too, agree with the adage that "the patient's pain is whatever he says it is" but that adage is referrring to ACUTE pain----not chronic pain.

    Chronic pain is a whole different ball game, and needs to be managed by chronic pain specialists. Chronic pain patients should know better than to be using emergency rooms as drop-in clinics--they need to be compliant with their own agreed to treatment plans, and I am betting those treatment plans have detailed instructions as to how to avoid running out of medication before a weekend (which includes taking the prescribed meds ONLY according to the schedule prescribed) and therefore having to drop into the friendly neighborhood ER, expecting them to become a partner in a chronic pain treatment plan to which they don't have access, and are therefore reluctant to interfere with.

    For those of you ER nurses who frequently hear the story, "My meds fell down the sink" (or the toilet) check out www.placebojournal.com
    There is an amusing animated picture called "Narcotic Mystery--just click on it.
    Last edit by stevierae on May 31, '05
  7. 1


    That was soooooo funny !

    Cool website too.

    As for the ER visits while under a narcotics contract. Totally happens all the time but for the legit pts....who get a set amount of narcs a month...they're told to go to the ER if they run out to receive IV treatment. What the doc doesn't want to happen is the pt going to a clinic and acquiring another PCP to prescribe meds. This way the ER sheets get sent to the pt's doc and everyone is aware of the visit and a reassesment of the contract is in order.

    The pt doesn't ask for a pain Rx but receives treatment.

    That's how we do it here.

    Z
    twotrees2 likes this.
  8. 0
    Quote from z's playa

    As for the ER visits while under a narcotics contract. Totally happens all the time but for the legit pts....who get a set amount of narcs a month...they're told to go to the ER if they run out to receive IV treatment. What the doc doesn't want to happen is the pt going to a clinic and acquiring another PCP to prescribe meds. This way the ER sheets get sent to the pt's doc and everyone is aware of the visit and a reassesment of the contract is in order.

    The pt doesn't ask for a pain Rx but receives treatment.
    That's how we do it here.

    Z
    I think thats a great way to handle the situation.
  9. 3
    Quote from stevierae
    Here's what's confusing to me about people who have genuine chronic pain conditions for which they are under the care of a chronic pain specialist, and have an agreed to (often signed) treatment plan, including a narcotic or two.

    Why would they ever have to go to an ER (particularly to get refills of those prescribed narcotics) in the FIRST place? Just like diabetics or asthmatics or any other patient with a chronic disease, they HAVE (or SHOULD have, if they are willing partners in their own health care) a physician managing their treament plan and prescribing their narcotics according to a fixed schedule. Why should they ever be caught in a position where they have run out, and have to go to an ER where people don't even know them, their hx, or how their pain has been managed, since they have no access to their outpatient charts?

    I mean--if you have chronic back pain, or chronic migraines, you have a doc managing that chronic pain; a chronic pain specialist, if you've gone to the trouble to seek one out and have worked out a mutually agreed to treatment plan and are compliant with it--and that means keeping your scheduled appointments and getting your narcotic prescription refills as ordered and as agreed to in your treatment plan.

    If you've done that, then you have the meds you need and should be using them as prescribed. Why would you ever be caught in a situation where you have run out and have to visit an ER, essentially behind your doctor's back, for more of the same meds, or the same meds, but in IM or IV form? To me, that's non-compliance and in violation of your agreed to treament plan.

    I am anything but judgemental, and I, too, agree with the adage that "the patient's pain is whatever he says it is" but that adage is referrring to ACUTE pain----not chronic pain.

    Chronic pain is a whole different ball game, and needs to be managed by chronic pain specialists. Chronic pain patients should know better than to be using emergency rooms as drop-in clinics--they need to be compliant with their own agreed to treatment plans, and I am betting those treatment plans have detailed instructions as to how to avoid running out of medication before a weekend (which includes taking the prescribed meds ONLY according to the schedule prescribed) and therefore having to drop into the friendly neighborhood ER, expecting them to become a partner in a chronic pain treatment plan to which they don't have access, and are therefore reluctant to interfere with.

    For those of you ER nurses who frequently hear the story, "My meds fell down the sink" (or the toilet) check out www.placebojournal.com
    There is an amusing animated picture called "Narcotic Mystery--just click on it.
    I find your comments both amusing and judgemental. I am a chronic pain suffer, as well as an insulin dependent diabetic and an asthmatic. And guess what, I am under the care of physicians, on a regular bases. However, there are times, late in the evening, at night, on the weekend, or holiday, where I call my doctor and am advised to go to the ER for treatment and to instruct them to call him. Chronic pain suffers rarely go to the ER for pain management. The attitudes, of most staff, are too judgemental to deal with. Many would rather suffer then have to deal with the staff and their attitudes. :angryfire

    Back in the early 90s, when I first began to suffer, I was label as a drug seeker. I was seeking drugs, from my physician, to help control the pain that I was experiencing. The nursing staff was the most difficult to deal with, given their outdated attitudes towards anyone seeking pain medication. Fortunately, I found a pain management physician, who has successfully treated my pain. And I no longer have to deal with the attitudes.

    Please remember this:

    Pain is whatever the pain suffer says it is. It is not up to you to determine if it is real or not. And you will be unable to determine if it is. And please do not pass your suspicions on to the physician, only your direct observations. And even those should be done carefully.

    Grannynurse
    jesskidding, RLeeRN, and twotrees2 like this.
  10. 2
    This is a pretty long thread and there is a lot of great information and valuable observation and opinion. Let me add one caveat (and I hope I didn't overlook it if someone else has posted this.)

    Drug seeking behavior (or insert your label of choice here) is a bad thing and generally involves deliberate manipulation and (call a spade a spade) lying.

    But there is a close cousin that is often confused with DSB. People with chronic pain, or episodic severe pain (I'm a migrainer... full disclosure time) absolutely fear their pain. They don't want to be disarmed and helpless. They want to be sure they have a bottle of Vicodan handy if needed. And they can get really panicky if they start to get on the wrong side of the pain/med-on-hand ratio. When this happens, yeah... they'll start "seeking drugs". But it's fear of pain that is driving the behavior.

    These are the patients that you can really do some good for with treatment contracts and alternative management approaches. They will agree to do ANYthing if you can take the fear factor away. I know several migrainers whose narcotic use dramatically decreased after they were started on a triptan type drug. Other migrainers I know have been managed with a prophylaxis med (usually an anticonvulsant). But the point is that they stopped begging for narcotics. As long as they had enough for their breakthrough pain, they were cool.

    So the point is... some people are really "seeking drugs" but are not "drug seekers". It's a fine point, but a very important one, I think.
    RLeeRN and sharpeimom like this.


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