pain in the ed

Specialties Pain

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i am wondering if a percocet or an oxycontin drive thru right in the waiting room would be the answer. then perhaps, we would have the time to give quality care to our patients who are really sick.

our er uses the pixis and computerized mar's. the doc orders a drug, you have to wait, wait, wait, and then go to the pixis, get a witness for a waste (if you don't need all of the pre measured dose), and then give the pain patient his dose. never mind the fact that on the way to the pixis you have 6 other things that suddenly need to be done and that pain patient has sent each of his 6 visitors individually at 5 minuet intervals to complain that the 2 hour er stay is rediculous and that he missed his dinner and wants you to fix him something to eat.

by the time you get to the patient, the award winning draumatic preformance is simply breath taking!

now i know that some pain is true. but if i have a kidney stone, an acute appendix, labor pains, or chest pain, the er nurse shouldn't have to come out to the smoking area, tell me to put out my cigarrette, put down my big mac and accompany her to a room where my vs are 120/80 - 70 - 16!

thanks for allowing a "newbw" to vent!

Originally posted by MD Terminator

One could also say we over write Norvasc, Atenlol, or Clonidine.

People have chronic conditions. People need medication long term. We agressive treat hypertension, so why not pain?

It is in NO WAY criminial to prescribe enough medication to ease someones suffering. Not in the least.

Dave

Apples and oranges dave...Norvasc, atenolol and clonidine treat a condition that we can measure OBJECTIVELY...

But it IS criminal to continue to provide these meds at #120/month for example, with NO accountability as far as education, precautions, or the POSSIBLITY of addiction...

If you get into a serious accident, and "need" 4-6 percocets/day during your recovery, there is a HUGE possibility you may need some help getting off them after your recovery, especially if you are an alcoholic/addict, or have the addict gene...No one talks about the research on the addiction gene. And yet the overprescribing continues. And if the patient that gets 120 percs/month has "breakthrough pain" after picking up his son, and runs out before month's end, guess who picks up the slack? THE ER!

I absolutely never do narcotic medication with education and accountability. When we treat patients with these medications, we use a very strict accountability program. I have a liscence to protect and we all know to well what kind of trouble people can get into for writing these drugs (be it legit, or otherwise).

I keep getting the feeling that everyone thinks I'm NP Feel Good. Nothing could be further from the truth. I don't just dole out the pills and send up packing.

When people come into our program, they are (99.9%) of the time at their rope. NOTHING and no one has helped. They have pain that keeps them from having ANY QOL. Not more than a hanful of of my "pain" patients can be managed on anything but a CII. Oxycontin, Methadone, Duragesic, Kadian, MS Contin. This is what keeps them alive. W/O it, they are in such pain that they really have no will to live. Those who agree to live by the rules of the program get a big return on their investment. We, in exchange, treat their pain to the best of our ability. We don't tell them "oh, we don't write for that". They get whatever treatment that they need.

Yes, we have kicked out people. Failed drug tests, repeated calls for lost medication, even had one threaten the pharmacist at RiteAid. Of the people whe have discharged from the practice, some have gotten help, but the majority have presented as a OD in the ED. To my knowledge, not one patient has been discharged only to have to find treatment somewhere else for a true pain condition. If they have, the new doc never asked for our records.

Nextly, we do not just emplore narcotics for the treatment of pain. Our non "pain" patients receive a variety of medications which take care of the pain. We've had great success with Tegretol and Effexor. So no, the heavy hitters, as l like to call them... are not my first choice.

I will 100% agree with you when talking about using the "heavy hitters" as a first line choice. If you told me of a doc that was doing that, I would gladly be the first to tell him he's making a wrong choice. (Mind you were not talking about cancer patients, some ortho cases and such).

I really admire you strong desire to do what you feel is best for your patient. We share that goal. I think if you were to change your views a little, we could really get along.

Dave, who is really going to have to NOT try to quit smoking and have a baby in the same week... and to those trying. ITS TOO DANG STRESSFUL!

Dave, our problem is that your (type of) practice is the exception (at least here in Phoenix), not the rule. I was nursing supervisor at an HMO. Our practice had 50,000 patients. 4 out of the 9 of the Family practice docs had notebooks w/ hundreds of patients on 80-180 Percs, Vikes, and Oxys per month. We received at least 15-20 calls/day for early refills...95% of those calling were given their refills, irrespective of their "excuses"

I am speaking of "real life"

Your defense sounds similar to the defense of the "system" of psychotropics for kids. The usual response is "well, the kid is supposed to get a counseling referral, eval by psych, and a laundry list of other interventions before Adderal is started." In reality, pediatricians are prescribing it in the office, usually in response to pushy parents.

I have seen pushy patients when it comes to pain med prescribing, and FAR TOO MANY DOCS JUST WRITE THE RX and turn the other way...

That is my issue. And from your description of your practice, you too would disagree with the management of chronic pain thru the ED...

sean

good debate:p

Originally posted by MD Terminator

...... Even more rare, is psycological addiction.

Dependence is common. It doesn't mean people are addicted. It means they need a little more medication to do the job.

Dave

could it be that maybe the pain is getting better but the pt likes the way the narc makes them feel? the more they use it the more they need to use to feel as good.

let's face it. a person who doesn't normally take meds of any kind,who has pain from injury (or maybe even chronic), gets narcs and takes them for pain. now this person who normally does not take any meds is taking narcs. well, the pain gets better and maybe motrin would help. but the doctor said..... so now this person is taking the narcs for as long as they can justify it to them selves because the doctor said they need it right? we're all human. if a doc gave me permission to get high....

we are suposed to feel some pain. we are supposed to feel pain as a regulator so that we don't over extend ourselves. i am not saying that pain should not be treated. but i don't take oxycontin for cramps, i take motrin.

befor anybody jumps me, yes i have had my share of pain. i have chronic pain everyday but i don't live on narcs. i deal with it and move on. i don't obsess about it and blame alot of people for my problems. yes, pain sucks but so does addiction.

not all drug users are addicts. there are those who simply abuse the drug. they like the way they feel. yes, they can stop - but why should they when they can come into an er or see a pain doc and get all they want. some of these people even get out of work on disability. (i am not saying that all are bogus but i have done many many pre-litigation physicals in the er. you know the ones... "no, i don't have any complaints but my lawyer said i should come into get checked out.")

so, having said that, good night!;)

I do not believe that anyone that claims to have chronic pain can possibely have very severe chronic pain and say the things you did. Most of the people I know myself included who suffer with severe chronic pain can not have any kind of QOL without the aid of strong analgesics. I personally find it offensive to be told to suck it up and move on. Walk a mile in my shoes then we will talk. Sorry thats as nice as I can be at this point.

No...physiological tolerance does not mean that the pt is starting to "like" the effects of the med. It is something that happens over the course of long term use of opioids, but has absolutely nothing to do with addiction.

Using that theory, someone whose headaches used to respond to one Tylenol but now require two would be an "addict."

People with chronic pain do not get the "buzz" that someone who rarely gets a narcotic does. It takes all of the analgesia of the med to get rid of the pain...there isn't anything left over for a "high."

Daily, chronic pain is not normal, and to say that someone should live like that is cruel, IMO. Would you say the same thing about someone needing increased insulin to control his diabetes?

Living with daily pain may be your choice, but you shouldn't lay that trip on someone else. (Good grief, I can't believe I just fell back on that old saying.)

Forgot to add...I really wish the people making these comments would do some serious reading regarding new views on pain mgmt. I would be willing to bet that most have never read anything by Margo McCaffery, nor the AHCPR guidelines on pain mgmt. (That's your government saying your views are out of date, and lots of docs, nurses, other health professionals with the research to back it up. Where is the research to back up your statements?)

Well said fab4fan. I have never gotten high on vicuprofen which is my maintenance drug nor have I ever gotten a buzz to percocet or demoral when in crisis. I will say how ever that dilaudid did give me this tunnel like feeling that I did not care for but it was IV so maybe that was it. At anyrate you are correct all the med is used to relieve the pain no high to be had. If I wanted to get high I would smoke the wacky weed or drink myself silly. That is not the goal of someone who has chronic pain.

Originally posted by angelbear

I do not believe that anyone that claims to have chronic pain can possibely have very severe chronic pain and say the things you did. Most of the people I know myself included who suffer with severe chronic pain can not have any kind of QOL without the aid of strong analgesics. I personally find it offensive to be told to suck it up and move on. Walk a mile in my shoes then we will talk. Sorry thats as nice as I can be at this point.

angelbear,

i am sorry if i have offended you. i don't believe i said that anyone should suck it up and move on. i do believe i said that i deal with it and move on with my life. i also am sure that i we are supposed to feel some pain, otherwise we would have no pain receptors. (fab 4 - i have also read books).

if you have read any of my posts, and alot of posts by alot of others, the subject matter is drug seekers, addicts and abusers. so, i appologize to anyone who's feelings may have been hurt by my opinion. i do suggest that you add "the 4 agreements" to your reading lists if you are one of the one's who have taken anything that i have said personally.

to fab4-i have noticed that you seem to concentrate alot on criticizing posts by others. what't up with that?:rolleyes:

I hardly think I am the only one who thinks you were implying that people should suck it up since you do. I know you did not say that I do however believe that is what you were implying. I dont know if you are aware of it or not but this forum is intended to educate on pain management and support those who deal with it it was not intended to be a forum to insult addicts and seekers.

You obviously don't read a lot of what I post. Whatever.

I'm sorry, but I stand by what I say, and I also have the resources to back it up. I don't get what you mean by the comment that people are supposed to feel "some" pain...it's not like people on maintenance meds are anesthetized.

I am not criticizing you, personally...in fact, nowhere in those last two posts did I even mention anyone specifically. Might you be a bit defensive on this matter? I am criticizing comments that are outdated and presented as fact. Big difference.

Again, the use of terms like "seekers," "addicts," etc. are akin to epithets...instant negative connotation. And again, the literature will tell you that diagnosing addiction is not within the scope of practice of any ED professional. Docs included.

BTW: You've made some pretty personal attacks on me in several posts. Guess I should be offended. :stone

I have never done this. It takes alot, and I do mean ALOT to peeve me off (deeply) but I have honestly reached my limit.

To those of you with your labels. Make them. That's fine.

Go on about the abuse and misuse and addiction. Thats fine.

You practice nursing the way you see fit. That's fine.

Just keep it out my practice.

Because let me say this. If one of you were to come and express these views on any patient I am treating, I'm going to tell you this. (And I have never said it, but I beleive now the time has come).

Understand that you are the nurse. I am the Practitioner who has evaluated this patient and making a treatment plan. I will order the medication/s that I see fit. As the nurse, you will admister them. If you choose not to, then I will admister them myself, but understand I will also be relieveing you of your duties to this patient, and me as the Practitioner.

Call it pulling rank, call it a power trip. However a nurse with the kind of feelings posted in this thread will be useless to me, and will prevent me from doing MY job. And as the Practitioner, I will not allow that.

Good day to you all. For those nurses who are compassionate and caring enough to understand that patients complaints of pain need to be taken seriously, this is very much not meant towards you. I would be privilaged to work with any one of you.

Dave, who is hanging his hat up on this thread. I will not be responding to any other posts. I have nothing else to say. Explaining things again is waste of my time.

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