Welcome to our new pain management forum

angelbear · Jan 13, 2004

Personally if I were to come across someone I thought was a drug seeker I would assume their pain is legit and not being adequetly treated and would advocate to refer to pain specialist. If I suspected a true drug addict I would advocate for a pshyc consult or drug treatment consult. Whatever the case may be the pt deserves appropriate and compassionate care.

Dave ARNP · Jan 13, 2004

Completely agree Angelbear. Too bad we don't have more educated and caring professionals working in pain treatment.

Dave

Noney · Jan 14, 2004

I'm glad for this forum. I try to remember that pain is subjective, but to be honest it gets hard sometimes. I'm glad to have this place, to keep me compassionate.

The only time I've asked an md to d/c a pain med was a young girl early 20's that asked for a demerol shot for a ha then as soon as I gave it looked at her boyfriend and said "I'm so high" He said "You need to stop this" Now I do think she was having pain and it needed management, just not iv demerol. She got switched to something not so strong and did fine.

I think PCA should be utilized more with "the clockwatchers" They could relieve their own pain and not have to wait.

Noney

live4today, RN · Jan 14, 2004

Great forum to have, Brian. :)

As a former pre-op/post-op surgical floor nurse (many moons ago), I always loved teaching my patients about pain management from the day they were admitted to the hospital. It was very important for the patient to understand preoperatively how to manage their pain besides the medications they would be receiving to help with their pain relief.

That was the best floor to work on because I loved the teaching aspect, and being able to see what I taught my patients come to fruition in their post-op healing phase and recovery.

The patients who would come to the floor post-op without any pre-op teaching on pain or what to expect after their surgery were always the ones who were more frightened and had very little understanding of managing their pain, when to ask for their pain meds, and which pain meds were most effective.

Love this topic! :nurse:

fab4fan · Jan 14, 2004

The only person qualified to dx. a pt with addiction is someone who specializes in addiction medicine.

Even if a person is an "addict," does that mean his pain should go untreated? Why is this country so puritanical about treating pain, when there are far worse addictive substances readily and legally available (like ETOH)?

Pain is whatever the pt says it is, and occurs whenever the pt says it does. People with chronic pain can look normal; I can tell you from personal exp. that few people know when I am in pain because I have gotten very skilled at masking it. Families get tired of hearing about it, and pts feel like they need to put on a "brave face."

If I have to choose between possibly medicating an "addict" (not my term) or not medicating a pt with pain, I'll err on the side of the former, every time.

live4today, RN · Jan 15, 2004

Did anyone else see on the news or read in the paper about the doctor who is being accused of being "too pain management diligent" with her patients?

The doctor said that she evaluates each of her patients based on what they may need for pain management and has no real way of telling which patient is truly abusing their pain meds.

This doctor stands to lose her medical license over this.

Sounds like if we undermedicate, we're guilty, and if we overmedicate we're guilty.

sallyrnrrt, ADN, RN · Jan 19, 2004

What a great forum. I work in Rehab nursing and pain is a very real part of most of my patients' day. I have always thought it was sad to say a co-working is "addicted" to Vicoden or some such thing; usually they are talking about an 80 year old who just had a total hip replacement! I think the "clockwatchers" among our patients are not addicted--just scared to death of the pain. I think that as nurses we see so much pain and become somewhat desensitized to it. We need to be reminded every so often that pain is "what the patient says it is.":eek: :chuckle

JudyPRN · Jan 22, 2004

To Angelbear and Fab4fan, We do medicate with non-addicting meds. We know that pain is what a patient says it is. As a facility, we tend to either give everything or nothing. We have experienced patients who get surgery to obtain pain meds, and who have set fire to their legs, with cool deliberation on just how long to let it burn to destroy nerve endings, and then request the meds due to (our perception of) burn pain. Our chemical dependent units have substance abuse counselors, psychiatrists, and medical docs to help the patients. The Substance abuse counselors either buy the whole story and make sure that the guy who is drinking a coke and eating chips and claims a level 10, gets pain meds. Then other substance abuse counselors who the medical folks see (as being in great pain) who insist that 'He's drug seeking'. We were sent a patient who was on Duragesic patches, for treatment of his "prescription pain med abuse'. Can you see our dilemma? Our chemical abuse units wrestle with this question on a daily basis. We appreciate any thoughts on making an objective determination about pain.

Dave ARNP · Jan 22, 2004

Cheerfuldoer,

They phsyician you are speaking of is a TOP pain management specialist (I wanna say in NV?) Somewhere I have the link to an article on her.

She is a WONDERFUL MD IMHO, who was doing what she should.

The DEA needs high profile docs like her, if they're ever going to crack down on the quacks!

Dave

FranEMTnurse, CNA, LPN, EMT-I · Feb 11, 2004

wow, now that is reallynice. Thank you Brian. As a longtime sufferer of chronic pain with accompanying breakthrough pain (some that literally takes my breath away, and am still looking for the right one I welcome this. My body says no to most narcotics., and it leavs me in a dilemma :rotfl: :rotfl: :rolleyes: Oh happy day

FranEMTnurse, CNA, LPN, EMT-I · Feb 11, 2004

wow, cheerful, i didn't hear. i don't understand why they pick on the good guys and leave the monsters alone! the world we live in is definitely due for a makeover.

Dave ARNP · Feb 22, 2004

Frances, will you be the offical troll getter?

I think your the pefect woman for the job!

-Dave