Would appreciate some opinions on pain management - page 2

Hi. First let me say that I don't want this to end up as a debate over real pain or drug seeking. What I am looking for is reasons why there is such a suspicion of pain patients. I am in nursing... Read More

  1. by   kk2000
    Quote from BabyRN2Be
    KK2000,

    From what you are describing, the teaching that's taking place in your school is not in step with current thinking or methods for that matter.

    Please don't leave nursing because of it. Once you graduate from school you'll learn the difference between the "ideal" and "real life." I have found that some programs are not in step with real life.

    I believe that nursing needs more people like you. People who will take the laments of a patient seriously and not be ready to judge. People exhibit pain in different ways, and not everything goes by the textbook.

    Wow, I remember when I went in for a T&A in '74. I was a kid and was not told that it would hurt. They had all these books out for kids "glamorizing" T&A's. That you'd be put out to sleep, but when you woke up you'd get all the ice cream you could ever want!! You'd spend a night or two in the hospital, you'd go home and return to your normal life! WRONG!! Wrong on the "all the ice cream you want" bit and returning to normal life. And they didn't mention the pain. This was at a time in which they didn't have the wong scales and they didn't even ask kids if they were in pain. I was not offered anything the whole stay. I remember laying in bed, thinking I was going to die. I was having very morbid thoughts for a 7yo.

    I'm thankful for kids today that this is changing. Some people may say that we are "babying" kids for giving pain meds, because this wasn't done previously. After having gone through what I did at 7, and remember thinking "Where did I want to be buried? What do I want on my grave marker? What will the cemetery look like?" and having thoughts and actually crying because I'd miss mom and dad so much... this at 7 for a T&A! I'm so glad that there are better methods out there now, and I do hope that they continue to address pain issues.

    Please don't quit nursing...
    Thank you for your reply.
    Your post reminded me of a good article I read on pain in infants and children and how science is finding out how much kids really do feel pain.(think circumsion!)
    i will try to post the link if anyone's interested.
    Sorry about your t&A trauma, must have been awful!
    K-
  2. by   sjb2005
    Quote from bethin
    I feel that if a physician ordered the med, it should be given when requested within the time constraints. If you feel that a pt. may have a "problem" then I think it should be discussed with the physician. Everyone's tolerance is different. We should be objective. Last time I checked no one can crawl into a pts. head and detemine their tolerance.

    I too have chronic pain(Crohn's) and a year ago admitted to the med/surg floor where I work. Of course I got stuck with the nurse who is known to not give pain meds easily. She would lecture me for 30 mins. when I would tell her that a pt. needed pain med. Anyway, while a pt. I requested my prescribed pain med. She went to go get it and when she came back she told me bluntly "I hope you're not going to be one of those patients where we never see them in pain or throwing up." Those were her exact words. I worked with her and she treats me like this? I can only imagine how she treats others.

    And another thing, I hate when we generalize pain based on the procedure. You know the "my last post op bowel obstruction wasn't on a PCA". I know I'm guilty of it and I'm sure there's others out there.
    Please tell me more about what types of symptoms you suffer from with Crohns. My friend suffered for years..frequent hospitalizations, TPN, fistulas....she ended up with an ileostomy and has basically been cured.
  3. by   hjmcenti
    It really hurts me to hear this! I would like to know what school you are going to!! I work on a med/surg unit and at least 5 out of my 6 patients receive a narcotic pain med at least once in a day. If someone is laughing that does not mean that they are not in pain, it simply means that they are finding ways to deal with it until relief comes. You will always get your "drug seekers", but for every 1 drug seeker you will have 10 that are in true pain. For the sake of your patients, PLEASE do not judge them. Everyone has their own way of dealing with pain. Put yourself in their shoes and think of how it must feel to have to ask for Morphine every 3 hours. Of course they're watching the clock, they are in PAIN!
  4. by   BlocDoc
    Like Diabetes, HTN, Throid disease, CAD, Hypercholesterolemia, etc, chronic pain is a disease- In terms of the treatment ramifications, there is no "fix" for the disease, therefore, varied treatments, to include medications, are used to manage the disease prgression, to minimize symptoms and optimize quality of life- If the B/p doesn't respond to the current medication dose, then we raise it and add other meds until the number falls into line- If the blood sugar is too high, we adjust dietary restrictions, increase the oral meds or increase the insulin dosage- In thyroid we go up to .5, .75, .88, 1.0 and in some case, above 1.5 ! Nobody gaives this a second thought - This is perfectly fine from a societal standpoint- You don't find 2 healthcare workers in the hall or 2 people on the street whispering "Do you believe the dose of Cardizem Mrs. Johnson is taking!? She looks fine to me!"

    The perception regarding the treatment od chronic pain isn't a patient perceptual problem. It is one of misguided societal mores.

    If you believe that a patient has pain, then it deserves the very same aggressive treatment consideration their blood pressure requires.
    We are in the business of caring for people- Lets keep our eye on the ball.
  5. by   khine2mn80
    Quote from kk2000
    Hi.
    First let me say that I don't want this to end up as a debate over real pain or drug seeking. What I am looking for is reasons why there is such a suspicion of pain patients.
    I am in nursing school, and am discouraged, disgusted and quite frankly angry at what I am seeing as the judgemental attitudes of some nurses. How dare a nurses try to decide who is in pain, or to what severity they are feeling pain.
    Mind you,I am a chronic pain patient myself. You would never know it most of the time because I live with it all the time. This is a personal issue with me and I just don't get it. Heres the clincher, we are actually being taught how to recognize a drug seeker, and guess what...i have all the red flags of a drug seeker. My kidney stone patient also exhibited all the red flags, too...should I deny him pain meds as I am seeing some nurses do? Not actually denying, just being so busy it takes 2-3 hours to get him the meds.
    So, could you tell me what constitutes a 'seeker" in some nurses minds/
    I am seriously considering leaving the profession because of this. I am seeing this across the board, from the ED to a med surg floor, to PACU, for goodness sakes!
    please help me understand this!
    Please understand I am NOT trying to start a heated debate, I am just very, very stunned at what I am seeing.
    K-
    hi

    i dont like the idea that it takes 2-3 hours to get pain meds to a patient who is in pain. Thats poor nursing care in my opinion. whoever is in pain should be assessed properly and yes pain is a subjective thing. always remember the theory of pain threshold. each ppl have different threshold so why should u cALL them seekers?
  6. by   kk2000
    Quote from khine2mn80
    hi

    i dont like the idea that it takes 2-3 hours to get pain meds to a patient who is in pain. Thats poor nursing care in my opinion. whoever is in pain should be assessed properly and yes pain is a subjective thing. always remember the theory of pain threshold. each ppl have different threshold so why should u cALL them seekers?
    Yes, yes, yes...I totally agree. I am the original poster. Just need to point out that I am a huge advocate for people in pain getting timely and effective meds.
    I am a pain patient myself and have been really disappointed, sickened, disgusted etc ec, with the way I have seen patiets being treated in the hospital I was doing clinicals at.(from med surg to the er)
    Actually I came very close to quitting school altogether.
    Thank you to all that replied-good to know there are nurse that give a darn l out there.
    I know what it is like to ask for pain meds and be given the runaround. I know what it is like to be at the ER in pain and be sent home being told the "pain was all in my head".(actual quote from the er doctor, only to have an MRI at my expense and find out had 3 herniated discs in addition to the 3 I already have).
    Why are students not being taught enough about pain management???
    Maybe it is just the hospital I was at, or the classes I was in, but I feel that the general lessons learned in school were to be wary of thoses c/o pain, no matter what the situation.
    I find it very discouraging.
  7. by   sharann
    Wow, I am impressed with you as a nursing student...you will be one dynamite nurse!
    Unless you are an addictions nurse in a specific facility where it is appropriate, I strongly feel that you(or me) should NOT be labeling ,judging, preventing or treating drug seeking. I work in PACU and I give meds out fairly freely. Most of the time my pts are in acute pain and its obvious. Sometimes though, after being medicated with enough drug to kill a Rhinocerous, some of my pts still claim 10/10(even though I can't in good conscience agree).It doen't matter what I think or believe though, it is about what they feel and believe. I refuse to undermediate ONE, just ONE patient because I have a power trip or are playing know it all nurse. I want to sleep at night. I would feel like cutting my arm off at the though of intentionally withholding meds because I was judging incorrectly.
    BabyRN2BE and BLOCDOC, I loved your replies, you are right on.
    Bethin, I too have Crohn's and have been lucky to have very few times I was in that much pain EXCEPT once. I went to ER 3 yrs ago with severe pains in my left chest area(mimicked angina). I was 34. The ER doc gave me a knowing look and the a cocktail of stuff to "settle" my "heartburn".
    He came back an hour later with his tail between his legs and said "You have acute Pancreatitis, that really hurts". No crap Einstein:angryfire
    Please remain a fierce pain advocate
  8. by   vamedic4
    Hi kk2000 et al,

    I guess they don't teach in some nursing schools that the patient is the authority on his own pain. That's rule #1, basic concepts of pain management. Rule #2? The patient has a right to expect a RAPID and EFFECTIVE response to a complaint of pain.

    Makes me wonder.
    I empathize completely with those of you who have pain issues. And we can only hope that thru education we can make others see that not everyone is a "drug seeker".

    If not...I'll get out my aluminum bat and take out a few doctors' femurs...then tell 'em that all they can have is Toradol...that should work just fine.

    Sounds like you're doing a fine job advocating for your patients - my hat's off to you and all like you kk2000 - I'm sure you'll make a wonderful nurse.

    This issue's a little personal for me, forgive me if I offended anyone.

    vamedic4
    Last edit by vamedic4 on Jul 8, '06
  9. by   CharlieRN
    Just to offer a little balance. Pain meds are addictive. It is perfectly possible to have real chonic pain and be addicted to pain medication. While by no means does everyone who is put on pain meds become addicted, many do. I work with addicts all the time. Addicts lie. So saying that the patient must be the sole judge of their pain sounds a bit simplistic to me.

    This is a major issue treatment issue which should be addressed by the treatment team, not left up to the individual judgement of nurses. It is possible, even likely, for nurses to become cynical, particularly in high stress situations. Patients sometimes inadvertently trigger that cynisism. I recall once when I worked in the er, we had a woman who came in with a c/o vague but intense abdominal pain, but with a affect that seemed too controled and calm. She kept asking for, "something for pain". The ER staff, from the Doc on down, interperted this as learned "hospital jargon" and evidence of drug seeking. They treated her appropriately, drawing lab work etc. but with no sense of urgency and no pain meds. Until, that is, her her CBC came back low! Turned out she had a preforated gastric ulcer. She had a hole in her stomach the size of a quarter.
  10. by   CaseManager1947
    I agree with others postings here, yes pain is what the patient says it is... but lots of people don't believe you!!! I too am a chronic pain sufferer. and am just beginning (after 6.5 years) to take control of my own needs. I have a PCP who can't or won't develop a treatment plan with me, This is largely why the JACHO created pain as the 7th vital sign, because we (I include myself in that group) collectlvely were ignoring it. Patients are entitled to pain relief, and should seek appropriate avenues (referrals to PT, pain specialists, whatever it takes to help themselves). I say this only because I've been sitting back, still hurting and not getting any real treatment or treatment plan. So stick to your guns ladies and gentleman.

    Morghan
  11. by   lmessajumper
    Unfortunately I find that most nurses are not managing their patient's pain appropriately. Recent comments I have heard during report:
    1. She hurt all night but I only had Tylenol ordered. It didn't do any good. (Please note that RN did not call MD to report pt's unrelieved pain)
    2. He kept call for pain meds every hour. I kept telling him he could only get it every 4 hours. (Also did not call MD)
    3. She didn't sleep at all last night. I was giving the maximum dose but I was worried about her getting too sleepy.
    4. He kept rating his pain from 8 to 10, but he tested positive for marijuana in the ER so I figure he is just drug-seeking so I didn't call the doctor.

    This is the majority of attitudes I am finding all over the country.

    Please remember:
    PAIN IS THE 5TH VITAL SIGN!

    YOUR PATIENT'S PAIN IS WHAT THEY SAY IT IS.

    JUST BECAUSE YOUR PT IS SLEEPING DOESN'T MEAN THEY AREN'T IN PAIN

    I respond to these nurses in different ways according to the situation. I try to be casual and non-critical. I try to approach it with a sense of humor and irreverence.

    I joking remind them that we do not work on an alcohol or drug dependency unit so my priority is not getting this guy off drugs, let the rehab nurses worry about that. Besides, you won't have to worry too much about oversedating him, he probably has a high tolerance. Also, just because you are an addict, doesn't mean that you aren't in pain. Some pt's are addicts because "we" made them so! Poor woman has terrible chronic back pain and the meds we have to offer are usually pathetically uneffective and just for good measure, she has become dependent on them and she can't get anymore because she is dependent and her back pain is worse.

    When I get report about a "drug seeker" that has been calling "every four hours because he knows it is time to get another pill", or "I'll look in and he is sleeping but 10 minutes later he is calling for pain meds", I realize that this patient will probably be distrustful, angry, anxious, tired and/or hopeless and I will need to address these issues head on. If it is ordered, I usually walk into the room with the pain med saying that I know they have been hurting all night but I will not stop until we get this under control. I will be in here with your meds as soon as they can be given again. If your pain is not gone in an hour, call me and I will call the doctor and let her know. I do not want you to be in pain today, it slows healing, increases you blood pressure and keeps you from participating in your recovery. Don't worry, I will take care of this. I then review the pain scale and get a description of their pain: Where? What does it feel like, stabbing, aching, burning, etc? Does the medicine help? How soon has it been coming back? If they are still in pain when I reassess in 30-60 minutes (depending on the med), and I have no other meds or comfort measures to try, I will always call the doctor to let them know. Please be your patient's advocate when you speak to the doctor. Many doctors are not comfortable treating pain or are too cautious. If what they order doesn't work, call them back again! You are all that patient has to count on.

    When appropriate as far as the patient's comfort and consciousness level, I will then try to get as much info as possible about their pain. Does it come and go or is it all the time? Does anything you do make it worse or better? What do you do at home for pain? Are you having problems with constipation? How is it affecting your lifestyle, work, family, friends? I review deep breathing and relaxation exercises and I try reassure them that I am on their side and that I want them to call me for anything. They may test me by calling frequently or being quick to accuse or distrusting my assurances. I just keep them informed of what I am doing on their behalf and treat them respectfully and try not to be judgemental about anyone's history or lifestyle.

    It may sound simplistic, but I always think "what if this was my husband or Mom or sister"? How would I want them to be treated? If we all approach every patient with this thought, we can all go to bed every night knowing that someone's life was better that day because of us.
  12. by   vamedic4
    QUOTE: "Just to offer a little balance. Pain meds are addictive. It is perfectly possible to have real chonic pain and be addicted to pain medication. While by no means does everyone who is put on pain meds become addicted, many do. I work with addicts all the time. Addicts lie. So saying that the patient must be the sole judge of their pain sounds a bit simplistic to me."


    Okay waiittt a minute...this is not balance. First off, while we know that pain meds are addicting, anyone must realize that narcotics require a therapeutic level to be reached in the bloodstream in order for them to work effectively. Once that level is reached and maintained (whether short or long term) pain control is achieved.

    Hence, people who take narcotics (like they should) are not "addicted" to pain medication, they are "therapeutic" on their meds. And if they don't take it, they suffer withdrawal symptoms.

    Now sure, there ARE addicts out there. But are we to mistreat those who are actually in pain because we believe they're "drug seeking"??
    Like I tell the nurses I work with...most are just seeking RELIEF FROM THEIR PAIN, however that's achieved. If all it took was to eat Cheerios, spin around three times and sit in a north facing corner for an hour - then that's what people would do. Unfortunately...that doesn't work for everybody. And we owe it to people to adequately assess and manage their pain.

    vamedic4
    wanting a nap
  13. by   WillowBrook
    I must admit reading through some of the threads regarding drug seekers and legitimate vs non legitimate pain I am getting a much better understanding (and perhaps some empathy) for how I have been treated upon being admitted to the ED suffering from pain related complaints. I am truly sorry that Doctors and Nurses in the course of doing there job have to be exposed to people who manipulate and fraud the system. I am a former Heroin addict and not once did I ever try and scam a Doctor for drugs, mainly because it was a hell of a lot easier for me to just pick up a phone and call a dealer than it was to spend hours in th ED with some fictitious complaint and not be guaranteed I would even be given anything.

    The above being said I would also like to point out that even former heroin addicts do sometimes hurt themselves enough to warrant needing Opiod medications and that is not someone "drug seeking". Case in point: last year I fell through a roof (long story), landed on my backside and fell back cracking my head. I got up and walked around in a daze for a moment before I started experiencing cramping sensations in my back which quickly moved into full blown spasms of the back muscles. At this stage I could still move, albeit in a lot of pain, and I went upstairs to call an ambulance and then came downstairs to wait for them. By the time they arrived I could hardly move and it hurt to even breathe or talk. I got to the ER, was admitted immediately and assessed, by this point I couldn't move my legs at all and was experiencing extreme almost continual spasms. I was ordered to be X-rayed and the Doctor requested that I be given Fentanyl before I was moved. An orderly shows up, moves my down to X-ray and as a Nurse is preparing to move me onto the X-ray table I remember that I am yet to receive Fentanyl and I distinctly remember the Doctor saying I was not to be moved without it. I reported this to the Nurse who ordered me to be taken by to the ED. Upon arriving back the nurse who took over my care could only be described as a bully. I was given Fentanyl and in preparation for the X-ray I also had to have a pregnancy test. She put a bedpan under me, none too carefully I might add, and when I failed to urinate on command loudly announced that if I couldn't do it she would catheterize me and then I would really have something to be in pain about (like falling 8-10 metres through a roof isn't enough). Then she started prodding and poking my legs and giving me the third degree, why couldn't I move my legs, I was moving when I called the ambulance so why couldn't I move properly now, I managed to get downstairs to wait for the ambulance so why did I have this sudden onset of such great pain, all of this repeated over and over again in a very sarcastic "I know you're a liar and I'm gonna make sure you know I know" tone of voice. I didn't know why I could move around 5 minutes after the accident but then suddenly "locked up" the way I did, I suggested that perhaps it was because of the adrenalin or shock of the initial accident; to this she just made an exasperated noise of disgust. Later it was determined by the attending physician that my back muscles had indeed gone into an extended (and very painful) spasm which rendered me effectively unable to move in order to protect my spine from any injury and also that I was suffering from "bruising" due to jarring of the spine. Now the thing is, yes I have a track mark scar on my arm, yes I asked for Fentanyl because that is what I heard I needed to be given before I was moved, yes I have a prior recorded history of Heroin addiction, but I had fallen through a roof and injured myself so regardless of my past behaviours I did not deserve to be treated that way. Let me tell you if I had been trying to get Narcotics, I could have just headed down to the local corner picked up a guy willing to pay for services, hopped on over to the local Methadone clinic and waited for any number of people that I know got connected up with a dealer and scored, all within the space of less than 2 hours. I certainly did not need to fall through a roof and spend a night in pain in the ER
    Last edit by WillowBrook on Aug 27, '06

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