Addicts!!! NURSES How do you seperate addicts from pts. who really are in pain?!

caliotter3 · Jan 22, 2010

You should be working with an expert in pain management. Check with your primary physician and get a referral. We can't give any further specific medical advice. But I don't see why you aren't already with a pain management specialist. Good luck with this.

tri-rn · Jan 22, 2010

I worked as a Nurse Tech (aka, glorified CNA) while in school on a Hem/Onc unit. We almost always had one or two patients with SCD on the floor. One night one young woman who was well known from repeated stays came in in crisis, sobbing in pain. Her fingers were dead white from lack of blood flow (she was African - American). This young woman, like you, was dealing with her disease the only way she could, struggling to stay in school and stay strong. Her RN spent the whole shift on the phone with the MD (as well as a few other people) trying to find someone who would write for some pain meds for this young woman, no one would. It was one of the saddest things I've experienced. the MD was, to put it bluntly, a bigoted jerk.

I don't work on that floor anymore, but when I think of patient advocacy, I still try to model that RN.

trixie333, ASN · Jan 22, 2010

GREAT question; I want to hear from other nurses too. I work mainly ER, a little med-surg. I usually believe the pt. or give the benefit of the doubt at the very least. But you got me thinking about what I call my 'red flags' and how to actually describe and list them in a professional way.

chelynn · Jan 22, 2010

I look for pysiologic signs such as higher bp and pulse. We also look into the pts old charts and visits. We see if they are under the care of a pcp and if they go their follow ups. Also when you see many FFs you get a sense of the real pts in need.

S.Gettes · Jan 22, 2010

I tend to try to believe the patients when they claim that they are in pain but there are some things that they may do which will set off alarm bells ringing in my head. I have noticed a few people who will be in once every month, when i was working at another nearby hospital to help them out as they were severely understaffed i noticed the same people coming in to the hospital every month as well, eventually i discovered that they do the rounds claiming to be in intense amounts of pain. Behaviour such as appearing aggitated, easily irritated, paranoid, scratching at or picking the skin in a compulsive manner to the point that they bleed as though they are trying to get at something that is under their skin, impatience, inconsistent stories about the pain and it's location and cause, unwillingness to provide personal details, these things are what cause me to think that i may not be treating someone for their pain but may instead be treating them for their addiction. I never stereotype someone that comes in in pain, i assume everyone truly is in pain, until they lead me to believe otherwise.

sssrn · Jan 22, 2010

My philosophy is that I'm a nurse and not a drug rehab counselor. If the patient claims to be in pain then I give pain medicine. That being said I also work at a hospital in an area that leads the nation in heroin addicts. If the quantity of pain medicine is reasonable then I don't question it. If the patient is receiving very high doses of pain medicine then I have to take into account that if that person is an addict then he/she needs a certain amount of narcotics to reach baseline then you start treating the patients' pain. We gave one alcoholic 800 mg i.v. ativan (yes, 800mg, not a typo) in a 24-hour period to get him over the DT's. The amount given comes with experience and not becoming the jaded, cynical nurse.

GilaRRT · Jan 22, 2010

We also need to consider the fact that many people addicted to pain medications are in fact in pain. It can be a viscous cycle. This is especially true with chronic pain. Unfortunately, we continue to teach that giving pain medicine if you are in pain is not a problem. Not the case at all. If you continue to have pain, you continue to take pain medication, you build up tolerance, you require more pain medication, and eventually addition develops. However, do we not manage pain? It's a tough thing to consider.

Pain management is complex and I am not sure really good strategies for management exist. A strong psychological component can also present with pain further complicating the picture. I am really not sure how we can best manage pain. This is why physicians have entire fellowships devoted to pain management, it is a tough subject.

chasemelony · Jan 22, 2010

I tend to try to believe the patients when they claim that they are in pain but there are some things that they may do which will set off alarm bells ringing in my head. I have noticed a few people who will be in once every month, when i was working at another nearby hospital to help them out as they were severely understaffed i noticed the same people coming in to the hospital every month as well, eventually i discovered that they do the rounds claiming to be in intense amounts of pain. Behaviour such as appearing aggitated, easily irritated, paranoid, scratching at or picking the skin in a compulsive manner to the point that they bleed as though they are trying to get at something that is under their skin, impatience, inconsistent stories about the pain and it's location and cause, unwillingness to provide personal details, these things are what cause me to think that i may not be treating someone for their pain but may instead be treating them for their addiction. I never stereotype someone that comes in in pain, i assume everyone truly is in pain, until they lead me to believe otherwise.

And I truly respect that. I've heard that a pt. died from a sickle cell attack because the nurses and docs just thought she was lying so they left her there. Nurses and Docs need to assess pts. the right way so that pts. won't end up dead because they automatically think the pt. is lying.

TiffyRN, BSN, PhD · Jan 22, 2010

I no longer work with adult patients but I did for years. I cared for some sickle cell disease patients and I wouldn't wish for their life for anything. They were very chronically ill and in pain.

I know I formed my own opinions about some patients and their heavy use of narcotics. I kept them to myself and gave them the prescribed medication. I even called the MD to ask for pain medicine if the patient stated they were not getting relief. Sometimes before I did that I would review with the patient that the MD had made it clear earlier that no further pain meds would be written. I wouldn't fudge their pain med times if they were demanding them around the clock.

I guess my take home message was that some nurses felt it was somehow their moral obligation to not give or sparingly use pain meds for patients they felt were abusers. My opinion was; "not my place". I wasn't a psych nurse and no one I treated was there for addiction issues so if pain meds were ordered, I gave them.

Now I get to take care of their babies. Watching a baby in withdrawal; not pretty. But that's a whole other topic. . .

cherrybreeze, ADN, RN · Jan 22, 2010

I look for pysiologic signs such as higher bp and pulse. We also look into the pts old charts and visits. We see if they are under the care of a pcp and if they go their follow ups. Also when you see many FFs you get a sense of the real pts in need.

The problem with physiologic signs is that patients with chronic pain, even if they are in pain that is more severe than their norm, will very possibly not demonstrate them. They will have normal blood pressures and pulses despite being in unbearable pain. The body has adapted to being in that condition.

OP, I understand how you feel...I suffer from two chronically painful conditions. I am in pain management because of them. I come across physicians that do not believe my reports of pain, do not agree with my being on the medications I'm on, etc etc. The body truly does build up a tolerance. It's a constant battle just to get people to BELIEVE you. I avoid the ER like the plague (and I'm not saying for chronic things; for example~a few months back I had SEVERE abdominal pain, I thought it was my gallbladder...turned out to be apparently a mild pancreatitis, elevated WBC's and amylase but gb u/s was WNL...not sure the cause, but...I waited to see my regular doc rather than deal with the ER and their judgemental attitudes). I had surgery with a specialist for one of my conditions (she was supposed to be the best, and had techniques that regular GYN's don't have). Her attitude toward my pain was atrocious, and it's something she DEALS with! "None of my patients are on those kinds of meds." Really, none?? Perhaps they would benefit from it? Perhaps they are not dealing with other conditions on top of that one? My post-op pain control was pitiful. I went home 2 hours after getting out of the recovery room, since they weren't doing anything to make me comfortable, I would have rather slept on my own couch! It was a two hour ride home (she practices in a larger city) but I was willing to endure it just to be out of there.

Anyway, back to the question....the lucky thing is, it's not our jobs to have to determine who truly is in pain, and who isn't. We treat the patient's reports of pain. I know there are patients out there that pull your leg, and lie, to get meds. Dealing with that is worth it if you actually can and do make a difference to that patient who really IS in pain. I'll put up with the crap in order to be the advocate for the ones that need me.

GilaRRT · Jan 22, 2010

Yeah, chronic pain sucks. I am terrified of taking any narcotic because of the addiction potential. So, far conservative measures and ibuprofen are helpful. It's hard because these people do not often physiologically look like a person in pain.