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

Nurses General Nursing

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Ok let me make this short and straight to the point...

I am currently in nursing school for my BSN, and at the same time I have sickle cell disease. Basically I've been the patient plenty of times and now I will soon play the roll of a nurse (a good one at that). I am really tired of Nurses and especially Docs who think pts. with my disease are drug addicts and only want a high. We go thru serious and I mean SERIOUS pain. It is nothing to joke around with because I know exactly how it feels. I've experienced ignornant docs that try and make it seem like I am lying. This is a situation that ****** me off. I didn't ask to be born with sickle cell but i'm dealing with it just like everyone else in the world that has something they didn't ask for. Instead of nurses and docs to be on the pts. side to make things run smoother, they want to be judgemental. I really wish there was a mechine that had all of the diseases in the world which you can go into and live a life of someone else suffing for one disease or another just for a day, and maybe nurses and docs will change their nasty attitudes towards pts. in pain.

I want to thank all the nurses that have been there for me in the hospital because not everyone is like that. There were really sweet nurses who were caring and understood my situation. Again thanks too all those nurses who truely care for people.

Now I am not trying to start a riot, I just want to get peoples comments, ideas, respones, opinions etc. on either how they know a pt. is telling the truth about pain or what they think in general. Thanks in advance for all the responses:nurse:

Specializes in Trauma ICU, Peds ICU.

Two patient populations whose pain you should never question: sickle cell and renal calculi.

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Specializes in ER, TRAUMA, MED-SURG.

Good thread, OP. I have been a nurse for 19 years, and most of that I have worked ER or med surg. I have wondered the same thing at times during my nursing career. The sickle cell patients, especially the younger ones just really stick in my mind. It has to be just a horrible disease, and I would not wish it on anyone. I have taken care of some SSC pts that have asked me to give their Demerol 100mg "as fast as you can", and asked me not to dilute it. I have had a few that crimp their IV tubing under the sheet when I came in to give the IVP.

I had an instructor tell us that if a patient tells you that he/she is in pain, then they are in pain and we are to give what is ordered. I have also had patients that come into the hospital saying they are in intense pain, and bring an alarm clock. If their prn med is every 4 houre, then they set it to go off maybe 10 minutes before the dose is die "so you won't forget to bring it as soon as it is time."

Like I said, I am a nurse, but I am also an addict. August this summer marked my 10 year anniversary of being in recovery. I can also tell you that as an addict coming to the hospital I have said some really stupid things to get pain meds. I can still remember hearing nurses standing outside my room making fun of me and calling me a drug seeker. And some of the time I was definetly "just a drug seeker".

I try at work to give all my patients "the benefit of the doubt" when they ask for pain meds. I look at vs - BP, P that may increase when they are hurting. I know that some patients just don't like to admit they are in pain, until they are in so much pain it takes forever to get relief. Some people have a lot of trouble believing the patient that is an addict when they come in and are legit with their pain complaints.

A lot of the seekers ER doctor hop - we have 4 large hospitals in our city, and some of them will visit all 4 of the ERs in 1 week. Some patients will list as their allergies Toradol and ANSAIDS, and say that "the only thing that works is Dilaudid or Demerol."

Anne, RNC

Like some of the other posters here, I also have 2 chronic and debilitating diseases and a lot of pain at times. I am very lucky to have a PCP that listens to me and treats me with the meds she thinks will help the pain that I am experiencing when seen. I did see one in the past that was also an addict and NEVER gave anything other than Tylenol, no matter the complaint or diagnosis.

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Specializes in Cardiology, Oncology, Medsurge.

I believe that pain is subjective to the patient experiencing it. For instance, some may not cry out or grimace when in pain. Other's may be on the phone with loved ones when in pain.

I will give pain meds regardless of my spinning brain telling me it's wrong.

The med was prescribed for a reason.

The only three things that would prevent me from giving a pain med would be either a low blood pressure, an unresponsive patient, or a Pt's difficulty breathing, otherwise I just give it!

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Specializes in Med-Surg.

Correct me if I'm wrong, but sickle cell disease is not a disease of chronic pain, but becomes acutely, extremely, and excruciatingly painful when in sickle cell crisis, usually due to dehydration. Am I right? AND, the disease primarily affects African-Americans who have inherited it.

Now that that's out of the way... How do we know how much pain a patient is in? A patient's pain level is whatever they say it is. This is sickle cell crisis. It's not back pain, or whatever pain. This is blood clotting up throughout the body. What is there to talk about? I don't get it. Hydrate and administer pain meds. What am I missing?

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Specializes in Nurse Scientist-Research.
What am I missing?

I think mostly you are not missing anything about sickle cell disease. I believe some nurses unfairly group sickle cell patients with others who seek drugs, because they do demand a lot of meds. Are there some sickle cell patients that take the meds when they are not hurting? Not for me to judge, if they say they are hurting, I medicate.

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Specializes in diabetes.

In my experience it doesn't matter. Patient says they have pain- it is exactly what they say it is. They get the med.

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Specializes in OB/GYN, Med/Surg, Family Practice.

I agree with Katherined. I remember, very clearly, being taught that pain is SUBJECTIVE. It is what a person says it is, for them, which is why we have multiple pain scales. Yes, there are objective s/s to measure, chart and follow BUT it is still subjective. As registered nurses, we have no right to deny pain medication if it is safe to administer following all of our medication and assessment rules. If I was suspicious (and I have been plenty of times) I would discuss my concerns with my charge nurse and the patient's physician. Maybe pain management consults are in order, and they have been ordered after voicing my concern. The point is, it is never our place to decide a person's pain report is false for whatever reason. That's neglectful patient care.

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Specializes in Med/Surg, ID, Oncology, Ortho.

We can't feel another person's pain...period. Particularly in the case of chronic pain, we can't count on physiologic s/s (ie. high B/P) because the patient has acclimated to the pain over a long period of time.

If the pain med is ordered, I give it. I am no one's judge nor jury.

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Specializes in Med/Surg, ID, Oncology, Ortho.
Good thread, OP. I have been a nurse for 19 years, and most of that I have worked ER or med surg. I have wondered the same thing at times during my nursing career. The sickle cell patients, especially the younger ones just really stick in my mind. It has to be just a horrible disease, and I would not wish it on anyone. I have taken care of some SSC pts that have asked me to give their Demerol 100mg "as fast as you can", and asked me not to dilute it. I have had a few that crimp their IV tubing under the sheet when I came in to give the IVP.

I had an instructor tell us that if a patient tells you that he/she is in pain, then they are in pain and we are to give what is ordered. I have also had patients that come into the hospital saying they are in intense pain, and bring an alarm clock. If their prn med is every 4 houre, then they set it to go off maybe 10 minutes before the dose is die "so you won't forget to bring it as soon as it is time."

Like I said, I am a nurse, but I am also an addict. August this summer marked my 10 year anniversary of being in recovery. I can also tell you that as an addict coming to the hospital I have said some really stupid things to get pain meds. I can still remember hearing nurses standing outside my room making fun of me and calling me a drug seeker. And some of the time I was definetly "just a drug seeker".

I try at work to give all my patients "the benefit of the doubt" when they ask for pain meds. I look at vs - BP, P that may increase when they are hurting. I know that some patients just don't like to admit they are in pain, until they are in so much pain it takes forever to get relief. Some people have a lot of trouble believing the patient that is an addict when they come in and are legit with their pain complaints.

A lot of the seekers ER doctor hop - we have 4 large hospitals in our city, and some of them will visit all 4 of the ERs in 1 week. Some patients will list as their allergies Toradol and ANSAIDS, and say that "the only thing that works is Dilaudid or Demerol."

Anne, RNC

Like some of the other posters here, I also have 2 chronic and debilitating diseases and a lot of pain at times. I am very lucky to have a PCP that listens to me and treats me with the meds she thinks will help the pain that I am experiencing when seen. I did see one in the past that was also an addict and NEVER gave anything other than Tylenol, no matter the complaint or diagnosis.

Anne, I just want to say thank you for your post ~ you are very brave for sharing your personal experience with us. Hugs to you!!

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There are advantages working in a Surgical ICU.

The pain is real; no faking around here. Whatever a patient's past history with drugs, an open femur fracture hurts, pelvic fractures hurt, major abdominal surgeries etc. I freely give the narcotics.

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I was always told that you can not tell because pain is subjective. I can tell you though that if we know that the patient has issues with pain control and nothing works, we would call pain management to come up with a better plan.

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Specializes in RN, BSN, CHDN.

Pain is such a hot potato isn't it, I guess because you cant really see it! I have nursed for a long time and it has always been a subject greatly debated.

For me I truly believe that pain is what the patient says it is, most of the time they are truly honest it is the odd occasion when you come accross a pt who is indeed 'drug seeking'.

I would rather believe a patient is in pain when they say they are that asume all pts are not telling the truth.

Chronic pain sufferers dont always need the pain meds when they are due but from their experience it is better to keep the pain away than try to get rid of the pain when it gets there.

I have never thought of myself as a judge and jury of pts pain that way I am able to treat without any preconsieved ideas If they say they hurt and they are due medications I treat.

I spend time educating all pts on the available pain medications what kind treats what, what lasts the longest and help the pt make an informed choice.

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