Are we scaring our pain patients and doing more harm ?

[Gapeache]

Hi all you wonderful nurses !! I am new and just had to rant about my horrible shift last night ! I'm really aggravated by the fact we can't make our patients comfortable or their afraid !!! I have sympathy for all my patients and some I don't know if pain is real and some it's kind of noticeable ! I had a sweet lady around 44 come in complaining a little but was afraid to speak up much about receiving PAin meds when I asked what she was allergic to & tolerate etc . because she didn't want labeled as a drug seeker !! . This poor womans records revealed she has lupus , endo, hernia , some discs herniated and possible lymphoma !!! She was hurting really bad but said her pain was 7 . ( I felt she was worse ) temp. 101.6, She only wanted X-rays because she felt something wasn't right in her left flank area but she couldn't hold still long enough to get a CT . She was allergic to dilaudid , all NSAIDs , all hydrocodone ,oxycodone , basically everything strong , so in her records I discovered ultram & morphine was what her dr had her on . 15mg 3xs daily . Anyways , to make a long story short I finally convinced her it's ok to ask for pain meds and after that I got more out of her on her on what Was hurting her . She has GI bleeding from use of nasaids , and the other narcotics I think she's afraid how they made her feel plus she stated they made her itch , so morphine was all we could give her . After , further evaluation and tests the lady had 3 kidney stones ! She's a chronic pain patient and takes one pain medicine which to me she's undertreated ! Are we hurting our chronic pain pAtients by allowing the DEA to tell us what we can do ? Isn't this along with the media getting out of hand ? I feel we have a heroin & illicit drug problem but it's definitely impacting real pain patients . What's going to happen if this doesn't stop ? What if she has cancer and fears he medical community will label her ? I felt she was scared to be comfortable , talk , or ask for help . It was so sad ! I'm not used to the ER doing this and now some activists are wanting us to stop most all narcotics and resort to other drugs that seem to do more harm . I'm sorry but I find this is inhumane and I'd hate to be in a position like hers . I think we should treat their pain and reassure them they can ask . Look at the thousands their paying and it affects all of us to some degree . Maybe , I'm just having to learn that medicine is changing but I honestly feel it's harming the good . What do some of you think ? Sorry this is long , You should see me on break lol!

[Castiela]

I usually do a pain management teaching with my patients and explain that I want to keep their pain under a four because it takes less drugs to keep them under that level than trying to play catch up. I also reassure them that their reasons for needing pain medications are legit. I err on the side of trusting patients on their pain reporting when I first meet them - even if I'm uncertain about their behaviour, if the order is there, I will give it and bring my concerns to the doc after.

I feel that pain management and narcotics use is a pendulum, and we have definitely swung to the far side. However, most docs I've worked with still recognize patients with legit chronic pain and treat it as such.

I do know of patients with chronic pain issues who are afraid f being labelled "drug seeking" but it's our job to advocate for them and proper pain control

[MrNurse(x2), ADN]

She may also balance her pain meds with her need to be engaged in life. There is just as many issues with prescription drugs, the numbers are staggering. By the statistics, one car in six has an impaired driver. Wrap your head around that. Many chronic pain patients, myself included, choose to endure the pain rather than feel the way the meds make us feel and endanger others. I would rather be able to drive than be impaired.

[Gapeache]

Thanks for excellent advice . I'm just learning so much ! I also didn't cover much on lupus in nursing . I know it's painful ! It gets confusing ! Also , one month to the next it seems rules change !I do appreciate you that are way more experienced on this giving me advice & im always needing it ! Im new to being an RN but prior to that I worked in lab for many years . Then on my days off I help run our poultry & cattle company with my other farm critters I adopt lol yes I was made fun of a lot and everyone still gives me a hard time but I find it relaxing because my animals can't cuss me out ! I will add this in my bio , this probably wasn't the appropriate place to add this statement .

[morte, LPN, LVN]

She may also balance her pain meds with her need to be engaged in life. There is just as many issues with prescription drugs, the numbers are staggering. By the statistics, one car in six has an impaired driver. Wrap your head around that. Many chronic pain patients, myself included, choose to endure the pain rather than feel the way the meds make us feel and endanger others. I would rather be able to drive than be impaired.[/quote

If you are in significant pain, you are likely not a safe driver...

[nursej22, MSN, RN]

Yes, course we need to improve pain management, but I think we really need to look beyond narcotics, such as Lyrica, Tegretol, and amytriptiline. If the DEA would pull its head out and allow research and use of marijuana I think that would help a lot. And I think we discount massage and yoga.

Of course, drug companies aren't going to get rich. This is one of the problems with for profit health care.

[martymoose, BSN, RN]

Are we hurting our chronic pain pAtients by allowing the DEA to tell us what we can do ?

absolutely. Another reason I want out of hospital nursing.

Had a resident tell my long term, being treated by a pain mgmt doc, on 3000 mg gabapentin daily, patient, that nerve pain is all in her head. I was fuming.