caring for chronic pain pts

[abbysmom]

I'm a 6 mo. new nurse and look to the experienced ones to help with this. I work on a post-surgical gyn/onc floor and feel comfortable now dealing with my pt population. However, we get people from all services who have some coincidental issues. I am a night nurse, and have just come home from taking care of a lady with several yrs of GI issues. She is 42 yrs old, ulcerative colitis, many surgeries to do bowel work. Just now she had a benign ovarian mass removed as well as an ileostomy redirection--she seems to have had a few different stomas in different places depending on the problem at hand. She also has arthritis, occular problems, depression, carpal tunnel, a knee arthroscopy, etc. Every system seems to have some issue. My problem is that I could never get her comfortable--either nausea, pain, both, or a cough that she thought needed a CXR for, or an IV that she thought needed replacing. Her bed needed changing, her ostomy wasn't putting out enough, then it was too much, then her Foley burned. After taking out the foley, she couldn't pee so back it went. I spent more time with her than all of my other 6 pts combined. I really started to doubt her complaints and her motivation, and my judgment of her complaints was compromised. I thought she may have Munchhausen's (sp?) because everything needed a new intervention for her. Now that I am home, and she has stopped ringing her call light, I worry that my judgment was clouded. I'm not used to taking care of pts with such chronic illnesses who have different needs than your typical post-surgical ones. Did I ignore valid concerns? How do others handle such frustrations? I kept the docs aware of her complaints, but they too could find nothing to substantiate or explain them, so I was not alone in being befuddled and irritated by her needs. Help!

[EmmaG, RN]

Does your hospital have a pain service? Sounds like this woman could benefit from a consult with them...

[RN1989]

You will find patients like this periodically. Do your best and be satisfied with what you have done.

There are many people in pain every day. Healthcare has given the idea to the public that you should NEVER have ANY pain. Now everyone expects a magic pill to fix everything. I do believe in pain control but there are going to be times when nothing short of being in a coma is going to relieve pain. Example: you can give a new CABG pt all the meds you want and it is still going to hurt when they do their IS and TCDB.

Patients with chronic pain deserve to have an attempt at pain control. I say attempt because sometimes even the pain docs are unable to get pain relief for their pts unless they were to overdose them and kill them. The key is pain CONTROL not just pain RELIEF. And there are a lot of psych issues that go along with this, not just pushing meds at the patients. How a person thinks about pain, and whether they have an overall negative or positive attitude, directly affects their pain perception.

Pts in chronic pain sometimes learn to be professional pts. They can spot the caregiver that is easily guilted/manipulated. Often you won't even realize that they are manipulating you because you are so busy trying to fix their numerous complaints - like the conscientous nurse that you should be. After you get more experience under your belt, you will likely have a different demeanor that will help keep you from spending the entire shift in the room of pts like this. Boundary setting can be difficult, especially when you truly believe that the pt is in as much pain as they report. But you still have other pts to attend too and they need to know that. Watch some experienced nurses to see how they handle these types of pts.

BTW - doctors have no idea how to deal with these situations. Unless you have a specific complaint that they can write an order for a pill, test, or treatment - you are on your own. They spend 5 minutes or less with the pt. Most docs have no idea what nurses do other than "follow doctor orders" so docs are little help in this area.

Keep working on your great nursing skills. You are on the right track. As you gain more experience you will find these situations easier to deal with and have less self-doubt about whether you did the right thing or not. And remember: DOCUMENT!!!!

[mianders, RN]

In your post you went into great depth about the multiple surgeries, ulcerative colitis, arthritis, ect.., so I would think the patient has valid issues. I work in an area where the patients have mutiple chronic problems and some are needier than others. Don't let the fact that this particular patient is needy distract you from the fact that she is ill. It can be frustrating when your busy but you will go home feeling a lot better if you show her compassion rather than irritation.

[patwil73]

Chronic pain patients can be very difficult for any nurse to care for. They can either be in such constant pain that they want anything tried to help them (because they have not gotten the relief they feel they need) or they can be trying to compensate for having such little control over their lives (the pain) that they are trying to exert control in other ways, or they can enjoy the attention they have always received when complaining of pain and are trying to manipulate that response again.

Most often you will never know the reasoning behind what they do, since they most likely don't know either. All you can do is try your best, but when their care impacts your ability to care for your other patients then you have to set limits for them. This can be very hard as they will likely demand more and more explanation - remember they are in chronic pain and have been failed to control it, so your limit setting is going to seem like a failure again.

Assess thoroughly and depend on your nursing judgement and the experience of your colleagues. If the patient seems fine despite the complaints, most times they are. (of course it brings to mind the patient with minor hand pain radiating up the wrist to the forearm - sent to a rapid care for checkup turned out he was having a major MI. You can't always tell, just do your best)

Hope this helps

Pat