Just came here to blow some steam off. I just put in a three day stretch with a chronic pain patient assigned to me that was a royal pain in the behind to take care of. This patient was on our floor for a ORIF of her knee. She also had a hx of fibermyalgia and was on all kinds of pain meds and narcs and junk to keep her zoned out most of the time. I tried my best for the three days I had her as my patient to take very good care of her and meet her needs, but for the most time she was very rude and nasty to me. It did not matter what I did, I could never do enough nor could I do it right.
Here is the question I would like to put out there: Why do these docs keep ordering all of these highly addictive substances for these folks? I know that when I go see my doc he is very conservative about pain killers and does not want folks to become addicted to them. He will give you something for pain, but he won't keep ordering it over and over again for you. He also looks for alternative medicines to give to you that will do the same thing but are not addictive.
Another question to throw out there: Why are most chronic pain patients "nasty" to deal with? They always have "attitudes" with the nursing staff. Most are downright rude to everyone who takes care of them. Many do not know the words "thank you" and are very demanding and critical of your care to them.
Sorry if I sound like I am not compassionate. I really am. I just came here because this is a safe place to sound off about these issues. If anyone out there has some answers, please, please post them.
I just want to understand better why these people act the way they do. Thanks.
I do feel there is distinct difference between them and that's where I have my problem although I don't let it show and I never slow down my pace to get that patient their meds but inside it makes me angry.
The patient who asks for their pain meds as though they are in severe agony, just about lose it they're in so much pain, you get their pain med and 1 minute later you see them heading out to smoke, talking on their cell phone, laughing, joking with the nurses on their way out. No one can tell me that these people are not simply looking for a high.
I give them their meds with the same speed, courtesy and professionalism as my other patients but I just want to scream. The only reason I treat them the same is because they have a legal doctors order for their pain meds.
You might think that you don't let your feelings show, but some patients are sensitive enough to notice, especially someone like me, who knows the issues fom both sides of the fence.
Something to think about interms of the laughing, talking on the phone or heading out for a smoke, is that these are all mechanisms that we use to distract ourselves from the pain. When I am in pain, I smoke much more than normal. The deep breathing involved seems to be a factor as does quieting down the nicotine receptors that are screaming. When you've suffered with pain long enough, you learn how to put on a happy face even when you've got a pain level of 8. I can still carry on a conversation and sometimes do so just to occupy my mind as opposed to justing sitting and leaving myself no other option but to thik about the pain. This is in fact why many people complaining of worsening pain at night. They get into bed and have nothing to do but think about the pain. During the day, there are enough distractions that they don't feel it as much.
One way the physician I work for weeds out the potential "high" seekers is to change them from a short to a long acting opioid, going to Methadone from Percacet for example. I have seen several patients immediately object to this even though the Methadone is stronger, longer lasting and cheaper than brand Percocet. The long acting formulation and 33 hour half life of Methadone gives excellent pain control, but no "rush".
Although this sounds like a great plan for patients with chronic pain, it's far from optimal for many. I'd never agree to go on Methadone because of the extended half-life. This makes it extremely hard to taper down from and for someone who might have fluctuating pain levels, it's too hard to regulate an appropriate dosage. My disease flares and remisses. I need to be able to treat the pain acordingly.
SOmeone in chronic pain cannot be compared to an acute situation. People in chronic pain are more prone to suicide. Hurting ALL THE TIME will definitely affect your attitude.
If your patient were bleeding a lot and you could not get it to stop - would she still be a pain to you because she kept complaining about the messy sheets and feeling weak? Pain is a condition that needs careful treatment. I believe in the situation you described the MD had not found the magic bullet for that particular patient. Maybe she needed something besides analgesics (anti-inflammatory, tranquilizer, muscle relaxer,etc.). Stay in there and advocate for your patient and maybe, if you get them comfortable, they will not be so grouchy. At the very least, once the pain is under control they can go home.
You might think that you don't let your feelings show, but some patients are sensitive enough to notice, especially someone like me, who knows the issues fom both sides of the fence.
I know I don't let my feelings show. I have a legal and ethical obligation to give them their pain meds as ordered by their physician. If the patient feels I'm acting indifferent it's more likely because they have a guilty conscious.
Something to think about interms of the laughing, talking on the phone or heading out for a smoke, is that these are all mechanisms that we use to distract ourselves from the pain. When I am in pain, I smoke much more than normal. The deep breathing involved seems to be a factor as does quieting down the nicotine receptors that are screaming.
Sorry, I want to be honest...IMO that's just bull.
When you've suffered with pain long enough, you learn how to put on a happy face even when you've got a pain level of 8. I can still carry on a conversation and sometimes do so just to occupy my mind as opposed to justing sitting and leaving myself no other option but to think about the pain.
OK, this one pisses me off no end because of all the misconceptions in the OP.
First, chronic pain patients, and I am one, do not get a buzz off the meds we are on. We do not enjoy them and we hate the side effects. We are not on meds because we are gaming the system. We are on them because we have longstanding, serious pain. Untreated pain leads to things like social isolation and depression. Chronic pain KILLS as isolated and depressed patients just want it all to end and take their own lives.
Second, these people are not addicts. They may be dependent on those powerful drugs, but they follow their prescriptions, they don't experience addictive cravings, and they are not going to boost your car radio upon discharge. They are people whose brains make inadequate endorphins and enkephalins to cope with physcial illnesses and must be on pain medication to compensate so they can lead functional lives. Calling these people addicts is like calling insulin dependent diabetics addicts.
Chronic pain patients on a boatload of meds do present a pain management problem postop. You will be giving them enormous doses of opiates, doses you are sure would kill a normal person. However, this is what it will take to manage their pain, and managing their pain is your JOB, isn't it? Save the lectures for church.
Chronic pain patients are used to being treated like scum, one level above a shooting gallery habitue. They will be anxious about getting their meds on time because there will be consequences. You will therefore see drug seeking behavior. However, they are in pain. They need medication.
My advice is to check your drug phobia at the door and try to get these folks through whatever they came in for to the best of your ability. They didn't come in for a drug lecture. They came in for surgery or other compelling reasons.
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
And Chronic Pain Control is not best served by any ER
No, but breakthru pain...even for a chronic pain patient....IS. And as providers we have to remember that. Sometimes even patients with chronic pain problems have breakthru pain ..whether it's related to their chronic pain or not - and yes, the ER is occasionally the best place to have it controlled. Why? Because it's open when the doc's office isn't. Because at 3am you can't go pick up a script for Actiq. And more importantly, because there might be something much more sinister just under the surface that's causing this episode of breakthru pain - and it needs to be diagnosed and treated...at the ER.
another thing i have noticed about those suffering w/cp is many are extremely anxious. even if their current pain level is tolerable, they become anxious in anticipation of returning and more severe pain levels. because of these anxieties, all sorts of behaviors are manifested. i'd like to see more of this population receiving prn anxiolytics when hospitalized. and of course, the concept of a pain specialist on board, would be heaven....for staff and pts alike.
but in the meantime, docs/residents need to become more educated in managing these people.
Exactly! Too often, we are not appropriately medicated while inpatients. While the responsibility for this lies at the feet of the MDs, it is the RNs who we see all day and who may bear the brunt of our disdain and anxiety. I can't speak to what things are like in Nursing elsewhere, but here, the cutbacks have killed real patient care and I'm glad I am not working anymore. Our Nurses have a growing number of patients to care for and the charting is horrendous! I've seen meds delayed by pharmacy SNAFUs, waiting for an MDs order, the RN being on a break and his/her relief being unavailable or an LPN on duty who can't give the meds. While in Rehab, I had to get special permission for Mom, who is an IDDM to have her meds at her bedside because she was regularly getting them hours late. If she weren't an RN herself, it would have been a real problem. Most patients have experience in dealing with these situations and this greatly increases our anxiety. I have actually had an RN tell me that I didn't need to be on the dosage of meds I was on and take it upon herself to try and change my script. The Doc didn't agree, thank goodness. Anxiolytics might be a good idea, but all too often we have a hard enough time just getting the emds we absolutely need, never mind tying to add another one.
I know I don't let my feelings show. I have a legal and ethical obligation to give them their pain meds as ordered by their physician. If the patient feels I'm acting indifferent it's more likely because they have a guilty conscious.
I don't have a guilty conscious. I am far too experienced and educated to suffer such. I don't mean to single you out, rather to point out that you keep going back to "a legal and ethical obligation". To me, this seems to indicate that while may you disagree with the dosing of CPers, you do so because it's required and NOT because you believe it will help the pt. There is a big difference between doing what you must do and doing what you believe is right.
Chronic pain patients are used to being treated like scum, one level above a shooting gallery habitue. They will be anxious about getting their meds on time because there will be consequences. You will therefore see drug seeking behavior. However, they are in pain. They need medication.
Even a short delay can allow for the pain to get out of control and then a larger dose of meds might be required to get it back under control. Since that "bolous" nearly never gets written, we suffer for it. Most CPers know their pain intimately and can tell when the meds are beginning to wear off. Then, they begin getting anxious about receiving the next dose. When at home, this is in their control, but while impatients, all of the control is taken from them - thus, the anxiety.
No, but breakthru pain...even for a chronic pain patient....IS. And as providers we have to remember that. Sometimes even patients with chronic pain problems have breakthru pain ..whether it's related to their chronic pain or not - and yes, the ER is occasionally the best place to have it controlled. Why? Because it's open when the doc's office isn't. Because at 3am you can't go pick up a script for Actiq. And more importantly, because there might be something much more sinister just under the surface that's causing this episode of breakthru pain - and it needs to be diagnosed and treated...at the ER.
Ideally, this is quite true. However, in reality, it doesn't always work well. It's been years since I worked ER, but then, most of the Docs & RNs alike were put off by the "drug seekers". Generally, they operated in CYA mode and all too often fell back on the old excuse of "not masking the symtpoms". When I was Dx with Crohn's, even after they had ruled out a surgical belly, I had to beg to get something to give me enough relief to get a nap and I worked there! I was obviously not a junkie and had not yet begun my pain treatment, so I was not on any meds at all. I would like to think that this has changed, but inconversations I've had with other patients, I've been led to believe that it hasn't.
This seems to indicate that while may you disagree with the dosing of CPers, you do so because it's required and NOT because you believe it will help the pt. There is a big difference between doing what you must do and doing what you believe is right.
I disagree with the dosing of CPers who are simply looking for a high. I'm not saying that you, as a CPer, are one of these people. I don't even know you. But definately I do disagree with giving these people pain meds and you're correct. I DON"T give it because I believe it will help the pt. But the point is I do and I do with a friendly face because that is my job. It's not my job to judge these people outwardly. I am human and I cannot help the way I feel on the inside but they don't see it on the outside. Comments I've gotten many times include "Thank you, you're the only one who doesn't mind bringing me my medicine on time". When I know they are going to be on the call light every 3 hours like clockwork, I keep the narc in my pocket. These are patients who have tried to sneak out with their IV's when discharged, caught stealing syringes in the supply room (which now has a coded lock), a patient caught putting feces in his PICC line so that he would not be discharged, etc....could it be more obvious? There are fakes in every dimension in life and CPers are no different. It truly sad because the legitimate CPers suffer because of the druggies. :angryfire
if motrin was not contraindicated, all i was saying is that it still is a perfectly acceptable analgesic even in conjunction with the stronger narcotics.
ea analgesic targets different receptor sites, so they can act synergistically.
leslie
And dont offer them Ultram or Talwin either. They get upset over those for some reason also.And they are perfectly good meds also.
No, but breakthru pain...even for a chronic pain patient....IS. And as providers we have to remember that. Sometimes even patients with chronic pain problems have breakthru pain ..whether it's related to their chronic pain or not - and yes, the ER is occasionally the best place to have it controlled. Why? Because it's open when the doc's office isn't. Because at 3am you can't go pick up a script for Actiq. And more importantly, because there might be something much more sinister just under the surface that's causing this episode of breakthru pain - and it needs to be diagnosed and treated...at the ER.
vamedic4
And you come to the ER at 0300 saying you cant get hold of your doctor. Its 3 in the morning, he is asleep.And you are trying to tell me that you didnt know you were running low the day before. Or even the day before that. And you didnt contact your Doctor when it was convienient for him. I even had a pt tell me his dog ate his last few doses. I accidentally dropped my meds in the sink.Or is it more likely that someone ran out of meds because his doctor sets a limit that doesn't agree with the patient.
No I still say the ER isnt a place for Chronic Pain Management
I and this is a common enough scenario anywahere. Pt my back pain flared up. I was helping a friend move their furniture. Now pts whith chronic back pain know they shouldnt be helping lift furniture.
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KeahM
12 Posts
You might think that you don't let your feelings show, but some patients are sensitive enough to notice, especially someone like me, who knows the issues fom both sides of the fence.
Something to think about interms of the laughing, talking on the phone or heading out for a smoke, is that these are all mechanisms that we use to distract ourselves from the pain. When I am in pain, I smoke much more than normal. The deep breathing involved seems to be a factor as does quieting down the nicotine receptors that are screaming. When you've suffered with pain long enough, you learn how to put on a happy face even when you've got a pain level of 8. I can still carry on a conversation and sometimes do so just to occupy my mind as opposed to justing sitting and leaving myself no other option but to thik about the pain. This is in fact why many people complaining of worsening pain at night. They get into bed and have nothing to do but think about the pain. During the day, there are enough distractions that they don't feel it as much.
Although this sounds like a great plan for patients with chronic pain, it's far from optimal for many. I'd never agree to go on Methadone because of the extended half-life. This makes it extremely hard to taper down from and for someone who might have fluctuating pain levels, it's too hard to regulate an appropriate dosage. My disease flares and remisses. I need to be able to treat the pain acordingly.