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.
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
You are ABSOLUTELY CORRECT. Unfortunately, there are many who have made the journey of Chronic Pain more difficult for those of us who truly suffer and need the treatment. I never intended to mean that all patients are created equal. Certainly, they are not and we all know that there are some who will be rude and obnoxious no matter what you do. I'll admit that having been a patient myself, so many times and having had difficulties in getting the correct meds, among other issues has made me especially sensitive to some of these issues.
I don't doubt that many of your patients appreciate the efforts that you make on their behalf. My only point is this. If Mom and Dad have an argument and try to hide that from the kids, do you really think that they don't notice that Mom is angry at Dad? Of course they do. It's very difficult to mask your true feelings. Certainly we all try to be as professional as possible, but often, there are small tells which give away what we really think. This is not necessarily something bad. It just is what it is and I'm sorry if my previous statement on this issue seemed accusatory. I did not intend that.
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.
Again, the conversation is digressing into that of abusers only. The comment you are replying to was intended to adress the needs of true chronic pain patients. I am medicated well enough to make my pain level tolerable and I never run short. My dog doesn't eat my pills and I don't drop them down the sink.
Most chronic pain patietns are "under contract" with their MDs and self medicating would violate this agreement. It could get them discharged fromt he practice. Additionally, pain which is not controlled by their normal med regimen could spell serious trouble.
I have Crohn's Disease and Ankylosing Spondylitis. An increase in pain could indicate a true medical emergency or just an exacerbation of the disease activity. I need to know if I've got a stricture, partial obstruction, complete obstruction, abscess, appendicitis, or if the pain is only from a flare of inflammation causing none of those serious complication.
If my pain is in my back, I need to know if I've slipped or ruptured a disc, or possibly even fractured something. After all, my spine is trying to fuse. All the soft tissues, including the ligaments and tendons are calcifying and a simple sneeze could cause a majr catastrophe. Again, an increase in pain that is not controlled by my usual medications may just be from a flare, but without some x-rays and maybe a CT scan, I wouldn't know. In either case, additional medications may be required and at 3am, or almost any other time, the ER is the place for me to be.
And dont offer them Ultram or Talwin either. They get upset over those for some reason also.And they are perfectly good meds also.
Many people suffering chonic pain are reluctant to change their medication regimen for a number of reasons. First and probably most important is that we often suffered for years before finding either a reason or a Doc willing to try and treat us to get relief. Often, we've tried many different scripts at assorted doses and once we find what works, we are terrified to give it up.
I'm not even sure what the point of switching to one of these meds would be. Talwin is a Schedule iV controlled Substance, in the same catagory as Valium, Xanax, Versed, etc. and Tramadol, while not Scheduled in the US, is a synthetic opioid analgesic and scheduled as such in other countries.
If my Doc were to suggest Talwin, I'd try it. I trust him to script whatever he thinks is most appropriate for me and we work together as a team. When Ultram first came out, I was just headed into my CP journey and I actually requested to switch to it from narcotics while recuperating from surgery. Unfortunately, I had a paradoxical effect and was awake for 3 days. The side effect of insomnia was enough to make sure that I'd never agree to it again.
And dont offer them Ultram or Talwin either. They get upset over those for some reason also.And they are perfectly good meds also.
Talwin, nubain, stadol, etc., can cause withdrawal and/or diminished pain relief in narcotic dependent persons. I've seen it happen with nubain and stadol. (the most dramatic was a heroin addict admitted for acute cellulitis for whom the resident ordered nubain for pain... pretty abrupt and impressive withdrawal) I haven't given Talwin in years...
I've taken care of plenty of chronic pain folks on Ultram. But many of them will tell us what works, and ask not to be given certain meds; I have no problem with that. Why waste time and money not getting adequate pain relief?
On a side note, I've had some call these other meds an "allergy" when in fact they aren't.
Talwin, nubain, stadol, etc., can cause withdrawal and/or diminished pain relief in narcotic dependent persons. I've seen it happen with nubain and stadol. (the most dramatic was a heroin addict admitted for acute cellulitis for whom the resident ordered nubain for pain... pretty abrupt and impressive withdrawal) I haven't given Talwin in years...
I've taken care of plenty of chronic pain folks on Ultram. But many of them will tell us what works, and ask not to be given certain meds; I have no problem with that. Why waste time and money not getting adequate pain relief?
On a side note, I've had some call these other meds an "allergy" when in fact they aren't.
At work I suggest we just hand them a menu. Make life easier for all.
At work I suggest we just hand them a menu. Make life easier for all.
Wow.
Before my surgery, my doc, his PA and I discussed my post-op pain control. I told them I didn't want percocet or dilaudid (the meds most often used by this doc for postop pain control)--- they simply aren't effective for me, and cause other side effects I'd rather not have to endure after surgery. They are friends, and were respectful of my wishes and appreciated my input. I'm glad they did know me, and I felt comfortable enough to discuss this with them; I'd hate to think in other circumstances someone with your attitude would have judged me like that...
I have acknowledged there are those who abuse the system, and are truly 'drug seekers' looking for a high. I understand the frustration in dealing with these people; I've been there too. I just have a problem with them being lumped in with people who have genuine pain issues.
As far as giving them a menu, why would you want to waste your time and energy on something the patient knows isn't going to help them?
Specializes in pre hospital, ED, Cath Lab, Case Manager.
I really dislike people lumping all people with chronic pain together. I really dislike bad attitudes towards people with chronic pain. Yeah I used to be a bad a$$ed ED nurse who was graced with the God given right to judge all people anyway I saw fit too. Then reality came and smacked me in the face. I regret all the people I judged - some fairly I'm sure - and many not so fairly. There is a difference between addicts and people with chronic pain.
I have never asked for narcotics- I don't want to go down that road. I don't want to be judged by self appointed pain police.
"And dont offer them Ultram or Talwin either. They get upset over those for some reason also.And they are perfectly good meds also."
Some of "us" do quite well on Ultram- it takes the pain from a screaming roar to a more manageable pain that I can live with. Imagine for an instant maybe what it is like to have pain all the time. I never had HTN before the chronic pain. It changes the way your body functions in some very basic ways. I was amazed when I went to a lecture on chronic pain. You might want to get educated too. It's people that express those type views why I would do anything before I ever hit an ED again.
Imagine for an instant maybe what it is like to have pain all the time. I never had HTN before the chronic pain. It changes the way your body functions in some very basic ways. I was amazed when I went to a lecture on chronic pain. You might want to get educated too. It's people that express those type views why I would do anything before I ever hit an ED again.
Excellent.
I'm scared to death I'm headed down that path, and have so far resisted going to a pain doc or approaching the issue with my primary. I don't think he'd be judgmental, but I've seen it far too often from far too many...
I am in pain 24/7. It waxes and wanes, I have "good days" (if you want to call it that, and they are fewer and farther between as time goes on) but I cannot remember the last time I wasn't in moderate to severe pain. I have managed to continue to work the floor, but I often wonder how long I'll be able to do so. It has taken its toll, physically and emotionally, and I don't believe I'll ever be 'myself' again. That scares the hell out of me, because I'm not married, and have nothing else to fall back on.
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
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.
No, you don't go to the ER at 0300 telling the ER that you can't get a hold of your doc - they'll have him paged without incident. You go because what you're doing for whatever chronic pain you're experiencing is either 1. not working at all 2. not working well enough 3. causing some other symptoms which make the experience that much worse...say, adding nausea and vomiting to the equation. And much of the time the patient (IME) has already contacted their physician to let him know what's going on.
Going because you're "out of meds" isn't the answer either. Ideally - and in truth you have an obligation to yourself and your doctor to do this- you'd be in the ER long before you ran out of meds. This way the doctor knows that you must be suffering...otherwise - why isn't what you're doing at home working for you? That's a question for your doctor- in his office.
Ideally of course, Tom, you are correct. It certainly is NOT the place to handle chronic pain management. But there are times when a patient needs something "other" than what they've been using to get over their pain. Is that the patient's fault? To hear some arguments, yes...but anyone with half a brain and even 25% of a heart knows that's not true. If they're truly in pain- they need to be treated, and treated effectively.
Other posters have made statements that chronic pain patients don't get a "high"...unless you know someone personally who is a CPer or are one yourself, you honestly don't know how true this is. They don't come to the ER for a "high", they come for relief, period.
If all it took was to spin around three times, eat Cheerios and sit in a north facing corner for 3 hours, don't you think people would rather do that than sit in a noisy, bright ER to wait for someone to pass judgment on whether or not they are someone with a legitimate medical need??:angryfire Give me a break!
While we all acknowledge the fact that there ARE abusers out there- the number of legitimate CPers who suffer probably outnumber the fakes 100:1.
And God forbid anyone who judges CPers harshly end up being one themselves. It's a little different view from the other side of the fence:trout:
At work I suggest we just hand them a menu. Make life easier for all.
This is sooooooo true! My favorite is when you go to give a med that was ordered, and the patient "suddenly" remembers that they are allergic to that particular med. Example- last night, I went to give someone Toradol & Norflex for back pain and while they had an allergy list a mile long in triage, they suddenly remebered that they were also allergic to Toradol & Norflex. And, of course, the ONLY thing they weren't allergic to was Dilaudid...... I have come to learn that for many of these patients, Allergies = "Medications that I don't want."
I have literally had patients do this several times in one visit- I bring one thing in, they "suddenly" remember they are allergic to it, get a different order, bring in the new med, they are suddenly allergic to that too..... So now it's to the point where I just ask "What AREN'T you allergic to?" The answer is usually Dilaudid (through they usually pretend they can't remember the name of it...). A menu would make things easier! I have also had patients ask me to "push it faster" when giving IV narcotics- now THAT is someone looking for a high or a buzz. I'm not saying that all chronic pain patients are like this, just the majority of the ones we see in the ER- unfortunately, they give all the rest a bad rap.
I have also had patients ask me to "push it faster" when giving IV narcotics- now THAT is someone looking for a high or a buzz. I'm not saying that all chronic pain patients are like this, just the majority of the ones we see in the ER- unfortunately, they give all the rest a bad rap.
Point taken. I've had certain patients ask me to do this too; of course I tell them I won't do so. (one in particular swore that if we didn't whoosh her narcotic and phenergan in as fast as possible, her port would clot off...)
you know, i do empathize with nurses/md's who may confuse addicts with cp'ers.
i happen to work in a specialty that has made me adept in assessing pain.
but for those who don't understand its' complexities, then misinterpretation is bound to continue.
realistically, what can be done to implement change?
you don't want to continue in enabling addiction;
yet it's cruel to undermedicate those w/severe pain.
leslie
Excellent point.
One step in the right direction would be something like what was mentioned earlier on this thread--- a pain management department in hospitals who are solely responsible for such for all patients.
To be honest, I'm not sure the oncology docs I've worked with would be willing to hand this over completely to the pain docs, unless they were given the final say-so in the matter. I suspect there would have to be alot of discussion between the two before they'd go for it...
So perhaps starting with certain populations of patients? General medical and surgical patients? Leaving those of more specialized units to direct their own patients' pain management?
Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.
AWWWW Tadpole! I am with you on the crabby ones who come in with some sort of 'disorder', and along with it, the pain meds, the zero coping skills, the zero social skills...they are a royal PAIN!!
I am not sure why docs prescribe such huge amounts of pain medication.....maybe they get tired of all the whining as well....so a pill shuts them up. Many are complete addicts, so if they are off their meds for even a day, they become raving banshees!
There are pain specialists that can assist with some of these folks, but not every hospital has them.....and some patients just want to be addicted....
Hang in there.....this is just one small bump in the road....and doesn't define the whole of your nursing skills or career....just take a deep breath....let it out.....and look to the next challenge....you will in your lifetime of nursing have many.....put up your chin, and meet it head on....you'll do fine...
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). A menu would make things easier! I have also had patients ask me to "push it faster" when giving IV narcotics- now THAT is someone looking for a high or a buzz. I'm not saying that all chronic pain patients are like this, just the majority of the ones we see in the ER- unfortunately, they give all the rest a bad rap.
KeahM
12 Posts
You are ABSOLUTELY CORRECT. Unfortunately, there are many who have made the journey of Chronic Pain more difficult for those of us who truly suffer and need the treatment. I never intended to mean that all patients are created equal. Certainly, they are not and we all know that there are some who will be rude and obnoxious no matter what you do. I'll admit that having been a patient myself, so many times and having had difficulties in getting the correct meds, among other issues has made me especially sensitive to some of these issues.
I don't doubt that many of your patients appreciate the efforts that you make on their behalf. My only point is this. If Mom and Dad have an argument and try to hide that from the kids, do you really think that they don't notice that Mom is angry at Dad? Of course they do. It's very difficult to mask your true feelings. Certainly we all try to be as professional as possible, but often, there are small tells which give away what we really think. This is not necessarily something bad. It just is what it is and I'm sorry if my previous statement on this issue seemed accusatory. I did not intend that.
Again, the conversation is digressing into that of abusers only. The comment you are replying to was intended to adress the needs of true chronic pain patients. I am medicated well enough to make my pain level tolerable and I never run short. My dog doesn't eat my pills and I don't drop them down the sink.
Most chronic pain patietns are "under contract" with their MDs and self medicating would violate this agreement. It could get them discharged fromt he practice. Additionally, pain which is not controlled by their normal med regimen could spell serious trouble.
I have Crohn's Disease and Ankylosing Spondylitis. An increase in pain could indicate a true medical emergency or just an exacerbation of the disease activity. I need to know if I've got a stricture, partial obstruction, complete obstruction, abscess, appendicitis, or if the pain is only from a flare of inflammation causing none of those serious complication.
If my pain is in my back, I need to know if I've slipped or ruptured a disc, or possibly even fractured something. After all, my spine is trying to fuse. All the soft tissues, including the ligaments and tendons are calcifying and a simple sneeze could cause a majr catastrophe. Again, an increase in pain that is not controlled by my usual medications may just be from a flare, but without some x-rays and maybe a CT scan, I wouldn't know. In either case, additional medications may be required and at 3am, or almost any other time, the ER is the place for me to be.
Many people suffering chonic pain are reluctant to change their medication regimen for a number of reasons. First and probably most important is that we often suffered for years before finding either a reason or a Doc willing to try and treat us to get relief. Often, we've tried many different scripts at assorted doses and once we find what works, we are terrified to give it up.
I'm not even sure what the point of switching to one of these meds would be. Talwin is a Schedule iV controlled Substance, in the same catagory as Valium, Xanax, Versed, etc. and Tramadol, while not Scheduled in the US, is a synthetic opioid analgesic and scheduled as such in other countries.
If my Doc were to suggest Talwin, I'd try it. I trust him to script whatever he thinks is most appropriate for me and we work together as a team. When Ultram first came out, I was just headed into my CP journey and I actually requested to switch to it from narcotics while recuperating from surgery. Unfortunately, I had a paradoxical effect and was awake for 3 days. The side effect of insomnia was enough to make sure that I'd never agree to it again.