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'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.
Please, seek the treatment that you need. If you were having a toothache, you'd see a Dentist. If you had chest pain, you'd see a Cardiologist and take whatever cardiacs meds s/he prescribed. Please do the same for your pain. Untreated pain only leads to further problems and the longer the pain is untreated, the harder it is to get under control. Yes, I've run into issues with people & providers who do not understand, but those difficulties pale in comparison to the pain I would have 24/7 if I was not aprropriately medicated.
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.
One of the Hospital I worked at had such a Pain mgmt Dept and the results were amazing. Not only did they work with the CP patients, but there were many other aspects of care they were in. When Mom's surgery had complications, the Pain Doc performed a Lumbar Sympathectomy to increase the blood flow to her LE. Without that, she would have likely lost her foot. So, not only do these Docs deal with the meds, but with many other procedures which in the long run can seriously improve morbidity of certain conditions.
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....
MDs prescribed the amount of medication necessary for that patient. With the FDA getting tougher about cracking down on Docs who allow their patients to abuse or divert meds, I seriously doubt that these scripts get written without the appropriate documentation and follow up. As you know, these meds can't be written with refills, so these patients are required to come in every month for new scripts.
Many meds are ordered in varying amounts. Something simple like Lipressor could be given in doses ranging from 25 mgs to 450mgs. Why would it be different for narcotics? The patients get what is required based on the MDs discretion.
Yes, some of these people may well be addicts, but that's not up to me to fix. That falls on the MD who is ordering their meds and trying to change that during a short hospital stay is not going to work. A real substance abuse program would be required.
I am not an addict. I can taper off my meds at any time and have done so several times. I'd be in pain if I did that and barely be able to walk because I am dependent on the meds for the relief they provide. However, the key is that I'd need to taper down, just like the Docs slowly titrated me up. Being "off my meds for even a day" would throw me into withdrawl and yes, I would be a raving banshee.
It is important for us, as providers to determine what is really happening with the patient before jumping to a conclusion. We need to understand the difference between addiction, dependence and tolerance, because there truly are HUGE differences.
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.
very true .i have seen it too many times."that medicine its starts with a d worked last time i want that "
very true .i have seen it too many times."that medicine its starts with a d worked last time i want that "
It's OK for me to say that Pepcid & Tagamet aren't effective for me and I had an adverse reaction to Prevacid, but Prilosec works really well. Why can't I also tell you that Percocet or Fentanyl work better for me than Demerol?
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
If you don't work in ER, you'll just never get it......
You're so far off the mark it's scary. We do get it.
To the OP, I'm sorry your experience with CP patients has left you feeling the way you have. Not all CP patients are as you describe. I have no doubt you provided excellent care for your patient(s), but you don't know how they may have been treated prior to your care.
What you may not have seen was that "X" patient was angry because she called to go for help going to the bathroom after caudal cath placement and no one came so she tried herself and fell to the floor. Then the caudal cath had to come out. Or because some "other" doctor/specialist who's unfamiliar with her case said " you shouldn't be on this med at all"...despite the fact that it helps to maintain a more normal and less painful existence. I'm just sorry that the patients took it out on you. It is unfortunate but you are the most visible and readily available care provider. Perhaps by doing that they hope that you can convey their feelings to the doctor, because many times the doctors either A. don't know or B. don't care.
The judgemental attitude in some of the posters here is evident, and scary. Makes me wonder if your mother's were in chronic pain - how much of this judgement would you dispel in order to help her?
If you don't work in ER, you'll just never get it......
I worked ER for 12 years. I get it. I know the pt who took their weekend supply of methdaone from the MMTP on Friday night, who can't tell me their name, but can make it perfectly clear that they are allergic to Narcan. This is an abuser NOT an pt in chronic pain and there is a world a difference between that person and some who takes a large dose of narcotics in order to maintain a level of quality of life. The former patient will take whatever they can get their hands on for the high. The latter will take theirmeds as prescribed. Yes, they may want a specific med, but only because it has worked for them in the past. Truthfully, the last place they want to be is the ER, where it's busy, noisy and they'll have to wait hours, usually in an unconfortable chair only to have someone like you question their true need for medication. Sometimes though, that is the only choice left.
I have a lot of golfing buddies. The funny part is that one is an ER MD, another is Pain control specialist. It wasnt untill the 3rd hole that they started arguing about pain control. The complete total difference in belief and philosophies was amazing. Also amazing they didnt start smashing each other with their clubs.
They only agreed on one thing. That was how cute the beer cart girl was.
Working in the ER, I would say 90% of the chronic pain patients I see are drug seekers/abusers. That's not to say that 90% of CP pt's are, just most of the ones I get in the ER. The CP pts who are NOT drug abusers are the ones who are usually more pleasant, because they appreciate you trying to help with their pain, they also don't come into the ER as often as the abusers, because they are compliant with their pain control programs through the pain clinic & use the appropriate channels to get their meds. BUT, this thread is about the CP pt's that ARE a pain in the butt, and that tends to be the ones who are drug seekers/abusers. Now, there are a lot of people who have posted to this thread who are CP patients, and who have taken offense to a lot of what I have said, but, again, this thread is about those CP patients that ARE a pain in the butt, not those who aren't. So don't assume that everything is being directed towards you, because it's not. Everything I have said in this thread has been about CP drug seekers/abusers being a pain in the butt, NOT about compliant CP patients. I feel for you, really I do- I can't imagine being in pain ALL the time. It's not you I have a problem with. What I DO have a problem with is the patients who come in to my ER who are OBVIOUS drug seekers/abusers (for those who have worked ER, you know that seekers/abusers are VERY easy to pick out from those who are truly in pain & just seeking relief).
teeituptom.......great idea, but don't we all know...that will never happen, either in the US where you are, or in the UK where I am.
Have followed this thread with great interest, my mam is a chronic pain sufferer, am thankful for the nurses she had on her recent admit to hospital, they understood her need for her meds, (well after a bit of sorting it all out!)
). 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.
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KeahM
12 Posts
Please, seek the treatment that you need. If you were having a toothache, you'd see a Dentist. If you had chest pain, you'd see a Cardiologist and take whatever cardiacs meds s/he prescribed. Please do the same for your pain. Untreated pain only leads to further problems and the longer the pain is untreated, the harder it is to get under control. Yes, I've run into issues with people & providers who do not understand, but those difficulties pale in comparison to the pain I would have 24/7 if I was not aprropriately medicated.
One of the Hospital I worked at had such a Pain mgmt Dept and the results were amazing. Not only did they work with the CP patients, but there were many other aspects of care they were in. When Mom's surgery had complications, the Pain Doc performed a Lumbar Sympathectomy to increase the blood flow to her LE. Without that, she would have likely lost her foot. So, not only do these Docs deal with the meds, but with many other procedures which in the long run can seriously improve morbidity of certain conditions.
MDs prescribed the amount of medication necessary for that patient. With the FDA getting tougher about cracking down on Docs who allow their patients to abuse or divert meds, I seriously doubt that these scripts get written without the appropriate documentation and follow up. As you know, these meds can't be written with refills, so these patients are required to come in every month for new scripts.
Many meds are ordered in varying amounts. Something simple like Lipressor could be given in doses ranging from 25 mgs to 450mgs. Why would it be different for narcotics? The patients get what is required based on the MDs discretion.
Yes, some of these people may well be addicts, but that's not up to me to fix. That falls on the MD who is ordering their meds and trying to change that during a short hospital stay is not going to work. A real substance abuse program would be required.
I am not an addict. I can taper off my meds at any time and have done so several times. I'd be in pain if I did that and barely be able to walk because I am dependent on the meds for the relief they provide. However, the key is that I'd need to taper down, just like the Docs slowly titrated me up. Being "off my meds for even a day" would throw me into withdrawl and yes, I would be a raving banshee.
It is important for us, as providers to determine what is really happening with the patient before jumping to a conclusion. We need to understand the difference between addiction, dependence and tolerance, because there truly are HUGE differences.