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.
They think they're clever. Think we believe that they are allergic to all those meds.
When I walk in the room with the syringe they hold up their hand, "here put it in this port, it doesn't help as much if you put it in further down the line"
Or, I go back in the room and the clever one has figured out the pump and it's now running at 500cc/hr.
Puhleeaaseee, no one can tell me that these type patients are not simply drug seekers. It may have started out as a genuine need for pain meds but a drug seeker is what some of these people have turned into. It is sad I agree but it's true and they're out there.
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?
If it were only several pain meds that don't work for them, no problem but they have a list as long as my arm.
Specializes in rehab; med/surg; l&d; peds/home care.
I guess I was originally upset because the title of the thread states: "Chronic pain patients: pain in the behind to care for". That doesn't say, "crabby, drug seekers claiming their CP patieints: pain in the behind to care for". It was a generalized statement, the kind we all try to NOT make on this forum, because we know it tends to upset people. But, I do understand what the OP is talking about, and I am not angry at him for his title. I understand he's coming here to vent, a thing a LOT of us do, because being a nurse is extremely challenging sometimes. IF it wasn't we wouldn't see so many posts of heartbroken people needing to vent and de-stress.
BUT, I understand now that most of the folks here who are complaining about CP patients, are ACTUALLY complaining about those who come in, and:
1) are wanting everything pushed as fast as possible
2) immediately after being medicated for 10/10 pain, get up and want to leave
3) try to leave with their IV line so they can go score some (insert drug here)
4) have run out of their Vicodin 2 weeks early
5) etc, etc, ad nauseum
I understand that, you are not talking about me. When you see my chart with these dx: cancer currently undergoing chemotherapy, SLE, DDD, L2-S1 herniations with grade 4 annular tears currently on pain management therapy, etc, you more than likely know I am not a "seeker".
Believe me, I know that there are many out there struggling with an addiction, who do come into the ER seeking a high. That is what ruins it for people like me, a legit pain patient. I know this.
But, I simply responded to some of these posters who wanted to know some things that I happen to know firsthand, so I answered. I hope I helped people to understand some things that they asked about. I want people to know that, there ARE patients out there, who ARE compliant to the nth degree (because otherwise I'd be without treatment), who DO care about those nurses and doctors who treat me (cause I appreciate those who do care), and that even patients like me who don't go to the ER unless I'm told to are getting bashed by nurses and doctors everywhere. Now, it's not common, and it's not directed at you posters here. But there ARE people out there, HCW's, who are treating EVERY patient who takes pain medications like a junkie/addict or whatever you want to call them. It is these people who break my heart, because I hate being judged. I pray that none of these people who judge me EVER hurt their back at work and suffer chronic pain, or develop cancer and develop even WORSE pain. Cause it sucks to be hurting, and to be judged unfairly.
That's all I'll say about that. I really do understand it from both sides, or I try to. I am keenly aware that I will sometimes be unfairly judged. I try to educate as many as possible on things I happen to be aware of. I also try to educate myself on other's perspectives. I thank those who had the courage to post here, and discuss this topic. I did learn from a lot of you. This topic needs to be addressed. We all know there is power in knowledge. We all know our healthcare system is not meeting the needs of all who need it. Everyone of us knows that. Chronic pain is just one more thing that needs a major overhaul and major improvements in this system.
I hope I haven't hurt anyone's feelings here, cause that's not my intent. I don't want to come across rudely or inconsiderate. I do appreciate all you nurses here who care enough about those of us in pain to chime in with your feelings and observations. Thanks to all of you!!!
And I hope the OP has learned that this is a good place to come and vent, because it is. And I hope that I was able to help someone understand something new about chronic pain and/or its treatment. Cause that's the only thing I am able to do anymore, since I can't practice nursing anymore. As close as I get is coming here to see what everyone else is up to.
The whole pain management issue is frustrating, to say the least, especially when we deem a patient with multiple allergies to be using them as an exucse to get the "good stuff."
The problem with that are the patients like me. During a colonoscopy years ago I was given Demerol via IV and broke out in hives. In the recovery room after an ACL replacement I was given Morphine and broke out in hives.
Where does that leave me? I hate to even list allergies because the only ones I have are to two of the most commonly used narcotics, and it makes me suspect, somehow.
rehab nurse thankyou for your candidness .and you are correct not all cp pts such as yourself are pain in the behind .i have all the compassion in the world for someone in pain .i have pain everyday also after nursing 20+ yrs .i do what i must .i tolerate it as much as possible and take nsaids .but when it flares i need something stronger.my bil is dying of cancer so i do know and understand the cp issues. but those of us who work in the er also meet plenty of others claiming 10/10 pain and abuse the sx for a high .i medicate pts as ordered .but not every pt who says they have 10/10 pain is telling the truth .it makes us a suspicious lot.i know that pain is supposed to be what the pt says it is but it depends on the pt the situaition and yes culturally as well.my father was also a cp pt for years and thankfully saw a pain clinic we need more of those.
I also have chronic pain, I have SI Joint dysfunction. Sometime it is all I can do to get off the couch to get ready for work (i have to sleep on the couch so I have something to rest my back on). During the week, I am on a Durgesic patch, 75mg, and on the weekends when I work, I live on Ultram (WONDERFUL drug!! :yelclap:) Sometimes I can actually walk up and down the hall several times.
I have already expressed my views on under-mdicating pain patients, so I will just repeat this-- Remember that we can't see the pain that the patient is in, and YES, one can have pain 9-10 while sleeping. All we can do is believe that the patient is in pain, and medicate accordingly. By the way, I can funtion well on the patch, there is really no reason I couldn't were it at work. Just gotta get my conscious ready for that.:innerconf
I understand that, you are not talking about me. When you see my chart with these dx: cancer currently undergoing chemotherapy, SLE, DDD, L2-S1 herniations with grade 4 annular tears currently on pain management therapy, etc, you more than likely know I am not a "seeker". Believe me, I know that there are many out there struggling with an addiction, who do come into the ER seeking a high. That is what ruins it for people like me, a legit pain patient. I know this.
You are soooo correct! I have a friend who was in an MVA with 52 broken bones, she is literally pinned together. The last time she had to change insurance and went to a new PCP she was treated like a druggie....until she was able to supply a copy of her most recent MRI and then surprise...presto...she was taken seriously and referred to a pain specialist. She works full-time as an xray tech and I can see the pain on her face when she comes into work. Within a couple of hours she begins to feel better but is never pain free.
I am sorry about your diagnosis' and what you have to endure not only with the pain you have but with the stigma that is placed upon you. It is sad. As you say the druggies abuse the system and make it difficult on those who truly do need the meds.
I agree that the title of the thread was blanketing, however, we have all at one time taken care of a seeker. I know there are CPs out there that are legit, but some arent. I took care of a 15, yes 15 year old girl-shunt revision. She was on..diluadid IV q2h (and believe me it was q2h) 2mg, fentanyl patch, scheduled oxyIR q12, 50mg benedryl (per her request), valium, and more that i cant remember now. It was so obvious that she was seeking as she would say:
I need benedryl and I need it IV, oh and make sure its 50mg and not 25mg bc 25 doesnt work for me.
I say: You dont need benedryl, benedryl is not for pain.
She says: oh, I know...but Im really itchy right now, i really need it.
Ok..so I go to give it to her and before I even push it she says: ohhh thanks i feel so much better!
It was the same story with the dilaudid, i tried everything, but she just kept screaming and the before id even get it pushed shed claim how much better she felt. I tried weaning her but every time she would throw a fit and claim she was in soo much pain she couldnt stand it and that i was "stupid and obviously didn't learn anything in nursing school bc I could not treat her pain effectively"
After my 3rd shift she had worn me down, but I had her maintained on oral pain meds and her pain was "controlled" or at least her behavior was.
We have a hospitalist who at one time was really fed up with a couple drug seekers (or so he believed them to be) who came his way because their PCP's do not admit to the hospital and he being a hospitalist was the unlucky doctor stuck with them. Anyway, he said to me give them both 1cc NS the next time they ask for their pain medication. I did as ordered and neither one of them complained about pain. The hospitalist said interesting, lets continue. So I was pushing NS about every 3 hours to these patients. By the end of the shift he changed them to Darvocet N 100 and told them he didn't believe that they had enough pain to require narcotics. 1 left AMA and 1 pitched a fit and ended up having a visitor and he/she was perfectly satisfied once the visitor left. That patient was suddenly nauseated and needed Phenergan stat, allergic to Zofran. I wish more doctors would try placebo's. It used to be done all the time. It seperates the men from the boys so to speak. I'm not suggesting that this is done with patients with legitimate diagnosis' but those abdominal pain's, etc who want pain meds and then get up to go smoke could use a trial run of placebo's. IMO.
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
I agree that the title of the thread was blanketing, however, we have all at one time taken care of a seeker. I know there are CPs out there that are legit, but some arent. I took care of a 15, yes 15 year old girl-shunt revision. She was on..diluadid IV q2h (and believe me it was q2h) 2mg, fentanyl patch, scheduled oxyIR q12, 50mg benedryl (per her request), valium, and more that i cant remember now. It was so obvious that she was seeking as she would say:
I need benedryl and I need it IV, oh and make sure its 50mg and not 25mg bc 25 doesnt work for me.
I say: You dont need benedryl, benedryl is not for pain.
She says: oh, I know...but Im really itchy right now, i really need it.
Ok..so I go to give it to her and before I even push it she says: ohhh thanks i feel so much better!
It was the same story with the dilaudid, i tried everything, but she just kept screaming and the before id even get it pushed shed claim how much better she felt. I tried weaning her but every time she would throw a fit and claim she was in soo much pain she couldnt stand it and that i was "stupid and obviously didn't learn anything in nursing school bc I could not treat her pain effectively"
After my 3rd shift she had worn me down, but I had her maintained on oral pain meds and her pain was "controlled" or at least her behavior was.
All that for a shunt revision??? Geezus. I wanted off the meds they gave me quick after my revision (didn't help the pain but did let me sleep)...now it sounds as if she has worked the system before.
We have a hospitalist who at one time was really fed up with a couple drug seekers (or so he believed them to be) who came his way because their PCP's do not admit to the hospital and he being a hospitalist was the unlucky doctor stuck with them. Anyway, he said to me give them both 1cc NS the next time they ask for their pain medication. I did as ordered and neither one of them complained about pain. The hospitalist said interesting, lets continue. So I was pushing NS about every 3 hours to these patients. By the end of the shift he changed them to Darvocet N 100 and told them he didn't believe that they had enough pain to require narcotics. 1 left AMA and 1 pitched a fit and ended up having a visitor and he/she was perfectly satisfied once the visitor left. That patient was suddenly nauseated and needed Phenergan stat, allergic to Zofran. I wish more doctors would try placebo's. It used to be done all the time. It seperates the men from the boys so to speak. I'm not suggesting that this is done with patients with legitimate diagnosis' but those abdominal pain's, etc who want pain meds and then get up to go smoke could use a trial run of placebo's. IMO.
I know it was legal when it was done 30 or so years ago. It had to be a written order. 1cc NS IM Q 4 PRN as a placebo. We didn't do IV meds back then. This doctor did write the order. Nothing was said so I assume it's still legal today. The way everything has changed with HIPPA etc....I really can't answer that with any certainty.
Hi Guys--I'm back,.thumb.jpg.2605487e9a1cc011342d44bcf46e0b55.jpg){kind=small}
Just curious--Is this legal?
DutchgirlRN, ASN, RN
3,932 Posts
When the patient lists their allergies as:
Demerol, Stadol, Tordol, Hydrocodone, Oxycodone, Fentanyl, Ultram, Percocet, Morphine, Tylenol, Motrin. What's left?
They think they're clever. Think we believe that they are allergic to all those meds.
When I walk in the room with the syringe they hold up their hand, "here put it in this port, it doesn't help as much if you put it in further down the line"
Or, I go back in the room and the clever one has figured out the pump and it's now running at 500cc/hr.
Puhleeaaseee, no one can tell me that these type patients are not simply drug seekers. It may have started out as a genuine need for pain meds but a drug seeker is what some of these people have turned into. It is sad I agree but it's true and they're out there.