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 don't know exactly how I feel about placebo's. But in the case of these two particular patients I agreed with the doctor that they were drug seekers. If they had asked me what I was giving them I would not have lied. They didn't ask.
This is a case report from a community hospital. The patient, referred to here as KC, was an adolescent with migraine headaches. The substitution of a placebo (saline solution) for an opioid analgesic (morphine) was made during KC's treatment. Results.
The patient's pain subsided sufficiently following the administration of a placebo to permit his discharge from the hospital. The subsequent discovery by the patient's mother of the deceptive use of a placebo prompted her to file charges of professional misconduct against the treating physician and three nurses with their respective professional licensing boards. The medical board declined to take disciplinary action against the physician, and the disciplinary action by the board of registered nursing was successfully challenged in a ruling by an administrative law judge following a hearing in which expert witnesses took conflicting positions on the acceptability of the deceptive use of a placebo. Conclusion.
While there is a developing literature that challenges the ethical legitimacy of the deceptive use of placebos in pain medicine, that literature has yet to be recognized as unqualifiedly setting the standard of care or of professionalism in medicine and nursing.
Maybe healthcare needs to revisit the ethics in this type of placebo trial in the case of certain patients who appear to be drug seekers. Yes, we need to believe people's pain, but we all know there is a certain type of frequent flyer who plays the system. There's no doubt that some poor souls show up in the ER with abdominal pain over and over, with no clinical findings that ever support a definative diagnosis. They know the meds, the pain scale, they know how to get what they want. Often they are uninsured.
As long as this is not abused, perhaps some sort of placebo protocol would be appropriate in order to help diagnose this presentation. This could be based on past medical history, ER visits, and other criteria. Maybe it's time that medicine dealt with this problem.
Maybe healthcare needs to revisit the ethics in this type of placebo trial in the case of certain patients who appear to be drug seekers. Yes, we need to believe people's pain, but we all know there is a certain type of frequent flyer who plays the system. There's no doubt that some poor souls show up in the ER with abdominal pain over and over, with no clinical findings that ever support a definative diagnosis. They know the meds, the pain scale, they know how to get what they want. Often they are uninsured.
As long as this is not abused, perhaps some sort of placebo protocol would be appropriate in order to help diagnose this presentation. This could be based on past medical history, ER visits, and other criteria. Maybe it's time that medicine dealt with this problem.
I think if used sparingly and very limitedly placebo's are appropriate. If a doctor has a difficult patient that he/she suspects is a drug seeker and they try a placebo and it works then they know where they stand and are better able to treat the patient. IMO
I only advocate placebo's for those patients who are frequent repeaters with no plausible diagnosis or those whose dogs keeping accidently eating their pills.
UM Review RN, ASN, RN
1 Article; 5,163 Posts
I don't think so. It's certainly not ethical.
I wouldn't be able to lie to the patient about what I was giving.