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.
Soooo, I have CP, I truly AM allergic to morphine and I lie about my pain level. I always knock it down a notch, & I try to laugh, giggle & smile, talk on the phone. Whatever it takes to distract myself from the pain that I really am in.
What am I supposed to do... let everyone see me cry all the time? I'm too stubborn for that crap & my eyes get all red & puffy & it's way obvious that I've been crying.... so I fake it. I don't let people see me sweat.
I'm 2 months s/p spinal fusion....2nd back surgery in 3 yrs & I'm not even 40 yet!!
I won't tell my true pain rating to anyone. I need to get back to work & if I'm on pain meds, I've been told that I can't work ... Funny that nobody had a clue, except my doctor what I was taking BEFORE surgery & I was not impaired. I functioned the best that I had in years, b/c my pain was in CONTROL!
So, before anyone tries to classify me as a seeker, try walking a mile in my shoes.
Most people who know me do not know when I'm in severe pain. Those closest can pick up on it at times. I tend to get very quiet and withdraw, trying to ride it out. I too distract myself as much as possible.
The pain scale means nothing to me (personally). A couple of years ago, I worked a crazy 12 hour day shift on our unit with an intestinal abscess, and the last 4 hours or so with a bowel perforation. (I know exactly when it perf'd... I remember thinking "uh oh", but at least the white-hot pain went away for a little while). When I was admitted to my own floor, the nurses I'd worked with that day were stunned to find out what I'd gone through that shift.
Last year, I had a loop of bowel slip through a midline incisional hernia (that I didn't realize I had) and it became incarcerated and strangulated and according to the surgeon, I'd developed early peritonitis. Again, I knew what had happened (I could feel it through the skin) and drove myself to the ER (funny looks from the registration and triage nurse when I told them what was wrong).
I used no painkillers with my first labor and delivery; had an abruption with the second. I attended nursing school with a staghorn calculus in my left kidney, which then led to an abscess. (I thought I'd pulled a muscle in my back)
Point is, I have an exceedingly high tolerance for pain. To assign it a number is ridiculous. A migraine can be just as bad as (just prior to) the bowel perf. I thought the tonic contractions/abruption was painful--- until I strangulated the bowel. Yow. It's all relative, and part of me is superstitious about assigning a pain "the worst I've ever had" because with my luck, as soon as I say that something worse will come along. I've had enough excitement in my life, thanks :stone
With me, it's either I'm tolerating it, or I can't take it anymore. I'm in constant pain, and there's no middle ground. But once I hit that wall, I need relief NOW. I know that's not how you're supposed to approach pain control (I'm not practicing what I preach lol) but I do not want to end up on meds and face the sort of prejudices I see every day.
I suppose sooner or later I'm going to hit the wall and stay there. Then I guess I'll be forced to do something. Until then, I muddle through and try to distract myself as much as possible.
So, before anyone tries to classify me as a seeker, try walking a mile in my shoes.
Most people who know me do not know when I'm in severe pain. Those closest can pick up on it at times. I tend to get very quiet and withdraw, trying to ride it out. I too distract myself as much as possible.
I think everyone is in agreement that there are patients who legitimately need pain meds. There's not a problem with that. I'm glad you have a good doctor and meds that do help you. We're discussing those patients who are allergic to all pain meds other than the particular one they want and pain level stays at 10+ despite the amount of meds they are given.
I think everyone is in agreement that there are patients who legitimately need pain meds. There's not a problem with that. I'm glad you have a good doctor and meds that do help you. We're discussing those patients who are allergic to all pain meds other than the particular one they want and pain level stays at 10+ despite the amount of meds they are given.
If I show up at an office or ER and give a true description of my pain level, tell the doc and staff what I know does and doesn't work for my pain ... and given that I don't "look" like someone in pain, I guarantee you I'll be labeled as a "seeker". So why bother.
i am under the impression that using placebos without patient permission, ie, research....is unethical and possibly illegal.....if ever a doc wants one given he/she will have to do it themselves.....AND it doesnt prove anything anyway, the whole basis for the "placebo effect" is that SOMETMS they do work, especially if the person giving it is TRUSTED to be doing the right thing....
As I was standing outside a pt's room (pulling her meds) I overheard her speaking to her daughter, she stated that I was being a real jerk for not giving her her meds every 3 hours. I walked into the room and loudly announced that I was currently pulling her meds and her vicoden was ordered to be given every 4 hours, if she wanted it changed then she should speak to the Dr. Problem was that you give her two 5/500 vicodens and she'd be stoned for and hour and a half then start immediately demand more. Her daughter called me 2 hours later stating MOM is in pain give her more meds. I suggested she contact the Dr, she wanted to know if I could give it "just this one time" I stated that my license was worth more to me than that and hung up. Luckily my co-worker was standing next to me when I took the call. It was reported to the DON then the Dr who promptly cut back on her vicoden order after explaining to Mom & daughter that mom was addicted and needed to withdraw.
I read 10 pages of this thread and then couldn't resist adding my 2 cents worth. If I repeat what someone else has already posted, forgive me. I, too, am a chronic pain sufferer who hasn't worked as an RN in years. When I was nursing, before I started having pain, I routinely saw patients undermedicated. Watching them suffer and not being able to do anything about it broke my heart. Never, ever did I give a placebo nor would I ever. Yes, we had patients who were frequently admitted to the hospital for pain control. Some of them would be sitting up in bed, eating, talking, laughing and at the same time be asking for their pain meds. Never did I pass judgement on that patient because it wasn't my place to decide whether they were having pain or not. It was my place to give them what the doctor thought they needed. I would, however, always chart the behavior of the patient who requested the meds. Anyway, here's what I've learned since having chronic pain:
1) It's not the nurses or doctors place to decide if a patient is having pain. Everyone reacts to pain differently. There are days when I work with a pain level of 7 or 8. The average pain-free person would either be home in bed crying or at a doctor's office or ER begging for relief. I am able to work because my pain has increased gradually over a 4 year period and I have built up a high pain tolerance because of that.
2) Chronic pain changes your quality of life. I can no longer enjoy doing things that I once did. I am depressed because I know that the only thing awaiting me in life is more pain.
3) Those in chronic pain feel helpless and hopeless. We live in the richest country in the world with more advances in technology, medicine, etc. than anywhere else in the world yet we treat our animals with more compassion than we treat our people.
4) 90% of doctors, IMO, are not skilled at treating their patient's pain adequately, especially chronic pain. And the sad part is, they don't care. They would rather the patient remain in pain. I've even had doctors tell me that they know I'm miserable but there's nothing they can do to help me so learn to live with it.
5) I am not an addict but when my pain level is off the charts, you better believe I'm drug seeking. So don't give me that condescending look or act like I'm a piece of dirt if I come to your ER to be treated for pain. I hate going to any ER and would not be there if I didn't have to be.
6) NO ONE can imagine what it's like to be in pain 24/7 unless you've been there/done that. Oh, how I wish I could transfer my pain for just 5 minutes to the doctors who have refused me pain meds. I guarantee they would be screaming for the morphine.
7) No one should have to beg for a medication that would only give them some quality of life. I think that with all of the pain meds available today that it's not too much to ask for something that will at least give me some semblence of a normal life.
8) The medical profession has failed humanity when a person in chronic pain has either suicidal thoughts or has considered finding a drug dealer in order to be relieved of the pain.
Sorry for going off on this tangent, but I'm pretty fed up with the whole medical community, nurses included. I'm tired of people stereotyping me if I need something for pain. I don't get high when I take pain meds. I just feel like a regular person who can function with some normalcy. I know I got off topic. There's no need for anyone to be rude to a nurse. However, there are days when my pain is so bad that it takes everything I have to be nice to anyone. If my post does nothing else, I hope it makes everyone who's prejudiced towards chronic pain patients reconsider. I wouldn't wish chronic pain on anyone. Should you ever experience chronic pain you'll know what I'm talking about and feel completely different about this subject. Thanks for taking the time to read this and letting me vent. It's late and not very well written, I know. Please forgive!
When I know a patient has chronic pain, I make a point of giving them as much control over their pain control as possible. When I ask them their pain level on the pain scale (which is highly subjective; your "7" might be my "10"), I ask them what they are used to, what works, and what their goal is. Obviously for someone with chronic pain, achieving a zero on the pain scale is unrealistic. Usually they're happy just to knock it down a few points, which is, again, completely subjective. Pain control, in my opinion, is more an art than a science, and as a nurse, it's not my place to be judging whether they are truly in pain or are simply "seeking". One of the signs of poorly controlled pain is drug seeking behavior such as "clock watching". This is a sign that the person is not getting adequate pain relief, but can also be perceived as drug seeking. It's not my place to judge.
Specializes in rehab; med/surg; l&d; peds/home care.
DBMC, You are right on!!! I am sure you've seen my posts in this thread, but my "chemofried" brain is not the greatest at writing anymore.
Since I wrote on this thread, I am now confined to a wheelchair most of the time, unless in my home. I cannot walk more than a few yards without having my pain jump off the pain scale. It used to be that sitting was the worst position for me to be in. Now it doesn't matter what position I'm in, I hurt all the time, 24/7, and changing positions doesn't do squat like it used to. I used to pace my hallway when my pain was bad, because it gave me something to do to distract me. Now I am stuck in place, and you're darn right, it sure does affect my quality of life. What 30 year old woman wants to be in a wheel-chair? Do you even realize the kind of looks I get when I use a store-issued scooter on those very-rare occasions I must go out with my family to get necessities???
I also have a handicap sticker now from my pain doctor. You would not believe some of the hurtful comments I have received from people, usually elderly people, who see me get out of my car with my kids and my driver (usually a friend or a parent) after parking in a handicap spot. I have been called all kinds of horrible names. I guess because "I look okay" and "I am so young" that I am not disabled. I sure wish people would learn: 1) words CAN hurt, and 2) disabled people come in all kinds of packages, and 3) pain is what the person IN pain says it is!!!!
Chronic pain is woefully misunderstood and under-treated in this country. Most physicians I have been to (cause I have other health problems too, ya know) always raise their eyebrows when they see the amount of morphine I take in a day. I take a hefty dose, that's for sure, but it brings my pain to a usually-tolerable 5 or so. It sure doesn't get me "high", "loopy", "stoned", "drugged up" or any other negative term people can come up with.
And you are right that it causes depression. There are many studies out there that prove what chronic pain does to a person's brain. I've seen MRI images of people with no pain, and those with chronic pain. Chronic pain causes depression, no doubt. Who wouldn't be depressed if you had pain every second of every day, couldn't sleep well because of the pain, couldn't do anything you used to do because of the pain, can't work or support your family because of the pain, and (the worst part) get mis-treated by SOME medical professionals because of your pain and/or your need for meds. I am one of the lucky ones who found a doctor who believes that I suffer from pain, because it's been proven.They know what causes my pain, and it's not fixable. So many of those who suffer with disabling chronic pain can't find a physician to treat them or offer anything other than some awful Darvocet or Vicodin to treat their pain for a few months before they're "cut off" for "asking for more pain pills, because you are an addict!!!!"
What scares me, horrifies me more than anything? The thought of being unconscious after a trauma of some kind, or being in the ER and unable to verbalize that I am on morphine for chronic pain. I wear a medic alert bracelet and subscribe to their service (a nurse/doc can call the number on my bracelet and give the code on my bracelet and find out a list of my meds, the doses, who prescribed them, who are my doctors, my medical history, etc), and I keep a list of my meds in my purse, and my best friend and my parents also have copies of my medication lists. I am so scared that I will be in severe pain and that nobody will help me.
And, because I am so young, I am scared of when I become terminal and ready to die. I am so afraid that I will not be given the amount of medication needed to take away my pain, because by then, if I am still on oral meds, the dose will be much higher than it is now, and I know that it will probably make the nurse administering it and/or the doctor ordering it VERY uneasy. I've seen more than my share of nurses scared to administer morphine and adjunctive meds to a dying patient. I've also seen nurses who think a person with a higher-than-normal dose of opioids admitted to the floor is an addict, and try to get their meds reduced (and I've seen doctors who go along and reduce the meds).
I am not saying that all nurses and doctors are like that. For the most part, the nurses and doctors I have worked with in my career have been very good at managing acute pain. But I do think more needs to be learned on managing chronic pain, especially managing chronic pain in the hospital, because as we get ready to have the baby-boomer generation need more medical and nursing care, we will come across more and more people who are being medicated with opioids for chronic pain. I saw a informal study not to long ago that found that the baby-boomer generation has a higher incidence of chronic pain than previous generations did.
Alright...that makes two posts for me today, and that really wiped me out. I HATE chemo, I am really tired of chemo....
Specializes in icu, er, transplant, case management, ps.
I have read this thread with interest. I am a chronic pain sufferer. And my chronic pain is due to failed back syndrome. In late 1988 I underwent partial removal of disk material that was entrapping my L4-5 nerve root on the right side. The relief I felt was pure heaven. I took to my rehab like a duck to water. A duck to water until I was hit by a big rig eight weeks after my surgery. I suffered major trauma that threw my back into the pain I had initial suffered, along with the inability to walk and it took several years before I was able to ambulate.
I realize that a good number of my peers judge patients who complain of pain based on their own pain levels and tolerance. This works well when the person complaining of pain is being care for by someone who suffers from the same level of pain. Unfortunately, rarely does it happen. Do you want me to come to you crying, moaning and groaning? Or do you want me to be cheerful, distracting myself with jokes or talk? I honestly don't know because regardless of the face I present, most of you will judge me and my needs. And most of you will under medicate me, either fearing to contribute to my so called addiction or having all ready labeled me, don't want to give me the dose I need.
I'll let you in on a few things. I can't walk more then twenty feet without sending my lower back and right leg into severe spasms and pain. I can't lift more then ten pounds. I avoid the ER for any pain management, you are too judgmental. I try everything I can before seeking out a narcotic. And like a great many chronic pain sufferers, I suffer in silence. We are general under medicated, over labeled and tired of being judged.
My friend was using a wheelchair last summer due to no less than five prolapsed discs. She could walk short distances, but staying on her feet much longer caused her excruciating pain. If she was out in public and got up out of the wheelchair, people would give her dirty looks.....
EmmaG, RN
2,999 Posts