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.
Specializes in icu, er, transplant, case management, ps.
In some states, it is illegal to video tape someone without their permission, regardless of what is being video taped. Not even police officers can video tape a wrong doer and then put their video on the net or TV without first blocking out their face. Perhaps some people haven't even noticed the the Houstan ASPCA block the faces of all individuals, except the officers, who appear on their show.
Specializes in icu, er, transplant, case management, ps.
In the not too distant past, I parked in a disabled parking space, went into the store, did my shopping and returned to find our local traffic enforcement officer writing me a ticket. I explained that I had forgotten to hand my tag. His response "You don't have a tag, you are getting the ticket. You can plead guilty and pay the $500 fine". I had the tag in my glove box. I got it out and he ignored me, got in his car and drove off. I plead not guilty. Went to trial, having a judge hear me and defending myself. The State Attorney made a motion to dismiss, which was granted. One officer wasted my time, the State Attorney's time, the judge's time. And cost the tax payers of my county several hundred dollars in the process.
Just think, if someone had been in my area, he could have video taped the whole incident, posted it on the net and given the entire world the wrong impression of me.
In some states, it is illegal to video tape someone without their permission, regardless of what is being video taped. Not even police officers can video tape a wrong doer and then put their video on the net or TV without first blocking out their face. Perhaps some people haven't even noticed the the Houstan ASPCA block the faces of all individuals, except the officers, who appear on their show.
Woody:balloons:
As a former broadcaster, I can tell you this is not true. You can be photographed if you are in public with or without your permission. If the photographer wants to use your image for commercial purposes, then they need your permission.
Tom..I think you have the right idea Pal! I'm severely peed, I take my Mam shopping once a week, she has chronic athritis/spondylosis and has recently had her bowel removed. Walks with a stick...at only 60 yrs old! Loss of dignity etc, from a former latin american dancer, who looked like Sophia Loren! Now looks like an old woman, shes frustrated that I have to drop her near the store and leave her till I park. Then, I have to leave her till i get the car and settle her back in.....often to the horns a blazin etc, as we dont park in the disabled space! SHAME on those who do so and dont need it! Keep on shamin those idiots Tom.............job well done!
I see more of a problem with pts that have high narcotic tolerances to begin with, they get admitted, come to my ICU, and the treating doctors are afraid to order the amount of narcotics that these pts need to control their pain.
I recently had a pt in with a thoracotomy/decortication/x3 chest tubes. Normally a pt with this procedure would have a PCA to control his pain and let the pt be in control. This pt was already taking 160 mg of Methadone at home! They cut his Methadone in half at the hospital and allowed marginal doses of Morphine Q6hrs. No wonder he was mad at the world, he got less pain relief than he did on a normal day of his life!
It sometimes takes a lot of guts to stand up to the Dr and advocate for the pt in these types of situations. They think "He's a narcotic addict, I am not risking my MD license by ordering what he need to relieve pain."
I tell them, at least give the amount of drugs you would a NORMAL patients. Give him a PCA, let him be in control. Geez, stuff like this really upsets me.
GEEZE!!! I know how it is!!!! Fortunately in my hospital when we get a person who is on the methadone program, the clinic which is at our hospital has to be notified and most of the treating docs understand (or will come to an understanding) that they need the maintence methadone as well as something else for the acute pain. Maybe one of the doctors who is involved with treating pts. with methadone could come and do and inservice to all staff.
GEEZE!!! I know how it is!!!! Fortunately in my hospital when we get a person who is on the methadone program, the clinic which is at our hospital has to be notified and most of the treating docs understand (or will come to an understanding) that they need the maintence methadone as well as something else for the acute pain. Maybe one of the doctors who is involved with treating pts. with methadone could come and do and inservice to all staff.
It's ironic that since I wrote that original post I suffered a horrible fall at work herniating C4 - C7 and NOW I AM A CHRONIC PAIN PATIENT!:trout: The next day I devloped 10/10 pain in my L shoulder, shoulder blade, arm, and my L hand turned numb. It was a Workmen's Comp injury and my life has turned upside down since. I now suffer from something I had never heard of before - Reflex Sympathetic Dystrophy. Reporting this work injury is definitely in the top 5 mistakes of my life. I have to beg WC for any healthcare and must use their doctors, the max pay in my state for being disabled at work is only $375 a week :trout: (ha, try paying your bills with that)! My treatment by some doctors and nurses has been a horrible nightmare because they all ASSUME I am a drug seeker. WHat possible motive would I have to fake this, certainly not monetary! I can't even used my own short term disability, long term disability, or health insurance because it was a workplace injury :angryfire
All I can add to the discussion is please don't treat every patient you have as a drug seeker. It only adds to the hopelessness of chronic pain. If I wanted to be a druggie, I wouldn't have herniated my whole neck, get a bizzare neurological disease, and give up a high paying job to do it! I am on the verge of losing my car and house because of the screwing that WC and the healthcare system have given me. A nurse that can't get healthcare because the WC insurer thinks I am too expensive to treat. I am telling you, it is outrageous.
Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
It's ironic that since I wrote that original post I suffered a horrible fall at work herniating C4 - C7 and NOW I AM A CHRONIC PAIN PATIENT!:trout: The next day I devloped 10/10 pain in my L shoulder, shoulder blade, arm, and my L hand turned numb. It was a Workmen's Comp injury and my life has turned upside down since. I now suffer from something I had never heard of before - Reflex Sympathetic Dystrophy. Reporting this work injury is definitely in the top 5 mistakes of my life. I have to beg WC for any healthcare and must use their doctors, the max pay in my state for being disabled at work is only $375 a week :trout: (ha, try paying your bills with that)! My treatment by some doctors and nurses has been a horrible nightmare because they all ASSUME I am a drug seeker. WHat possible motive would I have to fake this, certainly not monetary! I can't even used my own short term disability, long term disability, or health insurance because it was a workplace injury :angryfire
All I can add to the discussion is please don't treat every patient you have as a drug seeker. It only adds to the hopelessness of chronic pain. If I wanted to be a druggie, I wouldn't have herniated my whole neck, get a bizzare neurological disease, and give up a high paying job to do it! I am on the verge of losing my car and house because of the screwing that WC and the healthcare system have given me. A nurse that can't get healthcare because the WC insurer thinks I am too expensive to treat. I am telling you, it is outrageous.
(((((((((Hoozdo)))))))))))) I am so sorry that has happened to you!!! There is nothing I can say to make things better except I will keep you in my thoughts and prayers. I hope things look up for you soon!!! All the best Katie (katfish:)):flowersfo
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Hoozdo, I am so sorry. It sounds like you are going through hell; nobody deserves this.
I guess I too, can be a chronic Pain in the behind....I have migraines and I do all I can to avoid the ED. But on the rare occasion my meds do not work and I have to go as nothing helps (last time was 2 years ago), I appreciate being taken seriously and not as a drug-seeker. I also see the other side. We are a challenge to care for-----those of us who have pain that may be difficult and vexing to cope with...both for us and our health care providers. Where did I hear "but there for the Grace of God go I".........truer words never spoken. I try to keep my tongue and attitude in check when I get patients like this.
Most of the ones I have cared for are a pain in the behind because they have been labled " a chronic pain person" ie- drug seeker. I cannot tell you how often I have followed a nurse who gave the minimum ordered pain meds to a
post-op patient because they were "a drug seeking chronic pain history patient". It's amazing how much more compliant the patient gets when I max out his meds.
Patients who are being treated for chronic pain with opiate meds have a tollerance for those meds. What would work for your 80y/o grandmother won't help them at all. In addition when a patient has chronic pain issues the nervous system is unable to regulate painful stimuli as effectively. They feel even minor pain more acutely than people who have no history of chronic pain issues. Pain tolerance gets worse with the length of time the patient has had chronic pain not better. For this reason all the "warm fuzzy" interventions mearly annoy the heck out of them- distraction, music therapy, relaxation therapy...all can help non chronic pain sufferers but the mechanism that provides relief with there therapies is broken in this patient population. All you are telling them is that you won't or can't manage thier pain. That will make them a bit panicy and exacerbate thier pain. Even if the patient is drug seeking to feed an addiction, drug withdrawl is painful and additive to other painful health issues that are going on (post-op or the like). Get off your high horse and treat your patients pain. You are not qualified or capable of providing a drug rehab program in the midst of an inpatient stay for another health issue. If they need a referral to an approp detox/rehab program post recovery that is for them and thier doctor to decide. Making them suffer in pain isn't going to make them "see the light" and give up drugs. You are the patients advocate and for this admission the patients complaint includes pain. If the ordered medication is ineffective call the doc-get a change in the order and ask for a referral to the pain management department. Your shift and thier admission will be much better for it.
Most of the ones I have cared for are a pain in the behind because they have been labled " a chronic pain person" ie- drug seeker. I cannot tell you how often I have followed a nurse who gave the minimum ordered pain meds to a
post-op patient because they were "a drug seeking chronic pain history patient". It's amazing how much more compliant the patient gets when I max out his meds.
Patients who are being treated for chronic pain with opiate meds have a tollerance for those meds. What would work for your 80y/o grandmother won't help them at all. In addition when a patient has chronic pain issues the nervous system is unable to regulate painful stimuli as effectively. They feel even minor pain more acutely than people who have no history of chronic pain issues. Pain tolerance gets worse with the length of time the patient has had chronic pain not better. For this reason all the "warm fuzzy" interventions mearly annoy the heck out of them- distraction, music therapy, relaxation therapy...all can help non chronic pain sufferers but the mechanism that provides relief with there therapies is broken in this patient population. All you are telling them is that you won't or can't manage thier pain. That will make them a bit panicy and exacerbate thier pain. Even if the patient is drug seeking to feed an addiction, drug withdrawl is painful and additive to other painful health issues that are going on (post-op or the like). Get off your high horse and treat your patients pain. You are not qualified or capable of providing a drug rehab program in the midst of an inpatient stay for another health issue. If they need a referral to an approp detox/rehab program post recovery that is for them and thier doctor to decide. Making them suffer in pain isn't going to make them "see the light" and give up drugs. You are the patients advocate and for this admission the patients complaint includes pain. If the ordered medication is ineffective call the doc-get a change in the order and ask for a referral to the pain management department. Your shift and thier admission will be much better for it.
FireStarterRN, BSN, RN
3,824 Posts
[bANANA]Each to his own[/bANANA]