chronic pain patients: pain in the behind to care for

[Tadpole]

Hello,

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.

[PoppaD]

I have practically thrown in the towel. If a pt c/o pain, AND has ok VS...I med 'em and chart 'em. I now operate under the premise that their pain is what they say it is. The only things that I am not flexible on is admin. Narcs to pt's who I have found to be overly sedated, yet are requesting more in the way of meds...and, I do not give meds just because a family member is requesting it (you know, the concerned son/daughter at the bedside).

[SuesquatchRN, BSN, RN]

Rehab Nurse, I'm so sorry for what you're going through.

[rehab nurse]

Rehab Nurse, I'm so sorry for what you're going through.

Aww, thanks for that, Suesquatch. Means a lot to me to hear you say that. :)

I'm still hanging in there even though I've lost my car, losing my house soon since it won't sell, and I've blown through my whole 401k paying my COBRA payments. I've been denied for every type of assistance. I've contacted EVERYONE and I couldn't even get food stamps to feed my two young children. THey are just 6 and 5. When my money is gone, it's gone, so I'm not sure what I'll do. Don't even want to think about it.

Sorry for hijacking the thread. Just had to reply.

[SuesquatchRN, BSN, RN]

Aww, thanks for that, Suesquatch. Means a lot to me to hear you say that. :)

I'm still hanging in there even though I've lost my car, losing my house soon since it won't sell, and I've blown through my whole 401k paying my COBRA payments. I've been denied for every type of assistance. I've contacted EVERYONE and I couldn't even get food stamps to feed my two young children. THey are just 6 and 5. When my money is gone, it's gone, so I'm not sure what I'll do. Don't even want to think about it.

Sorry for hijacking the thread. Just had to reply.

Oh, my God, that's horrible. I hear you on COBRA. I pay my own bennies and some months I clear nothing. DH and I have been taking money off credit cards to make ends meet - and that can't go on forever. And I'm pulling out my 401K this month. But it's just us, no young children.

Can you put the house up way lower than it is? Or does that leave you in the same situation, of losing any equity that's left?

Once your money (and house) are gone you'll be eligible for some assitance. Although God knows where you'll be living. Are your folks nearby? Anyone who can lend a hand?

[teeituptom, BSN, RN]

as per the original poster, yes they are a pain.

I just fell like giving them a menu or offering them a vending machine with their choices there.

[icie rn, ADN, RN]

Chronic pain is as much a killer for many patients as cancer. It does take a lot of skill, compassion, and concern to manage these patients. Meds are evaluated one at a time, so if there is a change in orders, the old med is dc'd and the new med does not work or work as well, these patients tend to get difficult. Hubby has chronic pain in knees, one replacement surgery that was a nightmare, and now he needs another replacement, but NO physician will touch him because of cardiac status. So, we deal with his pain issues, his cardiac issues, and his overall health in a very careful, controlled way. I always appreciate the nurse who listens to him when I am not there, attempts to be of help, or even just calls me to see if there is anything else to be done. I have a good relationship with his physicians, they do trust me to give them the truth regarding his condition. So far, and the road has been a long one, he is maintained on a level of narcotics that would kill me, but the physicians know he does not abuse them and he needs them just to be able to walk. I just pray everyday and trust in God, otherwise my hubby would have been dead long ago because he would have committed suicide to be painfree.

[nightmare, RN]

Years ago I had a resident who would wake up from a sound sleep and roar with immediate pain,like some of you I thought he was putting it on.When my husband had his stroke I spent a lot of time in the stroke rehab unit and learned there about post stroke neurological pain.This pain is so difficult to treat even morphine will not dull it and one of its characteristics is the fact that the patient can be in a deep sleep one minute and be in terrible pain when they wake up.I still feel guilty about that resident all those years ago and the unworthy thoughts I had at the time!

Now my own husband suffers from the same condition and every day is a battle to get through pain wise.Amitriptyline helps a bit but not enough.

I also know someone who suffers from fibromyalgia and tender pain in the muscles and joints which are agonising where her main pain concern.She eventually moved to Spain and I believe the heat has relieved her a bit.

Chronic pain is debilitating and yes they do get cranky and they know better than anyone that if they are moved the wrong way they will be in pain so if a carer/nurse goes to shift them and they know it will cause pain then of course they will shout!

I have also met the ones who just want pain relief all the time and yes they are irritating,they also give the real pain sufferers a bad name.

[fusster]

I also found this post very hard to read. My mother suffered from chronic pain for over a year before being diagnosed with a rheumatic disorder, for which the only treatment is prednisone and has worked wonderfully since she started it. Watching her in pain was horrible for me. She was very stiff, couldn't perform ADL's (couldn't even brush or wash her hair d/t the muscle stiffness), couldn't even hold her baby grandchildren. She tried everything to relieve the pain and muscle stiffness-pain specialists, chiropractors, PT, massage therapy, would lay in hot baths for hours at a time-but refused to take the strong meds because she thought she would then be labeled as a drug seeker and no one would take her pain seriously. She was diagnosed with fibromyalgia-the catch all term for people with chronic pain with no other IDENTIFIED cause, before she finally went to a rheumatologist and got a proper diagnosis. If someone has this diagnosis, please don't put the pain off as "all in their head" or label them as "drug seekers". If I have a patient with chronic pain issues, and they want the pain killers, I'll let them know about the possible side effects and, if they still want them, I'll give em to them. It is not my job to judge whether the pt's pain is real or not.

[CRDBear]

I think this post speaks to one of my frustrations in being a nurse - being your nurse does not mean that I am your personal "whipping boy". Nowhere in anyone's job description does it say that I need to put up with rudeness, threats or general LACK OF RESPECT for me as a person. I don't care how sick or in pain someone is - rudness is not acceptable. PERIOD. I understand that people in the healthcare setting are sick, hurting, scared and frustrated. In taking care of you, my job is to do that, not to judge. If my patients are in pain I will go out of my way to ensure that I do the best job possible to make them more comfortable and advocate for them. I will try not to judge wheter I feel their claims are legit or whether they are "drug-seeking" or whatever. All I ask is that I am treated with the basic respect and courtesy that I extend to ALL of my patients. I will listen to anyone vent, cry, scream ect. and offer whatever support I can.

Just please don't direct it at the person trying to help you!

[rehab nurse]

as per the original poster, yes they are a pain.

I just fell like giving them a menu or offering them a vending machine with their choices there.

i'm sorry you feel this way. has EVERY chronic pain patient you had been horrible to take care of?

[Tweety, BSN, RN]

My heart goes out to the chronic pain patients, it really does. We certainly can't understand what it's like.

I'll be honest. I work in med-surg trauma and when I get in report that I'm getting a chronic pain paitent who just broke some bones, or some other kind of surgery I groan "oh my God, this is going to be a challenge to manage". But I do rise to the occasion and advocate. Usually because the docs don't acknowledge their home meds and routinely order morphine and percocets at doses appropriate for the "normal" patient. Or worse, they order the home meds thinking this will be enough. (Wrong, they need their homes meds and then some.) I usually wind up making multiple calls to the MDs.

Each chronic pain patient I've worked with has a unique response to trauma. Some become very unhinged, crying and carrying on. Some become rude and demanding thinking this is how they are going to get more pain medicine from us. Some are quiet and stoic. Most however, express that their pain is uncontrolled, ackwowledge they are narcotic dependent to function and merely want us to work with theim to control their pain.

All of the patients deserve their pain to be controlled. It's quite a challenge and sometimes they suffer for a day or two before things are under control.

As for the question as to why docs order these addicting pain meds? Rehab answered that quite well...........because they work, and allow patients the opportunity to participate in life.

[Joe NightingMale, MSN, RN]

I think it helps to keep in mind that pain management has only been given priority fairly recently, and thus there still is a lot to learn about how to control a patient's pain,