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.

[Tweety, BSN, 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,

Right.

Plus we have to learn the disctinction between a chronic pain patient and a "drug seeker". There are far fewer drug seekers than we would like to think there are, however they jade us terribly, clouding our judgement causing us to label all chronic pain patients negatively.

[teeituptom, BSN, 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,

And Chronic Pain Control is not best served by any ER

[bethin]

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.

I'm so glad that you don't say "oh God, they're going to be a pain in the butt for 12 hours." Glad you look at it as a challenge and not a burden.

You last paragraph sums up how I feel - as a chronic pain sufferer it's hard to enjoy life. Everywhere I go I scope out the nearest br and carry my pain meds, phenergan and others along with a bottle of water in case they're needed. If taking a narcotic once a day so I can enjoy a vacation I'm ok with that. And in all honesty, when I'm in pain I use the pain scale like in hospitals. If it starts out as a 4 I wait. If it increases rapidly to a higher level then I take a pain pill.

Chronic pain can be mentally draining. I remember first being diagnosed with Crohn's and I hit bottom. Thought my life was over. If you're taking care of a pt with chronic pain, IMO you need to look not just at the physical aspects but the mental and emotional aspects also. If you have a newly diagnosed pt with chronic pain of course they are going to be confused and asking "why me". This needs to be addressed also.

[leslie :-D]

i don't have stats but do know that most who suffer with chronic pain, also have concurrent dxs of depression.

i've seen the debility it creates on their lives.

dang, i work in hospice and still work with some who fear the pt is going to get addicted!

we live in a judgemental society.

we also live in an ignorant society, although it is improving.

more research is being done.

more avenues are being created.

yet i do understand the frustration of dealing w/demanding pts.

as someone else stated, i will not be anyone's dart board.

i let them know i will do all i can in helping them;

and that respect is a 2-way street.

i thank God every day that i don't live the types of lives of many of the people i see.

many are truly desperate situations.

leslie

[ERRNTraveler, RN]

And Chronic Pain Control is not best served by any ER

AMEN!!!

[deeDawntee, RN]

It is not just the patient that makes these situations unbelievably difficult. It is that they aren't set up in a way so that they can be taken care of adequately. The surgeons or anesthesiologists don't want to deal with it, the hospitalists certainly don't, I have found the pain clinic docs aren't involved in their in-patient care. So no one will order the dosages that these pts need, as a matter of fact, they frequently cut back on their meds (in an acute situation!) So the patient has only the nurse to blame and as we try to get this patient help we are shut out at every turn. I hate it soooo much, I can't tell you, and it is rarely because of the patient, although when they start getting rude and demanding, I just want to pull my hair out, becasue I really try to help!!!! It is probably the most demanding situation I personally have to deal with. I had an extremely hard situation recently with the patient blaming me for her inadequate pain control!!! What a pain in the ass that has been. I'll spare you the details.

[P_RN, ADN, RN]

I am also a chronic pain patient. I have been unable to work for the past 8 years. I take no narcotics now, but I have in the past. Fortunately I am able to maintain on neuroleptics and muscle relaxants. Also fortunately I have had quite compassionate care givers. I walk with one or two canes or on bad days forearm crutches.

As our Nativie Americans have been quoted in the movies, " in my moccasins......." Pain is apparently NOT the 5th vital sign to some nurses as yet.

[rehab nurse]

I TOTALLY agree that systems problems are a big contributor to inadequate chronic pain control. Pain docs often don't have the rights to prescribe for their patients who are admitted to the hospital. And I also agree TOTALLY that the ER is an inappropriate place to handle chronic pain.

However, at times, a chronic pain patient ends up in the ER for trauma or accident, etc. If that happens, what is a CP patient to do?? We need treatment, and we need someone who will prescribe us enough meds to treat the pain. Don't we deserve that?

I absolutely have had horrible experiences with pain patients (and all types of OTHER patients as well) in my previous practice. So, I feel for the nurses who are having difficulty with these patients. I really do. A nurse should not be a doormat, or be treated horribly by ANY patient, period. But, it happens all the time. Such a shame.

I know also that it is the malingerers and the fakers who ruin it for the legitimate pain patients like myself.

I have been fortunate for the most part in my hospital experiences. My most recent surgery, for cancer, I was given adequate medication above and beyond my home (base) meds. I am also grateful that my physicians and PA's give me enought leeway with my medication so I can AVOID going to ER for a flare of pain. I can call 24/7 to get help and for that I am grateful. I have never gone to the ER for a pain crisis, thank God. I have enough to manage at home. I have had to go to ER for my migraines, but all I need for that is usually fluids and some IV zofran. Narcotics do nothing for my migraines.

I hope no other nurse has to go through what I have after multiple back injuries and other health issues. It is horrible to be thrown out to the dogs after years of dedicated service. My mind is still good, even though my body isn't. Chronic pain definitely changes a person, no doubt. Having to "prove" your pain is "real" and hauling along my multitude of medical records everywhere I go is humiliating. Like I'm guilty until proven innocent.

I am truly sorry for those nurses who were treated horribly by a chronic pain patient. I wouldn't ever do that to my nurse. So, please know that not all of us CP patients are horrible!!! Thank you to those nurses who advocate for us CP patients when we are hurting!!!

[ayla2004, ASN, RN]

i'm still a student but pain management is a skill i'd like to learn. one of the key facts i've come across from evidence is the golden rule is pain is what the patient says and where the patient says. yes we may be taken for a fool by those drug seeking but at least we won't be denying patients in pain relief. PCA for post ops are great they use less opiates than if nurse adminstered. For chornic pain most pain patients would love to get off their pain drugs and will try TENS heat, cold massage relaxtion and nerve blocks.

nurses are bad judges of someone else pain unless they listen to the patient.

[leslie :-D]

rehab,

i'm so sorry about your ca dx and wish you continued healing.

i have found however, that if one has a verifiable dx, such as yourself, it is easier to be treated.

yet there are too many that go through test after test, only to yield unremarkable results.

doctors then start suggesting that the pain is in your head;

or you just lose credibility on all counts.

and so, this pain persists, in the absence of anything remotely treatable.

abd and back pains are common complaints but frequently 'show' little trauma.

fibromyalgia seems to be the new syndrome when all other dxs have failed.

one is easily stigmatized if using narcotics for mgmt.

i will say again-we are a very judgemental society.

compound the use of narcs with no evident pathology...i can't imagine anything more frustrating and discouraging.

healthcare members need to become more educated in the assessment and treatment of pain.

it is not as simple as "pain is whatever the pt says it is".

living w/chronic pain, comes with alot of baggage.

doctors need to really start listening to and believing their pts.

further education in distinguishing between the drug-addicted med seekers and those who are truly suffering, is also paramount.

we will do a great service to our cp's, once we understand and appreciate all dynamics involved.

we owe them that much.

leslie

[paytonsnana]

I was hit by a truck that was going 75mph when he crossed a double yellow line. This was in 1999. I have had several cervical plexus blocks, these work short time and are debilitating for a while. I have done well trying to live through the pain, however when it gets out of control, it is really hard to be nice. I always go and appoligize to the nurses. My ortho DR is great at keeping my pain controlled, but there are time when nothing helps. I myself have had nasty patients. They are a problem, they drain your energy and nerves. This is the time for nurses to talk to their DR. and find out what they usually do at home to relieve pain or what they do to distract their attention.

It is always good to take time to blow off steam away from the job.

[SuesquatchRN, BSN, RN]

If we'd just get over our judgmental attitudes maybe we could medicate people out of their pain, psychic or physical.

I don't actually care if someone is "drug-seeking." Make it legal for adults to take what they want. Keep it illegal to get behind the wheel or show up at, say, your nursing job, high.