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.
PCA for post ops are great they use less opiates than if nurse adminstered.
I'm going to have to disagree to some extent on the PCA. In Jan I had a single level fusion and was on a dilaudid pca post -op. It worked, but sucked. To maintain pain control I was essentially forced to stay awake all night to hit that button every 8 minutes.
Fast forward to today and I am relatively pain-free (still alot of tylenol in my daily regime) and back working in the OR (actually went back after 8 weeks to light duty). After my own experience, I will never question a patient regarding pain having been there.
I'm going to have to disagree to some extent on the PCA. In Jan I had a single level fusion and was on a dilaudid pca post -op. It worked, but sucked. To maintain pain control I was essentially forced to stay awake all night to hit that button every 8 minutes.
pca where i work if the patient pain is not being addressed adequatley, and keeping you awake is a very good sign most would think, can be over written by a nurse and a bolus given within certain protocol we tend to use morphine or fentaynl. by bolusing a higer doss than the locked the pt then can get comfortable and use the pca when required.
however i think this happens more easily in pacu and ward nurses may be less willing and more.
unsure to do it.
however i do recongise that pain is not just physcial and if their are unlyting issues in a person life emotional/pscholylogical they may contine to report severe pain even when the dose would knock out a elephant, of which caterory chronic pain suffers fall into. however if these issues are unrelsoved but if they say their in pain i take it as they are, while talking with the pain mangament team and the MDT
pca where i work if the patient pain is not being addressed adequatley, and keeping you awake is a very good sign most would think, can be over written by a nurse and a bolus given within certain protocol we tend to use morphine or fentaynl. by bolusing a higer doss than the locked the pt then can get comfortable and use the pca when required.
however i think this happens more easily in pacu and ward nurses may be less willing and more unsure to do it.
And in the UK. You have no idea what a PITA the controlled substance laws here are, and how difficult they make pain management.
I recently sent 2 people to a pain clinic on the same day. One who is already overmedicated (IMO) came back with lots of orders. The other, no med changes. Pain is so subjective. If you tell me your in pain, I'll medicate.
One story though. Upon sitting up, 1'st time 3 days post-op back OR, 3 days of laying flat , my nurse commented that I was the first person she had cared for who smiled when getting up.
Not everyone in pain responds the same way, and those pleasant chronic pain sufferers don't stick in the memory as often as the nasty ones.
i have never known more pain than the 2 migraines i suffered over 10 years ago, tg
how cp pts/people get out of bed and carry on, i cannot fathom
they need what they need to live/be/survive
yes they can be difficult pts but we have a job to do to meet their needs , right ?
I don't know about other CP sufferers, but for me it was going through the same stages as you would when a loved one dies. Denial, depression, bargaining until eventually you learn that this is your life and there's nothing you can do about it. I've learned to cope. Life is short and I refuse to sit in bed all day crying "why me". And I do still have those moments.
After living with GI problems for 6 years I still meet resistance from others: when I went to Korea (both times) family and coworkers told me I shouldn't take the trip, what if I got sick? Skydiving? What if you get sick (ya know, in those few mins I could get sick)? Traveling alone to San Diego? They thought I was nuts. Well, anyone could get sick in Korea or anywhere. I deserve to be able to live my life. I take my trips and do everything anyone else would do (ok, maybe not skydiving) but I feel such a sense of accomplishment afterwards.
I'm not sure I would want to go back to my healthier self. I've learned so much about myself. I'm stronger now.
Having been both the nurse and the patient with uncontrolled chronic pain, and acute pain, I hope I will always be the advocate for my patients in pain. There was a book out a couple of years ago,about the disgusting federal control of physcians , and pain management. There were many being forced out of their practices, due to government regulation, where it was felt they over medicated and prescrbed too many narcotics. Many patients in one practice were traveling 3 states to just get a month's worth of painmeds. The prescribing in this particular practice maintained, if the patient required the large doses of narcotics to feel lke a person, and function in their lives,they should have it. BUTthey were using cocktails, with the anti depressants,in addition to gving stimulants to help counteract the side effect of the narcotics. Although, over time, the sedation,etc becomes less of a problem. There is also the use of methadone, which works really well for some patients, but not those that are a a PIB who want to "feel the effects" of their meds. Methadone tends to give them greater relief with less side effects. BUT these patients are treated badly by staff who think of methadone as for heroin patients only.
Not too long ago, I had a surgery, that before hand I addressed the fact that I was on these meds at this dose, and previous experiences (three previous for the same thing) with post op pain had not beengood. HE promised me that he would get anesthesia to be sure I had adequate pain control WRONG
When I recovered I called the director of that unit, and gave her a blow by blow, and insisted that the nurse who out and out lied to me, be addressed. Her answer; "Sorry, they charted your pain as 3, so nobody questioned it IN addition,we were using 60% float staff." Excuses are just that THERE is NO excuse for a patient, esp. post op, to cry all night in pain. One of the biggest helps with a pca is to also order a small continuous dose, allowing the patient to drift off and yet still get enough meds to not be awakened by severe pain. Post op my OS denied me meds as he did not do that. HE was a surgeon only. but he thought that my gp should be covereing my preop meds, as "now was not the time to cut down".Believe me any chronic pain patient who is lucky enough to find a compassionate, educated physcian who believes in adequate pain control, and trusts the patient to manage their pain with the best and smallest amount possible is very lucky. THERE are too many who merely suffer, some self imposed,as they fear addiction, which in chronic pain becomes tolerance.
I, too,have had the PIB patients,who are not satisfied no matter what. I try to remember all the contributors to their unhappiness.I give them the best care I can, I mention to physcians during rounds, in front of the patient, if their pain is not controlled by their present meds. IF I admit a chronic narcotic patient,and their home meds do not appear, I call the physcian, and I ask for additonal pain meds for their acute pain. I offer backrubs, a favorite tv show, just let them talk, anything to get their minds off the pain. But I am in the unique position of having been there done that, and know how much a competent, caring nurse can do to make the experience less traumatizing. This is one of those situations where you can say "WHAT can I do to make it betterfor you." SOME will take advantage, but then they will always try. As a student, I met an OS, who insisted we give his obese patients their injectable narcotics with a spinalneedle, OR up in the upper shoulder area. HE said they did not "get any benefit",as the medstook forever to penetrate that fat, and was absorbed too slowly when given with a 2 -3 inch needle" It is like every dr ordering MS instead of demerol.Demerol has a better effect for many patients, but drs. don't like the fact it hangs around so long and actually accumulates some and does provide better pain relief. I am one of the few patients for whom MORPHINE does absolutely nothing.Vicodin gives me better pain relief.
Please just treat every patient with compassion and respect, and remember they won't always be on their best behavior and their reasoing may be overcome by their pain and discomfort.
Rehab -- as for qualifying, did your physcian or PM drs. not diagnose you with disability so that you can claim it? IF the diagnosis is overruled by the disability dr. , than you can use your narcotic pain control as a diagnosis for disability, as you would not be able to pass a pre employment drug test for nursing> In addition, they have to be able to show you a comparable job you can do at at least 70% or so of you previous salary. IF you have no income, I don't see why you would not qualify for food stamps, as each state has its own income, but with none, you would qualify. Also, at least in MO, you can keep your house, and have $2000 in the bank. At least, you should be able to qualify for medicaid or MCt for you and your children > I haven't helped somebody with this for awhile so am not uptodate on all levels. What about child support? Go to your DFS office, and just tell them you need emergency help. Best of luck. ( I am assuming you did not carry disability short or long term at your previous job) I, too, have paid Cobra, and it took almost all my disability to pay for it.
I'm going to have to disagree to some extent on the PCA. In Jan I had a single level fusion and was on a dilaudid pca post -op. It worked, but sucked. To maintain pain control I was essentially forced to stay awake all night to hit that button every 8 minutes.
Our docs, God bless 'em, order PCA's with a low level basal in addition to the patient controlled bolus doses for just that reason.
This is an interesting thread for me to read because as a new nurse, on a ortho unit, I am continully trying to better myself in terms of managing pain. Pain control is HUGE on our unit and we also get a lot of chronic back pain pt.'s, etc. through the ER.
One of my worst nights ever was a chroinc back pain patient who had a knee replacements that day. OMG, horrible pain, 10 out of 10. He was on a Dilaudid PCA but of course it was less than what they normally give pt.'s and this was a big fellow. Then, medical comes to see him, realizes he is in pain and DC's his PCA and orders 2MG Dilaudid boluses q 1-2 hours, or something like that, I can't remember exactly. Well, that isn't doing it either...10 out of 10. I just want to say to these DOCS you come take care of these patients then if you are going to make these kind of decisions. THen, had to call medical back to get SOMETHING worked out. PCA was started back up, pharmacy to dose. So, called pharmacy, told him the order, asked specifically for a continous dose since he was denied that with his first PCA. I mean, the first settings on the PCA were less than what we'd give anyone! Hello, he had knee surgery today!!!!
SERIOUSLY, i just want people to know that sometimes as nurses our hands are tied. Everyone is right when they say Dr's are so conservative with their pain management techniques with these chronic pain patients. I can say that and I have only been a nurse a short time, that's how obvious it has become to me. I do everything i can and I take peoples word for it. It is a challenge, no doubt.
What NEEDS to be done is for these patients to be seen and pain managed by a pain specialist who has total control over their first hours to days of hospitalization. My place had and entire anesthesia pain service.......surgeons and attendings could not write for or change narcotics. Only the pain service 24/7 could.
Wanted to throw something in - I'm only a student, but we have been tested on this topic repeatedly. Addiction, dependence, and tolerance are three very different words. Tolerance is when an increased dose is needed to produce the desired effect, while dependence is when stopping the drug abruptly will cause a withdrawal syndrome. Pain meds, as well as many non-narcotics cause both tolerance and dependence and they are physiological and involuntary. Addiction, on the other hand, is completely voluntary (in the beginning) and has only to do with the patient. Addiction to a drug is going out of one's way to seek it for its CNS effects alone and has nothing to do with pain control or symptom management. The same patient who becomes addicted to oxycontin would likely seek any narcotic or other substance he/she was exposed to. It's a psychological condition. That's the gist of what is being drilled into our heads repeatedly by my nursing school - one of our professors suffers from chronic pain, is a PhD oncology nurse, and has personally done several studies on the rampant inadequate pain control in our area.
Our docs, God bless 'em, order PCA's with a low level basal in addition to the patient controlled bolus doses for just that reason.
This is what we try to get ordered, but by the time we get our residents trained, a new group rotates in and it's back to square one. :trout: Cancer pain is never going away. These people wake up in excruciating pain or are afraid to fall asleep so their meds don't wear off. I can't tell you how many nights I've spent playing catch-up.
EricG
51 Posts
I'm going to have to disagree to some extent on the PCA. In Jan I had a single level fusion and was on a dilaudid pca post -op. It worked, but sucked. To maintain pain control I was essentially forced to stay awake all night to hit that button every 8 minutes.
Fast forward to today and I am relatively pain-free (still alot of tylenol in my daily regime) and back working in the OR (actually went back after 8 weeks to light duty). After my own experience, I will never question a patient regarding pain having been there.