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.
I think a good pain seminar would be appropriate, to help with some of the misconceptions. Just because you sleep doesn't mean you're not in pain by the way.
AGAIN.... I realize that someone who is sleeping may still have pain, BUT, if you are comfortable enough to sleep, your pain is not a "10". Pain of a "10" is the worst pain you could ever imagine (child birth with no epidural, surgery with no anesthesia....). Pain of a "10" is something you cannot sleep through. ALSO, as I've already said, if you are sleeping soundly enough to require a sternal rub to wake you up, your pain is not a "10," you are overly sedated, and giving you any more narcotic pain medication could be very dangerous....
If someone is in severe pain, they are going to rate it high regardless of how it compares to what others may consider 'worst pain ever'. And who are WE to say it isn't a "10"? At that time, for that particular person, it IS a 10.
A patient in severe pain can sleep--- it has nothing to do with being comfortable. Sheer exhaustion can take over and when they awaken, their pain can still be off the charts. A patient can also be "unresponsive" and in severe pain. No offense here, but what's with the repeated references to sternal rubs? A patient who has to be awakened by a sternal rub isn't necessarily over-sedated and they certainly can't be judged as not being in pain either.
Being awake is not a criteria for being in pain. Elevated pulse, respirations, and BP, sweating/flushing/tearing, restlessness, facial expressions and tension, muscle tension, etc., can all point to pain in a patient who is nonverbal or unconscious.
I've rarely used a sternal rub, even in patients who WERE over-sedated. I can imagine they would be in severe pain upon awakening from that... ouch.
No offense here, but what's with the repeated references to sternal rubs?
I mentioned the same thing twice because clearly, you & some others are not understanding my point. I NEVER said that if a pt. is sleeping, they couldn't be in any pain, only that if they would not wake up when spoken to or touched, and would only respond to painful stimulation, then they are overly sedated and should NOT be given any more narcotic pain medication.
A patient who has to be awakened by a sternal rub isn't necessarily over-sedated and they certainly can't be judged as not being in pain either.
YES, they are overly sedated. If the only way to wake a pt. up is through painful stimulation, continuing to give them sedating medications such as narcotics can cause respiratory issues. If you don't consider this to be over-sedated, then what DO you consider to be overly sedated??? Would you continue to give narcotics to a patient who was only responding to painful stimulation???
I've rarely used a sternal rub, even in patients who WERE over-sedated. I can imagine they would be in severe pain upon awakening from that... ouch.
How, then, do you wake someone up who will not respond to any other stimulus??? If not a sternal rub, SOME form of painful stimulation must be used when verbal or other tactile stimulation fails to produce a response...
Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
First of all, I think the 10-scale is worthless.
If someone is in severe pain, they are going to rate it high regardless of how it compares to what others may consider 'worst pain ever'. And who are WE to say it isn't a "10"? At that time, for that particular person, it IS a 10.
A patient in severe pain can sleep--- it has nothing to do with being comfortable. Sheer exhaustion can take over and when they awaken, their pain can still be off the charts. A patient can also be "unresponsive" and in severe pain. No offense here, but what's with the repeated references to sternal rubs? A patient who has to be awakened by a sternal rub isn't necessarily over-sedated and they certainly can't be judged as not being in pain either.
Being awake is not a criteria for being in pain. Elevated pulse, respirations, and BP, sweating/flushing/tearing, restlessness, facial expressions and tension, muscle tension, etc., can all point to pain in a patient who is nonverbal or unconscious.
I've rarely used a sternal rub, even in patients who WERE over-sedated. I can imagine they would be in severe pain upon awakening from that... ouch.
Debating the topic of chronic pain patients is the subject.
Narcotic-naive patients (those that do not take narcotics on an on-going basis) will need far less narcotics than those that take narcotics daily for chronic pain. It is a simple fact.
It is also simple that some folks are much deeper sleepers than others. It might take a sternal rub to wake me up because I've been a shfit-worker for many years and can sleep thru a lot. However, I can still have pain even though sleeping.
Good point traumaRUs. I once chained my door, locking my roommate out and he banged the door down with his feet breaking the chain after banging on the door for an hour. I was stone cold sober. I have occasional headaches, and sometimes I take motrin and fall asleep and wake up in the middle of the night and the headache is there. So yes you can sleep and be in pain. Personally, I doubt I could fall asleep with a pain of 10/10 though, but that's me.
AGAIN.... I realize that someone who is sleeping may still have pain, BUT, if you are comfortable enough to sleep, your pain is not a "10". Pain of a "10" is the worst pain you could ever imagine (child birth with no epidural, surgery with no anesthesia....). Pain of a "10" is something you cannot sleep through. ALSO, as I've already said, if you are sleeping soundly enough to require a sternal rub to wake you up, your pain is not a "10," you are overly sedated, and giving you any more narcotic pain medication could be very dangerous....
I agree with you. I would not medicate that patient. Nurses should not blindly medicate a patient with narcotics just because they ask....we must use good sound judgement and assess the patient first. For patients needing a sternal rub and slurring their speech mumbling they need pain medicine, I'll simply say "o.k." and step out of the room. I'll return a few minutes later to check on them and most of the time they are back asleep. If their oxygen sat is o.k. I leave them alone. Usually they don't remember asking for pain medicine at that time, so they're o.k. with it.
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.
:angryfire Hi there....
Not all chronic pain patients are "nasty", have "attitudes", or are "rude". My husband has chronic back pain--is actually disabled partly due to his back--and he is not rude, nasty, or have an attitude with a nurse that ACTUALLY cares. He is on a monthly Rx of pain med., and it helps 80% of the time. He is not "zoned" all the time, either.
:nono:We can't see pain, we don't know if the patient is in pain, how much pain that patient is in, ect. You can't judge a book by it's cover. True, some doc's do over perscribe, but for the most part, a good MD will give the patient the "highly additive substances" so that the patient can wake up in the morning and know that in about 45 min., s/he will MAYBE feel like doing something productive, like live.
:flamesonbIf I sound like I'm hot, it's because I am. This is not the first time that I have heard nurses complain about "chronic pain patients", and I feel that they are getting a bad deal. Even if my husband wasn't one of "those" patients, I would feel the same way.
Oh yeah--- remember too that there is a difference between being "addicted" and "dependent". A TRUE chronic pain patient is dependent on the medication to live, the junky is addicted.
If I have offended anyone, I appolige from the bottom of my toes. I guess this is one of my "pet-peves".
Not being nosey, but you ARE trying to get Social Security Disability, aren't you? Please say you are, or are in the midde of appeals!! It took us 5 years of fighting, but my husband finally won, so hang in there and DON'T GIVE UP!!!!!!!
I am SO sorry for your CA, I so wish that there was something that I (we) could do to help. Bad ex., 2 babies? Wow!! And I thought that I had it bad.
Specializes in rehab; med/surg; l&d; peds/home care.
I can also agree that you may be in pain while you sleep. I am in pain 24/7. On a good day, it hovers around a 4. On a bad day it can get up to a 10, but not too often. I intervene before it gets that bad. It does usually get to a 8 if i try to move too much. It usually goes to an 8 while giving the kids a bath. Just doing that does me in. And then I'm exhausted from the overwhelming fatigue thanks to chemo. But I know, that's just ME. Everyone is different. I do sleep when in pain. I've slept in severe pain from exhaustion. I slept through labor in short intervals, and that was without medication. And once when I had a migraine, I slept simply because I had been up for 48 hours.
But I think what ERRNTraveler is saying is that most patients don't snuggle up to go to sleep if their pain is high, like a 9/10 or 10/10. If your pain is that high, you are trying to move around and get comfortable, and your mind is focusing only on relief. And I think that when a patient is so sedated, whether on pain medication or anti-anxiety medications or whatever, if they are responsive to only painful stimuli, it may not be in their best interest to be further medicated. Especially in those who are opioid-naive, further medication may cause respiratory depression.
ERRNTraveler, if I'm wrong in my thinking of what you said, please correct me.
Pain management is a fine line to walk. Finding what works for each patient is difficult, because we all react so different. What works for one, may not work at all for the other. And since we must call the MD each and every time to change things, it can be very time consuming for the nurse. The nurse is the one caught in the hard spot, because they are the go-between. The patient may not see the nurse call the doctor, but when the nurse goes back to see the patient, the patient in pain may snap at the nurse for more pain medication. But if the doctor won't change or increase the medication, what can we do?? We spend even MORE time perhaps going up the chain of command, if necessary. A lot of times, pain patients don't understand we can't TOTALLY ERASE their pain. That almost never happens. So, the nurse oftentimes gets the angry, anxious, in-pain patient. And that can be emotionally draining for the nurse.
This may all be babble, because I haven't slept in nearly 2 days now. So I apologize if this is not making much sense. Pardon my grammar, spelling, and other errors.
I have enjoyed reading this thread. I hope the OP learned some things, cause I know I did. I really think it helps us to learn from others and it always helps to increase our knowledge. I love to learn. I hope the OP feels better after getting a break from his difficult patient, as well. I think we have all had "one of those patients" that try our patience and drain us, emotionally and physically.
Specializes in pre hospital, ED, Cath Lab, Case Manager.
I too have chronic pain. I have experienced frustration, anger & depression in dealing with healthcare providers who assume I am looking for narcotis. There have been times in the past few years where I would have given anything to not have pain. I have thought of suicide often at times. I do not take narcotics and have pain 24/7. I have learned to live with it. Normally it is about a 4.
Recently I was in a car crash which escalated my pain to a "10". The first physician I saw told me that because I have chronic pain he would not give me any narcotics. So I endured pure agony until I could see my PCP who did (for the first time) prescibe percocet.
Specializes in Open Heart/ Trauma/ Sx Stepdown/ Tele.
It is both amazing and saddening to me to read through some of the above posts on chronic pain. I hope that those who do not experience chronic pain never will, and for those that do I completely understand. Please remember a few "pointers". Not every person is "fibbing" when they state their pain is a "10" yet they are smiling, laughing, sleeping etc. Not every person who states they are in pain is a "drug seeker". Not every person that is in pain, especially chronic pain is intentionally rude and nasty. Please understand that living in chronic pain can unfortunately cause a change in the persons "attitude" if you will. Being in chronic pain myself that last bit was quite a surprise to even me. A family memeber pointed out what a different person I now am. Unbeknownst to me who thought I was doing great not snapping and being "nasty" to others.
I had/have lived with chronic pain since I can remember. I am now thirty five. Probably about the age of seven is when I first brought it to my parents attention, who took me to the MD to be told it was "growing pains". Well I "learned" to live with being in pain. Every day, all day. Finally at the age of 13 I was dx with bilateral hip dysplasia. To late at that point to fix. I didn't let the pain, nor what the MD told me stop me in anyway. I played basketball and ran track in school. I defied the docs by having my son (was told I was never having children...still amazed that I did upon seeing my xrays, not only are the acetabulum and femur heads deformed but also my entire pelvic structure.) and became an RN who works on a tele step down unit. All while having pain.
Thanks to one total hip, I now have pain on only one side.Point is that people can and do amazing "things" while being in chronic pain. So please next time, and yes I know sometimes we are not "easy" to deal with, but please try to understand what we are going through. I am sorry that the OP had to deal with the individual they did.
Oh yeah--- remember too that there is a difference between being "addicted" and "dependent". A TRUE chronic pain patient is dependent on the medication to live, the junky is addicted.
If I have offended anyone, I appolige from the bottom of my toes. I guess this is one of my "pet-peves".
ERRNTraveler, RN
672 Posts
AGAIN.... I realize that someone who is sleeping may still have pain, BUT, if you are comfortable enough to sleep, your pain is not a "10". Pain of a "10" is the worst pain you could ever imagine (child birth with no epidural, surgery with no anesthesia....). Pain of a "10" is something you cannot sleep through. ALSO, as I've already said, if you are sleeping soundly enough to require a sternal rub to wake you up, your pain is not a "10," you are overly sedated, and giving you any more narcotic pain medication could be very dangerous....