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 haven't read the entire thread so I hope I'm not fussing about something not relevant but here goes...
32 years ago when I was in nursing school my instuctor said to us "whenever you get irritated by your patient try to see them as if they were your mother, your father, your child, whatever fits. How would you want your family member treated by the nurse? Thats how you should treat that irritating patient". I think that was the most important thing I learned in nursing school. Thanks Ms. Mozingo...I've never forgotten. She is an angel now. Hopefully seeing all of her students following her valuable advice.
Irritable Bowel Syndrome is IBS. It does not involve inflammation or any of the other more significant damage that occurs in Inflammatory Bowel Disease (IBD). NSAIDS are contraindicated in IBD because of their impact on the GI system, including additional inflammation and ulceration which are hallmarks of Crohn's and Ulcerative Colitis.
My point about the dental problems were that the Dentist was not able to consider that first, his advice was contraindicated and that secondly, even if it weren't, it would be ineffective because of my opioid tolerance. Medications which would relieve pain in others, don't touch my pain. I didn't exactly expect him to do anything, it's just another problem that I have to deal with as a patient being treated for chronic pain.
I haven't read the entire thread so I hope I'm not fussing about something not relevant but here goes...
32 years ago when I was in nursing school my instuctor said to us "whenever you get irritated by your patient try to see them as if they were your mother, your father, your child, whatever fits. How would you want your family member treated by the nurse? Thats how you should treat that irritating patient". I think that was the most important thing I learned in nursing school. Thanks Ms. Mozingo...I've never forgotten. She is an angel now. Hopefully seeing all of her students following her valuable advice.
i very much agree with your nsg instructor, dutchie.
please don't misintrepret my post.
if ibd (which i think you're right?) is irritable bowel disease, then there are other analgesics that could be prescribed.
to target the sites of post dental pain, it needn't be the current regimen this gentlemen is on.
different pain meds for different pathologies, that's all.
if he didn't have ibd, then ibuprofen is a reasonable regimen.
i've been to many dentists over the years.
they've all prescribed what they expect the level of discomfort to be.
but specific to this poster, perhaps the dentist is aware of his current meds and so, purposelly undermedicated him?
i don't know what the procedure was.
i was just curious as to what he expected for a pain treatment...
Irritable Bowel Syndrome is IBS. It does not involve inflammation or any of the other more significant damage that occurs in Inflammatory Bowel Disease (IBD). NSAIDS are contraindicated in IBD because of their impact on the GI system, including additional inflammation and ulceration which are hallmarks of Crohn's and Ulcerative Colitis.
My point about the dental problems were that the Dentist was not able to consider that first, his advice was contraindicated and that secondly, even if it weren't, it would be ineffective because of my opioid tolerance. Medications which would relieve pain in others, don't touch my pain. I didn't exactly expect him to do anything, it's just another problem that I have to deal with as a patient being treated for chronic pain.
thanks for clarifying, keah.
i know what ibs is...just never saw ibd.
and i do understand about opioid tolerance.
if motrin was not contraindicated, all i was saying is that it still is a perfectly acceptable analgesic even in conjunction with the stronger narcotics.
ea analgesic targets different receptor sites, so they can act synergistically.
i very much agree with your nsg instructor, dutchie.
please don't misintrepret my post.
leslie
No leslie I didn't misintrepret your post and I agree with you 100%.
I just kinda got off the subject a bit before remembering my nursing instuctor. I think you're awesome. Always level headed. I admire that. Sometimes I'm too passionate for my own good.
Specializes in rehab; med/surg; l&d; peds/home care.
I have cared for many patients with narcotic addiction or tolerance issues and I am amazed at how few are actually honest about their issues. I have cared for several (some prisoners) who have admitted that they have used narcs in the past and thus have a high tolerance to pain meds. I have cared for a former nurse who had been addicted to oxycontin--a fact he admitted to me. I will go to bat for these people to get them the pain medication that they need. Yes, their tolerance level is much higher and thus they will need more medication to treat their pain than someone else will. I wish everyone was more honest--it would sure make my life easier. I get really tired of feeling like a "pusher" when I am administering IV narcs. Just be honest about your substance history folks!
I don't want to come across as mean or rude here, so excuse me if I don't word this properly. You say above "I get tired of feeling like a pusher when administering IV narcs". Why? If I am honest about my medication history (which I always am...I have a printed list of all my meds, and I have a separate list FROM MY PAIN DOC of what meds I've been on doses, etc) then why do you feel like a pusher? Or are you just referring to those who have an "abuse" history? People can be dependent or tolerant to a medication (I am) but not be an addict. Yes, if you take away my medication today, I will go through withdrawal. I don't crave my meds, in fact, sometimes I forget to take them. I always hurt, just hurt less if I take my medication. If I am out with the kids, I sometimes forget to take my pills. And that goes for all my pills, not just the narcotics. Maybe this has nothing to do with what you're talking about, but I was just curious at your statement. I want to know why you feel like a "pusher" if giving meds to someone. Maybe I am reading or understanding this wrong, but I just am curious.
Are you allowed to work as a nurse while on 40mg oxycontin BID? I thought that it was a no no to come to work after taking a narcotic, that it would impair your ability to be a safe nurse.
Specializes in rehab; med/surg; l&d; peds/home care.
I know this is not directed at me, but I'd like to answer, or put in my 2 cents.
I don't work anymore, due to cancer and it's treatment. And, I never did work on the floor as a nurse while on narcotics. However, I did do computer type stuff and case management during the off hours, when I could get there. It's difficult to explain. I kind of worked privately for a physician at the same place I was at. I worked mostly at an office and had no patient contact.
I would also like to say that, for most patients who are on long-term opiates, there is no impairment. If you worked at a pain management office, you would see a whole lot of people on what most people consider "heavy" narcotics: Oxycontin, MS Contin, etc, who drive, work, etc. Once on maintenance doses, the great majority of patients on these meds are not impaired. I knew of several nurses who were actively working while on narcotics for chronic pain. They were cleared by their physicians and cleared by their employer. When they went for a drug test, they simply produced their prescription, and as long as nothing non-prescribed showed up, they were fine. I know there are people here who disagree with this, but it's true, at least in my area.
I paid individually for neurological testing which proved I had no impairment while on my meds. They also tested me after skipping a dose of my medicine, and I was worse without the medication. However, I never did take care of a patient. I simply didn't do it. I did other work. But, I did this testing just to prove I was able to work.
I've seen many, many patients on long term opiates as well who work in all kinds of professions. They were mostly, with few exceptions, cleared to work by their physicians. They are all around, and I know some people would be scared at this knowledge. However, you'd be surprised at how different people respond to opiates. Most people, when they think of pain patients on long-term opiates, think of our post-op opioid-naive patients after analgesia. They're sick, nauseated, itchy, sedated, drowsy, etc. However, most chronic pain patients, even on high doses of opiates, are not this way. The side effect most of those patients have is constipation. I've seen many results of their neuro tests as well, and very rarely have they come up as "impaired".
You also have to think of all the other medications, besides opiates/narcotics, that can profoundly affect a nurse's ability to function. Benadryl, Adderall, Xanax/Ativan, etc. There are so many OTC and prescribed drugs that can "impair" a nurse. Even being tired can impair a nurse. But I know the topic is narcotics. I wish that more nurses who are now suffering from chronic pain could return to some sort of practice, after going through testing to prove they are safe. There would have to be regulations, but I think it's sad that so many nurses who are injured are thrown out the back door when they are no longer able to practice. It's sad when their mind is fine, but their body is not. Their years of knowledge is still there. It's sad that it's just thrown away. But these are my own thoughts. Perhaps I only think this way because I myself suffer from chronic pain. This is just my opinion, and I know not everyone will agree with me.
I hope I got this out alright, and that it's clear. I am sleepy now at 3am, but I just wanted to jot this off before I went to sleep. So, I guess it depends on the state practice acts, but I do know of nurses who practiced with permission. I don't know of any who practiced without their employers, BON, or physician's knowledge.
I haven't gotten this quote thin down, so I'll work around it.
Earle58 - I'm a woman
If the ibuprofen weren't contraindicated, it might have been an appropriate pain mgmt choice for some dental procedures and I suppose I should have made that clearer. However, what I had done was crown lengthening on 2 adjacent teeth. This involved peeling back the gums, cutting some off and then chipping away at the Maxilla to expose enough root to properly seat a crown. The result was some pretty significant bone pain and I doubt that ibuprofen would have given satisfactory relief to anyone having this procedure, never mind someone who is opioid tolerant. The meds I use now, bring me to the point of an average person. Adding additional pain from some illness, injury or procedure requires additional treatment, just as any other person would require.
I am very realistic in my approach to my narcotic use. I am not medicated to the point of complete relief, just enough to take the edge off and allow me some function. I know that the nature of my illnesses are such that I'll probably never be pain free and I accept that. DUring the periods where my disease is under control, I taper my narcotic use to a lower level. I beleive that this is the respobsible thing to do. There is no point in pumping myself full of meds I don't need.
jlsRN - In my first post, I wrote that my diseases have already cost me my carreer. When I was first Dx, I was working in QA, with NO Patient Care. I subsequently got sick enough that I had to stop working altogether. I am now debating the issue of filing for Social Security.
Hi all, I do agree that "chronic pain " people can be a pain but keep in mind a person who has a chronic pain condition may be predisposed to be more sensitive to painful stimuli than a non chronic pain patient. What you would feel as a 2-3 becomes an 8 for them. They also have spent years developing a tollerance to narcotincs that you are not going to change this during admission. Distraction, redirection, relaxation have little effect if your nervous system is not wired to screen out painful stimuli. You are probably not going to have much success limiting the amount of narcotics the patient requires during an acute care admission. Your best bet is whatever you normaly would give- give more.When in doubt- give more. Many of these patients have been stuck with the choice of addiction to narcotics or disabling pain. I can't tell you how many times I have followed a nures who was stingy with ordered pain meds since the person was "just drug seeking" leaving me to spend half my shift recapturing thier pain threshold. Once you medicate to the max most of my "pain in the neck" pain people are much more able to cooperate with thier recovery, and a smooth recovery from whatever has them admitted to the hospital is everyones best intrest.
I would also like to say that, for most patients who are on long-term opiates, there is not impairment....
I paid individually for neurological testing which proved I had no impairment while on my meds. They also tested me after skipping a dose of my medicine, and I was worse without the medication.
I am also more impaired when in pain than I am when I'm medicated. Pain leaves me with difficulty concentrating, severe ROM and short term memory loss. The reality is that non-narcotics have actually caused me greater problems than the narcotics have. While I was still working, I had to stop using Neurontin because I was terrified of what details it was causing me to forget. My memory was so bad that I'd frequently find the phone in my hand with no recollection of picking it up or of whom I intended to call.
Many of these patients have been stuck with the choice of addiction to narcotics or disabling pain.
This brings us to the crux of the issue. How is it that we, as HealthCare Providers see the use of narcotics for the treatment of chronic pain? Is a patient addicted based solely on the fact that they use narcotics on a regular basis? Really?
The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine just published a joint consensus document to discuss the issue of defining terms used in conjunction with the treatment of Chronic pain.
From that report:
The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definitions and recommend their use.
Addiction
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical Dependence
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
I have been enrolled in a Pain Mgmt Program for almost 4 years and using some form of narcotic for most of that time. Does that make me addicted? I think not. I have never once run short of meds. Actually, I tend to skimp when I am having a not so bad day, so I usually end up with extras and extend my time between visits for refills. Also, when the treatment for my underlying conditions was changed, I was able to slowly taper myself off all narcotics, without withdrawl. I had a significant increase in pain, but I could go med free. I just can't walk if I do so. When I went back on the Oxycontin, I did so at only half the dose. A subsequent complication in my treatment necessitated stopping it for a few weeks, so I needed to go back up, but I expectt o be able to taper back to half the dose soon.
I may very well be tolerant of opioids at a lowwer level and I am dependent on them to maintain some quality of life, but I am NOT addicted.
DutchgirlRN, ASN, RN
3,932 Posts
I'm thinking "irritable bowel (disease) syndrome"?
I haven't read the entire thread so I hope I'm not fussing about something not relevant but here goes...
32 years ago when I was in nursing school my instuctor said to us "whenever you get irritated by your patient try to see them as if they were your mother, your father, your child, whatever fits. How would you want your family member treated by the nurse? Thats how you should treat that irritating patient". I think that was the most important thing I learned in nursing school. Thanks Ms. Mozingo...I've never forgotten. She is an angel now. Hopefully seeing all of her students following her valuable advice.