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.
Specializes in rehab; med/surg; l&d; peds/home care.
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 spent 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 just wanted to point out the first line I quoted from your post. The sentence "patients have been stuck with the choice of addiction to narcotics or disabling pain". Patients are not "addicted" to pain medications solely by just taking them long-term. Addiction is a multi-faceted disease that includes psychological as well as physiological compulsion for the drug. They use more than prescribed, divert from illegal sources, buy off the street, etc.
A patient like me, who takes a hefty dose of a medication regularly but takes it only as directed, or sometimes even less than directed is not addicted. I am TOLERANT and/or DEPENDENT. I think a lot of people are confused by these terms, and use them interchangeably. They are not the same thing. Being tolerant/dependent simply means that without the medication, I WILL suffer withdrawal. My body is used to the medication being in my body, to achieve some sense of pain control. Of course I will go through withdrawal without the medication in my system.
It seems that a lot of nurses on this thread have seen a lot of drug abuse. Maybe I am in the minority of patients (though I hate to think the majority of us CP'ers are like that)but I have never abused my medications. My physician trusts me implicitly, and I don't want to break that trust. This is my only chance to have some relief. And that's like Keah, SOME not COMPLETE relief.
My pain, on a good day, is a 4. That's as low a pain score as I ever have. When I am walking, it's around a 5. Giving my young children a bath? A 7 or 8. Having to sit more than 10 minutes? A 7 escalating upwards. Waking up flat on my back? A 9. When I get up in the morning, I am so stiff from arthritis, lupus, and bone growth in places in shouldn't be that I need my kids to help me up sometimes. Same if I ever am stuck sitting for more than a few minutes. I just can't handle it.
I know my pain will never be controlled fully. I don't remember what it's like to be pain-free. I am truly thankful for the relief I do get, however. I know that in the present situation in this country, and the "war on drugs" that many patients are deprived of any pain relief. I met many whose doctors won't prescribe any more than Darvocet/T3/Vicodin. That's a shame.
Especially with the aging baby-boomers, our country will not have enough pain management specialists to treat. And bless those patients who even now can't find a willing physician to try opiates.
I also know that opiates are not the answer for every type of chronic pain. I did every non-pharmacological treatment out there. Acupuncture, PT/OT, massage, Cranio-sacral, home exercise, injections (epidural, facet, etc), rhizotomies, etc. I have tried EVERYTHING. Nothing helped as much as the opiates. Some say that makes me an addict, but I disagree.
I know I got off the subject here. I simply wanted to point out a part of the quoted poster's post. It jumped out at me. I think she/he wrote a excellent post, but I just wanted to point out that simply taking narcotics doesn't make one an addict. I intend no rudeness or disrespect to the poster when I say that, either!!! :) Really, I am just trying to clarify.
I am so glad that this thread has sparked some interest in a problem that will only increase as our nation grows older. There are so many intelligent nurses here, and I personally thank all who have contributed to this thread. I wish the OP would come back and tell us his/her thoughts as well!!! Tadpole, are you out there?
Specializes in rehab; med/surg; l&d; peds/home care.
Keah!!! I think I recognize you!!!
I see we both caught that one sentence in that post and you beat me to clarifying it!!! Thanks!!! I think you said it better than I could ever say it. :imbar I am just not so good with the written word, LOL.
There was one other point I had intended to make and I'll try to do it with less typos too. LOL
While working in the ER, I witnesseed a true horror. A patient came in with Psych history and on Lithium. The triage RN walked the paperwork back to the MD and asked him to see her ASAP. He declined and asked for the psych redient to be called. On a normal night, this evaluationcould take at least an hour or longer to occur. Instead, the RN pushed the issue and insisted that her levels be checked. The end result was tht the pt was Lithium toxic.
I was initially very reluctant to begin treatment with an antidepressant even though I was depressed and knowing full well that Cymbalta would also help with the nerve pain and peripheral neuropathy simply because I am well aware of the bias in the medical community. I know that patients on antidepressants are thought of as "psych" patients first and medical patients second.
I had the same reluctance about starting long acting narcotics too for the same reason. I've seen firsthand how MDs and RNs sometimes talk about patients on these meds. Most are assumed to be drug addicts or malingerers, even when like me, there are true medical conditions that necessitate appropriate treatment.
As a patient, I have picked up the vibes from some of my providers and responded accordingly. If you are under the impression that I am just another addict, I sense that. We don't always realize how our unconscious opinions translate into our outward appearance. Even little things like posture or other body language can tell me if you are really there with me or just trying to get through your shift. I know which RNs or MDs believe in opiate use and which don't. I know who is really listening and who is daydreaming while I talk. All of these things affect my attitude towards you. While I always try to put my best foot forward and be kind to everyone I meet, it's especially difficult when I'm in pain and you're not believing me or listening to me.
Perhaps the bad attitude you are getting from a chronic pain patient is the result of their pain and depression, unconscious signals you are sending, or just their past experiences with other nurses or docs. God knows, I've had some nasty run ins with rude, obnoxious staff while an inpatient. I even had an RN withold pain meds the night of my surgery for no apparent reason. During am rounds I found out I was supposed to be getting Demerol, but I had gotten nothing but tylenol #3. Is it possible that my frustration over that got taken out on the wrong person? I hope not, but I was in pain, my eyes were swollen shut and I was terrified that they'd have to intubate me to keep my airway open, so maybe I was a little nasty to the day shift.
The entire issue of attitude with chronic pain is very complicated and can involve way more than you'd think at first.
I think those of us who are chronic pain patients ( believe me it took me a long time to call myself that) and nurses are uniquely able to explore the components of narcotic use, and being able to function as a human being. I worked for four years, wearing my fentanyl patch, and never took my breakthrough meds at work. The sustainged blood level of the patch, helped enough to get me through, and if super busy, forget to the point, I often overdid it, and spent 3 days at home in severe pain, unable to hardly limp, to work one 12 hour shift on my feet. I, too, was told by my physician that as long as I had a script for the meds I would test positive for, I was ok. On the way to the Post office, a guy hit me head on in my lane of traffic after dark, he had not lights on, killing himself and injuring me for life. He had been in a bar all day, (since 10 am, and it was around 8:30pm) so the Highway Patrol ordered a alcohol level. They came to me and asked if I would allow a drug screen. I said Yes, but when that screen became part of my permanent record, showing positive for the meds I took, All I could think of was, that out of context, and with my patient history, any and everybody who saw it was going to judge me. THAT WAS, unfortunately, a GIVEn. AND inspite of Hippa, we all know how many unauthourized people can and will read it and repeat it. I was even , at times, embarrassed and ashamed,to go monthly and fill my scripts, as the pharmacist and tech don't treat you well,more like YOU DON"T LOOK like you are in severe pain. It is so unfair and proposperous that because we want to continue to function as self supporting, responsible members of society , and it requires meds to do this, that we have these feelings of shame, esp. since we get the meds in a legal, supervised manner. I, too, have NEVER had to go get extra meds, I signed my contract and abide by it. In fact , one time I had to go to ER for something and they gave me percocet to take in addition to the meds I was currently on, and I did NOT fill the script, as it would have violated my contract, I felt with the Dr I saw on a monthly basis.
Rather than as explained in another post, I have found that years of dealing with chronic, unrelenting pain, that I have become more pain tolerant of levels that I used to qualify as 7-9 and now call 3-4. Procedures I used to feel were unbearable,I not can do with no interventions. At the same time, I find myself more sensitive to a hard knock on the elbow, etc. It is as if my nerves are receiving TOO much to deal with, whenthey get that little extra. I, too, have had terrible post op experiences. The surgeons are just that,and don't deal with it. The nurses and Anesth. think you can't need that much. AND they give VERSED instead of pain killers. SOmetimes, just changing from oxy to Vicodin, or Demerol to MS or vice versa, gives that extra help you need. IN additon, narcotic tolerant patients, need BASAL rates on PCAS. In addition,most need boluses fairly frequently. If there were not so much shame attached to the amount of meds we need, we might get better control,and our nurses might rececognize more easily that our pain is not controlled,not matter that we are getting our regular meds, ( a must)and a bigger dose than usual of post op meds.
Fentanyl worked wonderfully for me, but when I used 100mcg past for 3 years, I needed to go up, as I was eating (it seemed) my breakthrough meds. The physcian refused to go higher. I kept explaining I had had LTC patients with 400 mcg (4 patches) but he just kept adding more and more drugs. IT was so much nicer to only have to change the patch every 3 days, than to worry about forgetting to take meds on time, and pain escalating, and have to work toget it back under control. I don't have a painfree moment, but I do function for times without thinking about it. Recently mypain has been esclalating, and the physcian has become more and more homeopathic in her responses. THEY do not give me relief. Perhaps I don't believe strongly enough. BUT I can take a narcotic, and in 30 minutes be comfortable enough to hobble across the room, and not sit and refuse to move.Taking the others don't get it. In addition, the cocktails of meds can and do make many';s pain much better, but again the stigma of anti depressants, etc.. As previously stated, when somebody reviews your list of homemeds, it is like a red flag goes off, and they think this is a psych patient. People are not honest because of the repercussions of that honesty.
The prejudices alone are not the only interferring factor. The physcians are afraid to give adequate paincontrol because of FDA being on their bu*** about giving too many narcotics. Every patient is entitled to a pain level they personally can tolerate. I once found myself doubting that a patient, first time OB, could possibly be in that "muh pain "when she had only been in labor 2 hours, and was demanding an epidural,as I had 5 kids, all totally natural, all labors longer than 12 hours. The fact that I was doubting her, and thinking to myself that she was a wimp, made me really angry, that I had come to that point, by making assumptions based on my experiences,not what the pain was for her,in her opinion.
... Along the way it is easy to lose your tolerance and your prespective. I work hard to give my patients the relief from pain that they expect and deserve. I treat them with respect and don't chastise them if they need 400mg of Demerol as opposedto 75mg.I advocate for them with the phsycian, when he neglects to write for proper dosesof meds.
Chronic pain is taxing,exhausting, and often distorts your priorities.
As nurses, we need to be the advocate. When my 3 yearold needed open heart surgery at Mayos in Rochester, about 25 years ago, I was told that after 48 hours post op, they would use tylenol only for pain, opened her chest from mid rib cage in front to mid back, and that was it. Was told that peds patients don't really need more than that. RIGHT, I am so glad we now medicate even newborns with morphine, when necessary. Please go the extra mile to try to comfort the Chronic pain patient that has exhausted his own efforts to cope, for the time being, and is being a pain.
Thank God I don't know what people with chronic pain go through therefore I cannot adequately respond to the issue. I think a person has to walk a mile in anothers shoes to understand. I can be impathetic but can not truely understand.
As a nurse I try very hard to not ever make judgements about my patients who receive alot of pain meds. I do feel there is distinct difference between them and that's where I have my problem although I don't let it show and I never slow down my pace to get that patient their meds but inside it makes me angry.
The patient who asks for their pain meds as though they are in severe agony, just about lose it they're in so much pain, you get their pain med and 1 minute later you see them heading out to smoke, talking on their cell phone, laughing, joking with the nurses on their way out. No one can tell me that these people are not simply looking for a high.
I give them their meds with the same speed, courtesy and professionalism as my other patients but I just want to scream. The only reason I treat them the same is because they have a legal doctors order for their pain meds.
The patient who asks for their pain meds as though they are in severe agony, just about lose it they're in so much pain, you get their pain med and 1 minute later you see them heading out to smoke, talking on their cell phone, laughing, joking with the nurses on their way out. No one can tell me that these people are not simply looking for a high.
I think what happens here is that some chronic pain patients stick out in one's mind because they were a total PITA, so then we stereotype chronic pain patients as a whole. It's a common human foible to stereotype groups of people based on our negative (or positive) experience with a few representatives of that group. I've done it myself.
So, the best thing to do is to approach each person as an individual, and try not to have a preconceived notion of how they are. Also, don't take the outgoing nurse's negative comments in report as gospel, as she/he is also a flawed human being with his/her own prejudices and biases.
The chronic pain patients who are legit move carefully not to injure themselves in any way and give themselves time for the pain med to kick in before they try to get up to even wash themselves. The last thing they get up to do is go out to smoke or have a good laugh at the nurses station. I truly feel for these patients. I work with a gal who was in a MVA 10 years ago and had 52 broken bones. She wears a Fentanyl Patch. It does not affect her performance. I have seen her in pain and she refuses to take her breakthrough pain med while at work for fear it will make her sleepy. She is very responsible with her meds. I would do anything to help make things easier for her. But for the glory of God, so go I. I never forget.
I have to tell you after reading most of these posts, some of you are better nurses, better humans then I'll ever be.
The patient who asks for their pain meds as though they are in severe agony, just about lose it they're in so much pain, you get their pain med and 1 minute later you see them heading out to smoke, talking on their cell phone, laughing, joking with the nurses on their way out. No one can tell me that these people are not simply looking for a high
I have to agree. These kind of patients were one of the major factors that ran me out of med-surg. "Give me coffee, give me ice cream and give me demerol" used to make me see red. No offense to waitresses but thats not why I went to nursing school.
Give me a complex surgery patient with lots of tube who needs me.
Now I work NICU where the babies need me and families need me.
Speaking of the NICU, we deal with pain issues too. You wouldn't believe how many doc still don't believe babies have pain after surgery or need coverage for painful proceedures. How many doc are afraid of babies becoming addicted. "So doc wouldn't you want pain med 2 days post op of major abd surgery? "Its getting better but sometimes.....
One way the physician I work for weeds out the potential "high" seekers is to change them from a short to a long acting opioid, going to Methadone from Percacet for example. I have seen several patients immediately object to this even though the Methadone is stronger, longer lasting and cheaper than brand Percocet. The long acting formulation and 33 hour half life of Methadone gives excellent pain control, but no "rush".
As for being impaired by narcotics, people who genuinely need high doses of long acting pain meds generally don't get high anyway, it's all absorbed by the pain.
360mg of Methadone a day would seem to be enough to fell a horse, yet we have a patient on that amount who works, raises a family, and still has pain in the 3-5/10 range. The difference is her pain is controlled and she is able to live a semi normal life, whereas without it she would be totally bedridden and in constant agony.
Judging each patient as an individual takes time, a commodity most medical professionals have little of, but wouldn't taking that time enable better and more accurate assesment of true sufferers as well as catching the drug seekers who also are in need medical and psychological help?
"Its getting better but sometimes.....
leslie :-D
11,191 Posts
i agree with you, ms. keah.
an addict's profile is totally different than one living in chronic pain.
an addict wants it for the high.
chronic pain needs it for the pain.
very, very different.
leslie