chronic pain

Has a cardiologist ruled out a cardiac cause? Even if that is the case, think about how many organs are between the belly button and the neck. There could be many very real physical causes for chest pain, including pulmonary, GI, an aortic aneurism, musculoskeletal, etc. Simply because a cardiac cause has been ruled out does not make the pain any less real. The patient should still be treated for pain, and a medical workup to find the cause should be done.

A couple of points:

When the pt tells you that no one is medicating him for pain, do the MARs support this? Is he asking or waiting for someone to notice that he's hurting?

Somatiform disorder is not all that common ... has he been seen by psych? Does he have an order for an anxiolytic and, if so does he get relief?

As pointed out above, there are a multitude of possible causes of pain. Physical causes should be ruled out before we look for psych issues. Horses before zebras!

more info.. Yes the MAR does confirm that these nurses are not medicating..pt is in early 50's and is A&O x3 and is very verbal about their pain. pt has had full work ups both cardiac and pshycial pt has refused mental health consults. no medications help pt pain pt states "they calm me enough so that i can sleep through it" pt also states "nurse #### told me they dont help you, you dont need them just learn to deal with it." my fear is being new at this i was taught that pain is what the pt says it is, i do believe this and i am really wondering if these nurses have cross the pt rights line... that is my big concern here. I know that I do what I can to try to help this pt and make the pt comfortable.

If the patient says he has pain, he has pain. Maybe the pain medication he is on is not working. Have they tried something different? Also, maybe if the patient was being medicated appropriately, he wouldn't be in pain. On the other hand, does this patient have multiple hospital admissions for the same thing? Does he have a history of drug abuse? Sometimes it is drug seeking behavior. I still go by the rule though, that if the person says they are in pain, they are in pain.

I have a pt that has chronic angina and complains on a daily and shiftly basis. There have been many test done and it is not cardiac.....................Pt states "they calm me enough so that i can sleep through it"

This actually sounds as though pt. may be having anxiety attacks. Anxiety can produce severe chest pains in a lot of people, often described as a heart attack or angina.

Pain meds can relax and calm a lot of people. Perhaps this has been the case for this pt. and that is why they state they can sleep better.

The opiates are actually working more as an anti-anxiety medication.

Also, what does the pt. say they their pain level is on a 0-10 scale? Are other Nurses documenting what the pt. states? This is very important.

Just throwing out ideas! Good luck!

....and medicate if this helps the pt. because you are right, pain is what the pt. states it is. :redbeathe