Drug seeker vrs severe pain

**canoehead, BSN, RN** · Mar 4, 2001

In the hospital I work if a patient does not recover per the established schedule, or requires more pain meds than usual they are labelled "spleeny" or a drug seeker. So I was wondering what practises, formal or informal other nurses use to determine if someone is "truely" in pain.

For example, if a person is asleep can we assume they are not in pain? What if they appear to be fighting sleep?

fergus51 · Mar 4, 2001

Pain is what the person says it is. Period. The research shows that addiction is not an issue for hospital patients and that their recovery is slowed when they don't receive adequate analgesics. You can't judge a person's pain by anything other than what they tell you. Just because someone is sleeping, joking, laughing or walking around doesn't mean that they aren't in pain. People cope differently.

This is my personal pet peeve because I think the percentage of people actually drug seeking is minute compared to the amount of people we force to be in pain because of our own beliefs about pain and drugs.

fergus51 · Mar 4, 2001

Pain is what the person says it is. Period. The research shows that addiction is not an issue for hospital patients and that their recovery is slowed when they don't receive adequate analgesics. You can't judge a person's pain by anything other than what they tell you. Just because someone is sleeping, joking, laughing or walking around doesn't mean that they aren't in pain. People cope differently.

This is my personal pet peeve because I think the percentage of people actually drug seeking is minute compared to the amount of people we force to be in pain because of our own beliefs about pain and drugs.

Lburns · Mar 4, 2001

This is one of my biggest pet peeves. With all the research and data out there on pain control vs addition that people will still withold medication. If a pt is in the hospital and under our care it is up to us to take care of their pain, not judge them. Part of our ability as RNs is to properly assess and control the pain. Elderly tend to underreport pain and often will state they "can't get comfortable" or "can't fall to sleep." If that pain med is ordered q 2hr prn, then use it and don't wait for the pt to ask, make your assessments and follow through.

Lburns · Mar 4, 2001

This is one of my biggest pet peeves. With all the research and data out there on pain control vs addition that people will still withold medication. If a pt is in the hospital and under our care it is up to us to take care of their pain, not judge them. Part of our ability as RNs is to properly assess and control the pain. Elderly tend to underreport pain and often will state they "can't get comfortable" or "can't fall to sleep." If that pain med is ordered q 2hr prn, then use it and don't wait for the pt to ask, make your assessments and follow through.

**canoehead, BSN, RN** · Mar 5, 2001

How about someone admitted for abd pain who has been worked up to the nth degree with no cause of pain found. Reports that nothing (imagery, relaxation) but narcotics help. Comes in every two-three months with the same problem. We want to do something besides keep admitting her and medicating her unconcious. She does not report relief unless she is literally knocked out with drugs. Stays about a week then gets better when we taper to po meds. What now?

**canoehead, BSN, RN** · Mar 5, 2001

How about someone admitted for abd pain who has been worked up to the nth degree with no cause of pain found. Reports that nothing (imagery, relaxation) but narcotics help. Comes in every two-three months with the same problem. We want to do something besides keep admitting her and medicating her unconcious. She does not report relief unless she is literally knocked out with drugs. Stays about a week then gets better when we taper to po meds. What now?

fergus51 · Mar 5, 2001

Sadly a lot of people with pain don't have a diagnosis, or don't get one for years. My mother was complaining for 6 years before they finally found out she had endometriosis so bad she needed a hysterectomy at 34. I would say to keep looking for a cause but treat her pain until you can find it, don't make her suffer because you don't know why she's suffering. Medicine hasn't solved all the worlds mysteries yet.

If she was a drug seeker I would think she would be in more than once every few months, ours were! I also think that when someone says things like imagery don't work but narcotics do we think they're drug seeking. Maybe they just know their own bodies and what works for them.

fergus51 · Mar 5, 2001

Sadly a lot of people with pain don't have a diagnosis, or don't get one for years. My mother was complaining for 6 years before they finally found out she had endometriosis so bad she needed a hysterectomy at 34. I would say to keep looking for a cause but treat her pain until you can find it, don't make her suffer because you don't know why she's suffering. Medicine hasn't solved all the worlds mysteries yet.

If she was a drug seeker I would think she would be in more than once every few months, ours were! I also think that when someone says things like imagery don't work but narcotics do we think they're drug seeking. Maybe they just know their own bodies and what works for them.

hollykate · Mar 6, 2001

Just because this patient comes into that facility every few months doesn't mean the patient isn't at another facility, doing the same thing. It also doesn't mean that the patient is a drug seeker. I agree that pain is what the person experiencing it percieves it to be. I think we fall into the myth of people who require few pain meds being "strong" and tough and courageous. It takes courage to show up at a facility every few months and continue to aks for help even when this patient knows that probably no one believes her.

I used to work in 2 different ED's, 50 miles apart and was amazed at the number of people who would come to one ED, get a script for percs and be in the other ED the next day, asking for Percs. Those people are real drug seekers, they don't tend to hang around in the hospital- too many rules.

Have you taken the time to sit down with this patient and ask them to tell you what their life is like- whats really going on for them? I don't think that will make this pt's pain go away (there's a cause for it somewhere), but it will let the pt know that you are committed to helping the pt conquer this pain.

hollykate · Mar 6, 2001

Just because this patient comes into that facility every few months doesn't mean the patient isn't at another facility, doing the same thing. It also doesn't mean that the patient is a drug seeker. I agree that pain is what the person experiencing it percieves it to be. I think we fall into the myth of people who require few pain meds being "strong" and tough and courageous. It takes courage to show up at a facility every few months and continue to aks for help even when this patient knows that probably no one believes her.

I used to work in 2 different ED's, 50 miles apart and was amazed at the number of people who would come to one ED, get a script for percs and be in the other ED the next day, asking for Percs. Those people are real drug seekers, they don't tend to hang around in the hospital- too many rules.

Have you taken the time to sit down with this patient and ask them to tell you what their life is like- whats really going on for them? I don't think that will make this pt's pain go away (there's a cause for it somewhere), but it will let the pt know that you are committed to helping the pt conquer this pain.