Drug seeking or real pain? How do you tell?

Specialties Pain

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I'm a new nurse on the list so please pardon my ignorance. I was quite interested in the pain links and explored several and probably will use some for staff training. I did not see any mention of dealing with chemically dependant people who may or may not be having pain. I work in a mental health facility which also serves chemically dependant people. We have a constant struggle with determining who is in pain and who is drug-seeking. We have isolated a few cues, but over-all are probably treating the wrong patients. Does anyone on this list have ideas on this subject, who can steer me to a few resources? I appreciate all the help offered. :confused:

Macsusan, I couldn't agree with you more! But as I mentioned a few posts ago, it is my opinion that people, including nurses, hate feeling like someone has gotten over on them; no one likes to feel fooled. And then there's anger that a drug-seeker uses valuable healthcare resources, including nursing time. Plus the fact that relatively few people have any sympathy for addicts in the first place. But I will restate: I would rather give 9 drugseekers pain medication they don't need than risk not relieving the pain of 1 person who is truly in pain. And while I'm at it, I have heard nurses express the opinion that drug users can't feel pain any more. What the hey?

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Specializes in trauma er, dialysis.
Too many nurses (and patients) do not understand pain control. I was a nurse in the ER and I suffered with migraines and since I was intimately familiar with migraines I was often called to exam rooms of patients requesting narcotics for migraines. Yes many of the patients were chronic migrainers but more than half were drug seeking. Nurses in the Emergency Rooms deal with more true drug seeking. This is a true problem for most ERs but not, I'm sure, in post-op. I have spent many hours instructing patients that not taking prescribed pain meds was detrimental to their recovery. Many patients are afraid of becoming "drug-addicts". I believe that pain-control should be taught as a subject in all nursing schools.

As a side note: I had one patient that bluffed even me - she got an INT and IV phenergan and demerol and she left (with INT intact) got in her car and drove away. Try doing the paperwork on something like that.

I am too a ER/trauma RN, charge nurse, but now disabled with chronic pain was treated horrible in the ER last night. I had 4 fusions neck and back,neurogenic bladder,bowel, quada equina syndrome. Anyway went to er for severe neck and occipital pain and a xray not meds because the pain was so bad i wanted to make sure my plate was not shifting. Anyway the DR comes in and he says "what do you want" with the look, negative body language, negative tone in his voice and i said! "not pain meds"! he replied "what then" i said how about an x-ray i pretty much had to beg for it, when he left the room i felt just so unwelcomed and ashamed of how patients are treated especialy RN's as patients. I am tired everytime i go to the er or pharmacy i get that look."another Drug Seeker" I even worked at the hospital for 6 years where i was treated like a piece of crap! Not once was i asked my pain level, neuro checks, examination of my neck, offered anything for the pain. I feel like writing a complaint about that DR, but what good would it be nice if all the er staff knew that true chronic pains patients addiction rate is only 1%, but treated more like 99% anyway i know how you feel, and feel for you.:crying2:

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thanks for the responses to my post everyone. Fascinating info for me. We have such a long way to go with this whole pain management thing. Seems that those patients in ICU units and more and more often those on palliative care wil receive adequate pain management. But those who are suffering frompost surgical pain, from chronic pain conditions etc are assumed to have "low pain tolerance," are drug seeking, whiners, etc. The impact of untreated pain on quality of life is SO huge -- I often wonder, and not happily, how my life might have been different in many respects if chronic pain had not become the "jello" within which I had to live my life for so many years. It is exhausting.

Nurses supposedly learn about pain management right? Doctors too. Why is there still so much misinformation and prejudice directing their actions?

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Specializes in ER - trauma/cardiac/burns. IV start spec.

I am sorry about the way you were teated by your own peers. I have had the misfortune to be treated the same way since I became disabled. I, too, have fusions in my neck now supported by plates and screws. Hang in there - you are not alone.

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I am a migrainer in nursing school and we are discussing how to control patient pain. As a migrainer, I've been labeled a drug seeker in the ER and have been treated rudely so many times. I do see a neurologist regularly, do have a preventative med (Topamax) that I take daily, along with an 'emergency' stash of Vicodin and Phenergan. But for some reason, there are times when the Topamax won't work and if I can't get to my emergency stash in time, I start vomiting. By that point, I know that my stash won't work since I'll vomit whatever I put into my mouth so a trip to the ER is necessary. I know exactly what works for me.....1-2mg of IV Dilaudid and 4-8mg of Zofran. But as soon as I mention the 'D' word, all hell breaks loose. I get an attitude from everyone involved in my care...right down to the guy who mops the floors. It's ridiculous! I have a legit medical problem and I take meds but because Dilaudid works best for me, I get labeled as a drug seeker. Can I help it if it works so well? I didn't manufacuter the freakin' drug, for crying out loud! IIt's a pain med and I'm in pain so give it to me! That's why it's in your pyxis! In school, we learned that "pain is whatever the patient says it is." Um, yea. Tell that to most ER nurses. I hope i will be a more understanding nurse than some of the nurses I have had. It's interesting that this is such a hot button topic...at least I'm not alone.

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Specializes in Med/Surg - Pain Management.

The best reference for pain management information is a book by Chris Pasero and Margo McCaffery called "Pain Assessment and Pharmoacologic Management". It is what I call the bible of pain management. You have identified a real issue - pain vs drug seeking. When the person has addictive disease that complicates the issue. There is no sure method of weeding out the drug seeking from real pain. The addictive disease patient may have real pain and then it is even harder to treat often as their tolerance is even higher. Try looking in this book under chapter 2, page 32. The other thing you can do it go to the American Society for Pain Management Nursing site (www.aspmn.org ) and click on "The Organization" then look on the right hand side for a shaded area with a list of topics. Toward the bottom you will find "position papers". That may be of help. Finally, the ASPMN list serve is a wonderful tool and I don't believe that it is limited to members - join that (directions on that site) and ask this same question of the pain management professionals on that list serve. Good luck.

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I have a question about this. I broke my ankle over a year ago and it still hurts a lot. Also is a delayed union fracture. But I wonder if it is real pain at this point. I call to ask my doctor for a refill on my pain meds. Because I have been going months now in so much pain I feel I'd rather die then have to be in so much pain anymore. The doctor is refusing the refill the meds. Could the pain be fake? I've almost went to the ER for said pain several times because of how badly I hurt. I am not sure if the pain is real. I don't want to be addicted to the pain meds. I just need relief very badly.

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I have a question about this. I broke my ankle over a year ago and it still hurts a lot. Also is a delayed union fracture. But I wonder if it is real pain at this point. I call to ask my doctor for a refill on my pain meds. Because I have been going months now in so much pain I feel I'd rather die then have to be in so much pain anymore. The doctor is refusing the refill the meds. Could the pain be fake? I've almost went to the ER for said pain several times because of how badly I hurt. I am not sure if the pain is real. I don't want to be addicted to the pain meds. I just need relief very badly.

Call your MD

We can't give medical advice here :)

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Specializes in Med-Surg/Neuro/Oncology floor nursing..

All doctors/PA's/NP's are completely different when it comes to pain management. In April I had a crani for trigenimal neuralgia. After I got out of the OR they put me in a PCA but the dosing was very low and the PCA only had a bolus rate and not a basal rate. The dosage was .3mgs of dilaudid with an 8 minute lockout. A few weeks later I was having complications from the surgery(dizziness, extreme pain in the surgery spot and shooting down my neck, feeling lightheaded and a few other symptoms). But my worst symptom was pain, not to mention I am a chronic pain patient. So when the doctor came over to examine me he ordered me a CT scan and said I "could have whatever I want for pain." He let me name the medication that I wanted. So spent 24 hours in the ER getting 2mgs of dilaudid IV push(I was admitted but it took a day to get a bed). The doctor made sure I got my dilaudid and he also gave me IV ativan(I didn't even ask for it). Then when I was on the floor they ordered me a PCA this time it was .6mgs of dilaudid every 6 minutes with 2mgs of dilaudid(put in saline solution)every 2 hours for break through pain. Same hospital, different doctors. Also another time I was brought to the ER(this was a couple of years before the surgery and a different hospital) for falling down the subway stairs(gross I know and it hurt a lot). I decided to wait it out a couple of days before going to the ER but my neck and back were in such excruciating pain/spasms my mom took me to the ER. The doctor didn't do a darn thing, just gave me some tylenol and gave me a prescription for motrin.

Every time I went to the hospital with my mother and she tried to advocate for me. It's amazing how one doctor said "name your pain medication" while another doctor gave my tylenol.

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Specializes in Psychiatric, School, Forensics, UR.

I advocate for pain management for my patients. Many are drug addicts, alcoholics and drug dependent. Because I snap, crackle and pop when I walk. Because I have experienced chronic pain. Because I am a caring, compassionate nurse. I prefer to believe my patients when they report pain. I educate about long term narcotic use. I chart patients behavior as well as their statements about pain. I sometimes have conflict with MD's who want patients to stop narcotics and take Tylenol for pain. I believe we have a long way to go and so much more to learn about pain management. But we must put our prejudices and suspicions aside - and treat the patient. And provide relief. There are so many good ways to soothe pain and provide relief. Like offering a hot pack or cold pack, positioning for comfort. But one of the best ways is just acknowledging the patients and their pain. Working as team to find relief.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

If in any doubt, the senior nurses I've worked with call the APS (Acute Pain Service).

Of course we get drug seekers - despite what people think, these people are chronic drug seekers as most have chronic pain. Also everyone's pain is very different. My brother cannot stand any pain at all - he is never ill - but any pain he can't handle. My Dad can handle lots of pain and narcs don't usually work on him (I've seen this with my own eyes in an ED). So we are all different.

I nursed a woman in a large ED once. She had had back pain for about 20 years I think. She had diabetes, hypertension, God knows what else. She was hugely overweight. She wouldn't even move off the bed to use a bedpan. She wailed & moaned in pain. She had had pain relief (can't remember what). She would have defecated in the bed, but I made her use the bedpan. We were incredibly busy that night & she took up a lot of our time; I think she was a frequent flyer, probably hadn't visited her pain specialist or whatever.

The whole point is some patients WILL have pain, but if they've had something for it, they still need to move as much as they can. If they don't their muscles & joints lock up, blood flow is decreased, etc & they can't then do anything at all. We still need to encourage them to move around at least a little.

I get horrid pain from long-standing endometriosis. Some days I get pelvic pain, pain going to the toilet, back aches etc from scar tissue. I have miserable, heavy periods. But I still make myself do things after taking some pain killers - I HAVE to or I will eventually wither up and die. I keep thinking positive thoughts and do positive things. On really bad days, I have to call in sick for work & just basically rest and look after myself.

Yes we are all judgemental it's human nature. But it does get wearying when u know who the drug seekers are. They also take up A LOT of time in any department you work in, whether it's ED or the wards. And they are never satisfied with the treatment they are given, they also get lazy.

As a RN I think it IS up to us to question these patients, and to r/v pain meds with the doc when we get hold of them. In the end, you don't do patients a favour by piling more meds onto them as it leads to more complications and problems.

Having worked with pain doctors & nurses, I can also tell you that when patients DO stop their meds - maybe in a trial or something - they have as much pain as when they're on their meds. Some also found better relief with OTC pain medicine too and using other methods, ie: stretching, gentle walking, water aerobics is fantastic for pain pts, yoga/pilates, and being referred to a pain clinic can help (though most pts don't go for follow up t/ment). If you can suggest these things, these may help chronic pain patients as well.

I also nursed MH pt with long standing neck pain, think she'd had 2 or 1 disc removed?? (can't remember). No pain killer had helped her except narcs but I noticed that the physio & doc thought it was psychosomatic. When I went in to assess her, I noticed she was holding her head to the side at an odd angle; this was how she 'coped' with the pain. I explained that the muscles on that side had probably tightened up & the pain would/had got worse. She kept insisting that how she held her head HELPED the pain, but I was trying to reiterate that yes it would for a while, but when she went to straighten her neck, the pain would get worse, due to tight muscles being stretched. She refused any help, just wanted the narcs. I think this is sad in a way as she (and the doc etc had written this) she would not do anything to help herself. Being scared is a big factor too.

So yes it is very, very difficult to help people sometimes. We have to accept their right to refuse t/ment as well.

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