Duragesic patch + recovering nurse with chronic pain = ???

[loerith]

The title really kinda says it all. I have been clean and sober for 2 years and have a long history of chemical dependency. Fortunately, most all of this history was pre-nursing. I did have a relapse while working in nursing and did get help. Prior to that I had several years clean and sober.

Now to the situation at hand. Recently I have been promoted to a clerical/supervisory job which is extremely busy {house supervisor}. Also, 6 weeks ago I herniated a disk in my lumbar spine. When I am not working the pain is bearable with just ibuprofen. But when working I have excruciating pain.

I am working hand-in-hand with my internal med doc who knows my history very well. Recently he prescribed the 25mcg/hr Fentanyl patches. They really help and I cannot perceive a feeling that I am "high" in any way. I also cannot tell that they affect my performance at work one way or the other. And most importantly, I do not control the dosing.

Now the hard questions....

As I see it I have 4 options:

1) continue to work and keep my mouth shut

2) talk to my Director and CNO about this and risk being viewed as "impaired" or "relapsed"

3) take a short medical leave of absence and pray and seek advice on this

4) try for a permanent medical disability

Two things I will NOT do:

1) surgery {yet again}....2 cervical fusions and previous laminectomy

2) suffer needlessly

Your help greatly appreciated,

loerith

[bellcollector]

I am a nurse with chronic pain. I have fibro and several herniated discs, degenerative disc disease and I am on duragesic 75mcq. I was on a 3day off leave from the doc to adjust to the medication. As soon as he put me on it I went straight to my DON (I am a floor nurse). She was very understanding and checked things out with the BON of my state. According to what she told me they could not discriminate against me just because I have a condition requiring narcotic pain meds and that like any other med the body adjusts so therefore I would not be impaired once my body adjusted. They did however request that I take an entire week rather than just 3 days off and that I have my MD fax my dx and current meds. I do not have a history of drug abuse and they had already known about my illnesses. I also had been on lower scale narcs for quite some time. Anyway I hope my experience can in some way help you out.

[NP2BE]

The title really kinda says it all. I have been clean and sober for 2 years and have a long history of chemical dependency. Fortunately, most all of this history was pre-nursing. I did have a relapse while working in nursing and did get help. Prior to that I had several years clean and sober.

Now to the situation at hand. Recently I have been promoted to a clerical/supervisory job which is extremely busy {house supervisor}. Also, 6 weeks ago I herniated a disk in my lumbar spine. When I am not working the pain is bearable with just ibuprofen. But when working I have excruciating pain.

I am working hand-in-hand with my internal med doc who knows my history very well. Recently he prescribed the 25mcg/hr Fentanyl patches. They really help and I cannot perceive a feeling that I am "high" in any way. I also cannot tell that they affect my performance at work one way or the other. And most importantly, I do not control the dosing.

Now the hard questions....

As I see it I have 4 options:

1) continue to work and keep my mouth shut

2) talk to my Director and CNO about this and risk being viewed as "impaired" or "relapsed"

3) take a short medical leave of absence and pray and seek advice on this

4) try for a permanent medical disability

Two things I will NOT do:

1) surgery {yet again}....2 cervical fusions and previous laminectomy

2) suffer needlessly

Your help greatly appreciated,

loerith

In general, I think you have come to the wrong place to get the answer you need. I am in recovery, have worked in recovery. the addcition center I worked at specializes in healthcare professionals. I had 5 years sober, realpsed, and now I have 3 years sober, I nearly died when i relpased. Most people don't understand addiction. Tell a doc your an addict, they will say "just take it as prescribed and you will be fine". Of course if you could do that, you wouldn't be an addict would you? An addictionologist needs to manage your pain for you. If you are an addict, after you have duragesic in your system, you will no longer be making rationale diecisions, your brain doesn't know the difference between legitimate and illegitmate use of mind altering meds. I urge you not to jump into anything , you have struggled with addiction, you can end your career and your destroy you life and ultimately die with decisions like this.

NP

[moia]

I think staying home with a doctors documentation is absolutely the safest most conservative thing to do.

I speak from experience as I am now coming to almost a full year off of work for herniation to L4 to S1..I tried all conservative therapy and I attempted to return to work in a modified position with no help from narcotic pain relief and failed badly..I had decompression and discotomy of L5 and am now well on the road to recovery.

I made it very clear to all concerned at work that I may need narcotic pain relief and if that happened I would be unable to come to work.

The fact that your pain is severe enough to require narcotic pain relief means your pain is pretty damn bad and NO ONE even a nurse should ever feel like they have to go to work when they are in that much pain...I know as a chronic pain patient myself we view pain medication in a completely different way then nurses and civilians do.

Most nurses think a 2mg shot of morphine is a "big" deal when I know some chronic pain patients who are on 2oo mg morphine a day..yes 200mg...

People who have no understanding of chronic pain and very little education about opoids react with fear and yes a little disgust ...they don't understand and for the majority they are unwilling to learn or accept that alot of people who are not dying of cancer require the same or more narcotics just to function minimally.

Most administrators however well meaning and supportive are going to be uncomfortable having you at work on narcotics..it is irritating and I know we can have an overwhelming urge to hold an inservice about pain and the use of narcotic pain relief but I don't think we are going to win at any level.

The courts have decided that ANYONE under the influence of ANY drug while driving a motor vehicle will be considered DUI...the nursing licencing body is going to believe the same of any nurse unless they have been given enough information from your doctor and your employer to believe otherwise.

Stay home..send in a doctors note that clearly states he is treating your pain with narcotics...let the employer decide if they are willing to have you at work...make sure you have a written decision agreeing to this....the last thing you need is them conveniently forgetting they agreed to this when the BON wanders in.

At all times remember the EMPLOYER IS NOT YOUR FRIEND...no..just because they are really really nice ...they are not your friend...I learned this the hard way.

[Tweety, BSN, RN]

If you are not under any kind of monitoring then I'm not sure I would feel the need to disclose my personal medical history, especially you being out of direct patient contact.

Whatever you decide good luck and I hope you pain eases.

[loerith]

I really apreciate everyone's input. I am not going back to work. Not until I get a lot more clarification on some of these issues and even then...I doubt it.

Seems to me the only safe bet is to:

1) take some time off work {medical} with a letter from my doctor

2) go back to work minus the Duragesic

I nearly lost my life too. I did it to myself though and my recovery is my responsibility. And I do agree with the poster who said I am lucky to even have a way ,period, to continue to practice nursing.

BTW...does the BoN have a policy on this?

Love and Peace,

loerith

[NRSKarenRN, BSN, RN]

Ask your states BON for info:

Boards of Nursing? Where can I find them?