Pain meds for the addicted

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by bellehill
May 29, '02 Views: 3,284 Comments: 32

Hey Everyone!
I have a real problem with giving narcotics to pts with known addiction. I understand the pain concept and I am usually very aware of my pts pain level, but when is enough. I had a pt who slept very hard all night, even through a blood draw, woke up and in a slurred voice asked me for his "rise and shine medicine". Demerol 75mg would not get me going in the morning. I held the med until he had woke up more. Was this wrong?

Another pt I had wanted something for nausea. The MD ordere Phenergan 50mg IV. I started with 12.5 mg. She asked for it every 2 hours, when I went it to give it she was fast asleep. She was also on a morphine PCA.

I guess my question is how do you determine when to keep giving narcotics or "rise and shine" meds.

Thanks!
About bellehill

Joined: Apr '02; Posts: 578; Likes: 66
Clinical Nurse Educator; from US
Specialty: 9 year(s) of experience in Neuro Critical Care

32 Comments

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May 29, '02
Occupation: REGISTERED NURSE Joined: Mar '02; Posts: 371; Likes: 10

We have a frequent flyer in our ER that comes in with "migraines" she gets stadol 1mg and phenergan ---- she refuses to stay for observation for 20 minutes after administration (our policy) It makes me so mad--the doctor keeps giving it to her. When he has ordered something else--or if another doc is on call she throws a fit until she gets what she wants. She doesn't even try other meds--why should she when she knows she is going to get the "good stuff".
May 29, '02
Occupation: RN-i (RETIRED) Specialty: ORTHOPAEDICS-CERTIFIED SINCE 89 ; From: US ; Joined: May '00; Posts: 14,479; Likes: 2,298

Do a search for the word NARCOTIC using the button at the top of the screen. I limited it to the GENERAL NURSING FORUM and got 62 discussions.

I will say this, I will give pain medicine to anyone that says they are in pain. It is not up to me to decide if they are or not.
May 29, '02
Occupation: retired Specialty: 36 year(s) of experience in OB/GYN,L&D,FP office,LTC ; From: US ; Joined: Jan '01; Posts: 609; Likes: 88

I agree with PRN> I will medicate my pt.
May 29, '02
Occupation: RN in L&D Joined: Nov '01; Posts: 720; Likes: 185

If the patient says they have pain and there is a valid reason why they might infact be in pain you give the med .. Unless they show signs of overdose or adverse reactions.
For one thing there is no way you can determine that they aren't in pain. You also have to ask yourself if the patient is in chronic pain and because of this becomes dependent on their pain meds.. what harm do you do by giving the med to them? even if they weren't dependent on it they would still need the med to treat the pain.

I too have had thoughts about contributing to a persons dependence by giving them narcs but I've also found that as nurses we become far too judgmental about who is and who isn't "really in pain". Just because one person responds to a procedure with little of no pain we assume that people who complain of pain from the same procedure are "drug seeking".

But all and all the bottom line is that you cant tell the fakers from the people in pain and I just can't justify leaving my patient in unnecessary pain even if I do end up giving a few narcs to people abusing nurses desire to treat pain.
May 30, '02
Occupation: RN.... Joined: Apr '02; Posts: 255; Likes: 6

I usually medicate as ordered, I was a patient for many many months after a severe trauma and i know that sleep can actually be an escape from chronic dull pain (I had a fx pelvis, several ribs, depressed skull fx, jaw fx with wiring, along with some internal injuries....)However, I am also not addicted to any pain meds at all, and I do get frustrated with pts who come in requesting specific amoutns of certain medications....multiple lists of allergies, and the migraines who are in terrible pain, but love to turn up the TV at all levels. But I must say I had a lot of pain, and would sometimes wake up and if asked rate the pain at about 8/10- hard to explain, because even now sometimes I look at a sleeping pt and think, well the pain med must have worked. Usually when we have a real issue in the ED the RN and the doc get a plan together....
May 30, '02
Joined: Oct '00; Posts: 10,236; Likes: 64

Originally posted by P_RN
I will give pain medicine to anyone that says they are in pain. It is not up to me to decide if they are or not.

Ditto. I would rather give an addict another fix than deprive my patient of relief.

Heather
May 30, '02
Occupation: med-surg Joined: Sep '01; Posts: 603; Likes: 96

I strongly recommend

www.baxter.com

for their on line classes on pain assessment and pain control. (get FREE CEUs for it too!!!) Found out about it right here at allnurses.com!

The classes really clarify pain, pain control, addiction, and all the myths surrounding control and pain meds!!

Pain is what the patient says it is. We are not going to "cure" an addiction problem by withholding a dose!!
May 30, '02
Occupation: RN Joined: Jan '02; Posts: 1,732; Likes: 1

give the meds. You have no idea what it is like for everyone to assume you not in pain when you are. I would sleep for hours when i was in pain. Never assume anything.
May 30, '02
Occupation: Legal Nurse Consultant/Defense Med Mal Specialty: 30 year(s) of experience in OB, M/S, ICU, Neurosciences ; Joined: Dec '00; Posts: 398; Likes: 19

I'd rather medicate my drug-addicted patient (carefully) and treat their pain than trying to cure their addiction--what can you "cure" during an acute ICU or med-surg stay anyhow?
May 30, '02
Occupation: Clinical Nurse Educator Specialty: 9 year(s) of experience in Neuro Critical Care ; From: US ; Joined: Apr '02; Posts: 578; Likes: 66

Thanks for all the input guys, I really appreciate it!
May 30, '02
Joined: Apr '02; Posts: 468; Likes: 20

we, as nurses, also need to have a clear understanding of the difference between a high tolerance and an addiction.
May 30, '02
Joined: Apr '02; Posts: 38,756; Likes: 16,285

I believe pain is subjective and it is what the patient says it is. We use the 1-10 pain scale and if the patient says it is a high number, I feel obligated not only to believe it but to chart and to DO SOMETHING ABOUT IT! And we can remember, THERE ARE NON-PHARMACOLOGIC means to deal with discomfort and pain. Sometimes, holding a hand, talking soothingly, LISTENING, repositioning, using heat or cold, and using diversionary tactics work very well, too. Also, it MAY BE the medication they are on is NOT doing the JOB and they need re-evaluation and a change of pharmacologic treatment.

But NEVER do I put myself in a position where I say a person is not in the pain they say they are, just cause they appear to be drug-seeking or addicted. NOT for me to judge this.....only for me to try to help and *chart* what works and what does not and contact a doctor if I need to. I would leave the diagnosis of addiction and its treatment to the doctor and/or psychiatrist.

Pain meds for the addicted

About bellehill

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