Working in orthopedics, we have a LOT of pts that have chronic pain issues. We have to deal with the chronic pain and the acute pain. Some of them have a baseline pain of 5-6/10 and are already taking lots of meds. We have to manage their pain with multiple modalities. We use regional nerve blocks, (we have an Acute Pain Team), they will also use ketamine and/or lidocaine drips to avoid the narcotic route (giving them their home doses of those)
I get very frustrated because we will get patients from local community hosp and all they do is give IV dilaudid. When the patient gets to us, they don't understand that's not how we work. We very rarely use PCAs anymore (usually reserved for the sickle cell patients).
It is very complicated and frustrating. One cannot judge the person with chronic pain or the on abusing/misusing opioids. On my unit, average length of stay is 3 days (more for a trauma pt, but that is usually 5-7 days). We are not going to cure someone's addiction in that time. We cannot judge them either.