Seeking Narcotics or Chronic Pain?

[samaletta]

I just recently graduated from nursing school and will be starting a GN position at the end of the month. I am still currently working as a tech in the hospital until I start the position.

Last week I worked midnight shift and was placed in the ER for one of the nights. A young woman came in for severe abdominal pain. I knew this woman from working on the other floors, she has crohn's disease. All of the nurses were disgusted and talking about her being a drug seeker, both in the ER that night and when she was on the floor I had remembered the floor nurses saying the same thing.

It kinda bothered me (and maybe I am being niave) because people who have chronic conditions with exacerbations will be going to the community ER for help, and they will be admitted at times. So the hospital nurses will know them, and because Crohn's can be a painful condition, the patient may be looking for relief.

I just thought a couple of the nurses were not treating her fairly or with respect, which made me feel bad for this young woman.

Do you think that sometimes people with chronic conditions that can be painful are sometimes labeled as drug seekers? I just don't think it is very fair.

[caroladybelle, BSN, RN]

As someone with IBD, yes, it is painful.

And, yes, pain is an important thing to treat.

That said, the ER is the worst place to get adequate treatment for pain, especially that arising from chronic conditions. One should judiciously utilize one's pain specialists/PCP/GI for that. Because many pain meds can seriously exacerbate the problem or mask complications of the disease.

The other issue is that the ER is for emergencies. And while pain is important to treat, it is generally not a fatal lifethreatening issue. And much of what is in the ER is.

I also have dealt with some fellow IBDers that do not take proper care of themselves and do "no-no's" that exacerbate the disease - leading to the pain issues. Or that have serious co-dependency issues - friends and family that feed into the "poor little X" syndrome. Any little ouch, gas attack, or diarrhea s/p "popcorn at the movies", and it is treated as a fullblown attack. This can get rather wearing on the nerves, after repeated ER trips w/the full range of required tests showing 'negative", or minimal disease.

Yes, we should take pain at what the patient says it is, but after you have your "10 out of 10" abdominal painer, come back with not using their meds for the last week (it's so inconvenient, or they make me fat), that was crying one minute and then 2 minutes later, dancing around the room (you know that the med takes longer to take effect), you get a bit jaded. Especially, after remembering when you were last in the ER, you had bled to a Hgb of 6.5 and lost 15 lbs in less than a week.

[time4meRN]

It's good to hear a refreashing view point from a new nurse. Sometimes as ER RN's we get tainted from sooooo many pt's that want pain meds. And I too have had those pt's who had "cancer, chrones, etc ,,,,etc,,,) and come to find out that it's not true or they have gone from hospital to hospital , DR to DR getting narcs. Most pt's don't doup us but there are many that do. I would have to know more about the pt's HX. , It would be interesting to know her allergies. ER staff always like those Toradol, motrin and compazine allergies. That's usually a big red flag. And as others said, has the pt followed up etc... Ohio has a wounderful tool through the Ohio Board of Pharm. that, a pt's narc prescriptions can be looked up. Boy is it ever an eye opener. I have to say, It's always a feather in our cap when the Dr can go to a pt's room and say, "so I see you have gotten 4 scripts for percocet in 3 weeks, is this true. Because if it's not, someone has your name and SS # ,and maybe it is a case of stolen idenity. So it's our duty to notifie the police of the possible idenity theft of medical records. ". However if they find that you have been going from DR to DR., that would be a feloney offence " I 've seen this happen 3 times in the last 2 weeks. You should see how quick the pain goes away.

[bellcollector]

I am probably very jaded on this subject. I am a nurse I have set behind the nurses station and heard the mean and hurtful things that nurses who are suppose to be the so called pt advocates say about their pts. I also happen to suffer from chronic pain and have been the pt in the bed. Personally I think chronic pain pts are and most likely always will be miss treated by the majority of healthcare providers. This has been my experience anyway. I hope it will change but I am not holding my breath. It is a shame that every nurse doesn't at least once suffer with untreated pain under the care of judgemental healthcare providers just one day would probably do it.

[gr8rnpjt, RN]

I do not work as a nurse anymore, because I am dealing with cancer.

((((((((((((((rehab nurse)))))))))))))))

I will remember you in my prayers(((BIG HUGS)))

[LilPeanut, MSN, RN, NP]

Just a quick question: Why does a compazine allergy raise red flags? I can't take compazine or phenergan, I get extra-pyramidal symptoms. It's not entirely uncommon, so I wonder why that's a warning sign

[JenNJFLCA]

In my opinion, pain is what the pt says it is. Period. If I notice their respiratory rate is too low or if they are hard to wake up, I won't give the pain meds, but if they say they're in pain, I'll give it as ordered. I deal with mostly post-op pts, so I am pretty darn sure they're in some type of pain. A lot of them also have neuropathy, which is very difficult to treat for pain. My mom has MS and she has chronic pain, but I would not consider her a drug seeker by any means. There are plenty of drug seekers out there, but I believe there are way more people with real pain. Keep in mind that I don't work in the ER. That's a whole different world!

[rn undisclosed name]

Just a quick question: Why does a compazine allergy raise red flags? I can't take compazine or phenergan, I get extra-pyramidal symptoms. It's not entirely uncommon, so I wonder why that's a warning sign

It's not those particular drugs (I believe) that raise the red flags. It's that coupled with certain narcotics.

Certain patients come in demanding narcotics with certain other medications such as Benadryl and Phenergan (I think) which enhance the effect of the narcotic. Can someone please explain how this happens? I'm curious.

[rgroyer1RNBSN, BSN, RN]

Ok guys this is a touchy subject, I have crohns and it is painful but I also have a GI doc who is great and I follow up when Im supposed to every three weeks and if I need pain meds he gives me scripts for the Vicoden, phenergan, and toradol, and bentyll because thats the regimen it usually takes but I do everything Im supposed to. Generally when Im having a severe attack I usually call him and he admits me he prefers to bypass the er completely because they always try to label his crohns and colitis pts. has drug seeking. And whats up with the compazine Im allergic to it, it puts me in anaphylaxis and Im not kidding about that. Im also allergic to morphine and codiene, so you know Im not seeking because they have to be careful what they give me usually if Im having a severe attack its either demerol or nubain, phenergan, toradol, and bentyll and thats how it goes.

[LilPeanut, MSN, RN, NP]

Hmm. Phenergan gives me EPS too. All anti-emetics in that class do. Reglan has the mildest symptoms for me, but I still avoid anti emetics at all costs.

[teeituptom, BSN, RN]

Oh, it's very common. Go to any ER and all the chronic pain pts are considered drug seekers. While some of them are indeed drug seeking, most are not. However, because they take larger than normal doses of narcs, they get the label too.

Of course they are seeking drugs

why else come to the ER

[Tweety, BSN, RN]

Just a quick question: Why does a compazine allergy raise red flags? I can't take compazine or phenergan, I get extra-pyramidal symptoms. It's not entirely uncommon, so I wonder why that's a warning sign

Some nurses judge a patient by their allergies. "Hey look he's allergic to haldol - he must be crazy"....."oh look, he's allergic to NSSAIDs, Tylenol, Morphine, Darvon, Stadol, but conveniently not IV Demerol, sounds like a drug seeker to me". "He claims he's allergic to compazine, but not phenergan because phenergan gives him a high".

[rgroyer1RNBSN, BSN, RN]

Oh thanks tweety generally though they give me nubain so u know if I was a seeker everytime they gave me nubain I would be in withdraw and no phenergan doesnt give me a high, it stops my vomiting because I will literally not go to the er unless its pretty bad and im vomiting my guts out.:angryfire