I work in the ER, therefore encounter many people with opiate problems. A lot of them, frankly, are unsophisticated people with low levels of education. We use the pain scale because we are required to. Many of these folks have been working the system for years, and are conditioned, like Pavlov's dog, to give a number that will give a result they need. We play along because we are required to put a number in.
I think the whole system is mostly highly inaccurate and subjective. A 10 often means how much they want the drug. The pain scale has contributed to our national sense of entitlement to be pain free through drugs.
I do find the pain scale useful with cardiac pain, but by and large, for the opiate seeking population, it contributes to the nationwide drug problem we are facing.
I think the system is the problem. We have doctors willing to dish out narcotics, and not looking at other methods of treatment. We have doctors getting patients hooked on these medications, and then refusing to refill prescriptions. I had a pain doctor who was under investigation for his practice. He stated that he was stopping narcotic prescriptions and did not have a suggestion for his patients on where to go for help. He literally gave them one month before he kicked them out the door. What happened to those patients? Patients who were on methadone for pain management, and other various narcotics. Those patients were left to seek in the ERs and flood the system. He stated he was going to practice Functional Medicine, and I respectfully told him that he had been a drug pusher and `should have his license revoked for his actions. I eventually weaned myself off narcotics altogether; but I was one of the lucky ones. I can't help to think what his other patients went through, and where they turned. Perhaps Functional Medicine is where we need to head, but I can't see how to help the current system when the first thing a doctor does is automatically hand out a narcotic. It just is sad to see and sad to see those using to cope for other symptoms, and mainly psych issues.
I suffer from terrible migraines. I totally understand seeking pain relief. I also like being able to be functional, though. I don't seek being snowed.
To answer the OP's question - no, I don't think so. Active addicts will use any effective tactic, including lying, to obtain their drug of choice either to get high or at least avoid withdrawal.
Meanwhile, the behavioral and physiological markers we use to determine "real" pain are woefully inaccurate outside of a very narrow range of acute onset severe pain. I don't think it's useful to automatically invalidate self-reporting because junkies lie. I think the problem lies with what we do about that self-reported pain score.
I see it everyday since I work at a Drug detox. The system has a problem I have some patients who have been to detox and treatment over 40 times and these kids are in their 20s. Yes some have long term pain, but that number is very few. Some of my patients will AMA after a few days and go out and OD go to the ER, then back to us for treatment and yes they will AMA again. And yes the pain scale is so funny, everyone is an 8 or 10. And they always have anxiety, I am like Mr patient you are still in bed just waking up, but he says he is so anxious.
As long as they have insurance to pay these kids will not stop, there needs to be a cap for how many times they can go to treatment. If it has not worked after 4 times something needs to change. It is hard seeing these 18 year old kids doing this to their bodies.
I see it everyday since I work at a Drug detox. The system has a problem I have some patients who have been to detox and treatment over 40 times and these kids are in their 20s. Yes some have long term pain, but that number is very few. Some of my patients will AMA after a few days and go out and OD go to the ER, then back to us for treatment and yes they will AMA again. And yes the pain scale is so funny, everyone is an 8 or 10. And they always have anxiety, I am like Mr patient you are still in bed just waking up, but he says he is so anxious.
As long as they have insurance to pay these kids will not stop, there needs to be a cap for how many times they can go to treatment. If it has not worked after 4 times something needs to change. It is hard seeing these 18 year old kids doing this to their bodies.
I tend to agree with you, there ... but I don't think the pain scale is anywhere near the root of the problem of addiction in general or opioid addiction in particular.
Unsophisticated and low level of education? My god is this a generalization. Here is the thing, instead of passing judgment on these individuals, how about taking addiction courses to learn how to help these patients? Most of the time, a great deal of these individuals have no where else to go; especially in inner city hospitals. They are not seeking these meds due to being a junkie. Most of the time, they are in pain. They are masking other symptoms and are using as coping mechanisms. Yes they clog the ER, but they need help. Get some empathy and put yourself in their shoes. I used to be like you, until I had an injury and a chronic pain condition. It was hell, but I eventually pushed through it and am back to work. Am I a junkie if I go to the ER because I cannot manage my pain properly? I work in part of the ER, and I can tell you that our pain seekers are of all classes and education levels. There was no need to even mention that in the first place, and it comes off very ignorant. I am not sure if you intended this or not. Here is some advice from someone who has been in their shoes. Ask the pain level, look at their facial reactions and ask them to describe the pain. Most pain specialists go by the description of the pain, and not the number. I used to attend a pain clinic for years, and my experience has made me understand just how easy it is to get dependent on a drug and even when you do not intend to. I do highly suggest addiction courses online. McMaster University in Hamilton has an excellent program. I do think it will help in the ER, and then help stop patients from being transferred to Clinical Decision Units to investigate their pain.
Thats because we dont give enough attention to mental health in the US. Many of these " repeat offenders never have their "problem " solved- which is to be able to feel NOTHING. They want no pain no anxiety , no reality.
Nope. I am just sick of seeing patients come to our section of the ER unmedicated and in hysterics due to being treated like a drug addict. If someone has completely lost empathy, they need to stop front line nursing. I do think perhaps a fast track system should be put in place regarding pain medication and those seeking it. I know some ERs in Canada have this, and it limits the ER from being clogged. There just has to be a better way for the patients, and those working with them. When a patient is being worked up for "chest pain" and it is actually about meds, we need to stop this; which again comes back to the doctors.
I also agree the pain scale should be changed. But, for now this is the system we use and most of the time when you go back the pain is down to a 2 or 3. Which means it worked. I don't work in the ER, but I do chart the patient's behavior. I don't work in the Er, but have been there when a patient request pain medication. Unless they are habitual ER patients, show no obvious signs of trauma, or bad actres, it hard to tell. I don't think one shot of demerol is going to make an addict(they probably already are), give them their pain med, follow up with their doc, suggest alternative non pharmaceutical control, follow up with their PCPi, psych consult and send them on their way.
I think the pain scale is a blessing for those patients who are in legitimate pain, doctors to write clear narcotic orders and for us to administer those narcotics. BUT..... For addicts the current pain scale or any other one that they would come up with is useless (unless they have legitimate physical pain.)
Researchers are working on methods to truly assess pain and treat it. It might be a long time until it gets to be used in hospitals but it WILL happen and that will help everyone.
I do think perhaps a fast track system should be put in place regarding pain medication and those seeking it. I know some ERs in Canada have this, and it limits the ER from being clogged.
CanadianAbroad
176 Posts
I think the system is the problem. We have doctors willing to dish out narcotics, and not looking at other methods of treatment. We have doctors getting patients hooked on these medications, and then refusing to refill prescriptions. I had a pain doctor who was under investigation for his practice. He stated that he was stopping narcotic prescriptions and did not have a suggestion for his patients on where to go for help. He literally gave them one month before he kicked them out the door. What happened to those patients? Patients who were on methadone for pain management, and other various narcotics. Those patients were left to seek in the ERs and flood the system. He stated he was going to practice Functional Medicine, and I respectfully told him that he had been a drug pusher and `should have his license revoked for his actions. I eventually weaned myself off narcotics altogether; but I was one of the lucky ones. I can't help to think what his other patients went through, and where they turned. Perhaps Functional Medicine is where we need to head, but I can't see how to help the current system when the first thing a doctor does is automatically hand out a narcotic. It just is sad to see and sad to see those using to cope for other symptoms, and mainly psych issues.