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.
This comment has me laying awake at night. Canadian Abroad, your answer was actually an A+ answer, if you're in school taking a test. It's just that many of the other posters are looking at this situation from a different perspective, that of nurses who have to deal with this situation on a daily basis. In a perfect world your answer would make perfect sense, however we don't live in a perfect world.
Specializes in Huntingtons, LTC, Ortho, Acute Care.
The thing that I find and I'm sure many health care providers find so hard to accept is yes addiction IS a disease... But it's a different disease. There are people that could eat a pound of bacon daily and live to be 100 then there's people that would die within 5 years if they did the same thing..l most people don't wake up and say, today I want CHF, or I want to become an addict. The saddest and most frustrating thing with addiction, is it is an uncontrollable illness that starts with a controllable choice. No body makes you put a needle in your arm, no one makes you eat a slice of cake or eat fast food... But the difference is, not everyone that eats cake gets diabetes, not everyone that eats at McDonald's ends up with plaque and MI... But a large percentage of people that decide to drink in excess or do drugs, get caught in the grips. And I think why it is so negatively looked at is because of the amount of money and time and resources society spends trying to keep people from doing drugs in thirst place. I mean when I was in elementary school I had DARE (drug abuse resistance education) never once had class dedicated to put the cake down and eat veggies. I'm not saying it's ok to treat addicts differently, but I feel like deep down... This is the reason why so many do. We can all feel sorry for someone that can no longer have cake, cause cake is EVERYWHERE! It's hard to find that sympathy for drug or alcohol abusers, because well they need to actively seek it out, you won't walk past heroin on aisle 5 when getting groceries for the week, but you'll probably pass the bakery... If this makes any sense.
We can all feel sorry for someone that can no longer have cake, cause cake is EVERYWHERE! It's hard to find that sympathy for drug or alcohol abusers, because well they need to actively seek it out, you won't walk past heroin on aisle 5 when getting groceries for the week, but you'll probably pass the bakery... If this makes any sense.
For alcoholics they certainly do walk past the alcohol section going to the grocery store. How many times a week I hear "lets get drinks"...
For other drugs I guess it depends- some of us live in neighborhoods where drugs are readily available- where others of us have social circles where drugs are very common.
This comment has me laying awake at night. Canadian Abroad, your answer was actually an A+ answer, if you're in school taking a test. It's just that many of the other posters are looking at this situation from a different perspective, that of nurses who have to deal with this situation on a daily basis. In a perfect world your answer would make perfect sense, however we don't live in a perfect world.
No, this answer is real life. If empathy and understanding of why people are pain seeking and what to do with them is lost, get out of front line nursing. Had my answer included how the hell to actually help them that is beneficial to them and not hand out a pill, that would have been a test answer. Real life, is being on the other side and having no where to turn for pain relief. Real life, is having a nurse think they have to "deal" with a patient and making the patient feel like garbage and a drug addict. Real life, was the nurse who labeled my mom a drug seeker (a fellow nurse) without knowing her or actually looking at her; hence missing out on key clues she was riddled with cancer, thus not helping her in any manner. Real life, is burying a parent who was a victim of front line nursing, and a nurse who felt they had to "deal" with the patient. When nurses get muddled with the idea that a patient is seeking and not actually looking at the patient and the pain they are indicating, people die; whether it is due to disease or self inflicted. It is time to stop thinking about the nurse having to deal with the patient, and think about the actual patient.
When nurses get muddled with the idea that a patient is seeking and not actually looking at the patient and the pain they are indicating, people die; whether it is due to disease or self inflicted. It is time to stop thinking about the nurse having to deal with the patient, and think about the actual patient.
I felt bad for a patient who was waiting for a liver transplant- he was in pain and had a paltry amount of medication ordered. He was in our department for a procedure- and he snapped me into reality with the statement that he was opioid tolerant as he had been prescribed opiates for some time. I refused to discharge him to his floor until he had proper pain control ordered. Sad that the patient had to educate the medical staff.
Specializes in Psych, Addictions, SOL (Student of Life).
That's about what I tell people when they rate their pain. I love when someone says 10 and is sitting quietly, no grimace, no outward signs of pain, vitals stable/baseline. I want to say to them "Have you ever had a kidney stone ripping it's way down your ureter? What about as it passes from your bladder through your urethra feeling like a piece of glass cutting it's way out from the inside?That's a 10. This calmness you display is not a 10. At least get with the program if you think you are a 10." But of course, we can't!
This whole argument is dealing with gross oversimplifications with regards to the phenomenon of Addiction and pain management. The first being that addicts tend to all be low class undereducated people who are not worth the time of day because they simply are not smart enough to "Get it" and so will use/abuse again and again and again. I work psych and have literally detoxed hundreds of folk from all socioeconomic backgrounds. I am an alcoholic in recovery sober since 2002. I am also familiar with acute pain (Have been a rodeo cowgirl ) and chronic pain as I now have fibromyalgia.
All that being said there is not a single day in my life that I am not in pain. I get up every day, I smile, I take care of my family. I go to work and at the end of the day I wash rinse and repeat. I am fortunate because I have never had to utilize the ER for pain management except for one time when I had a migraine so bad I though I was going to die. The Dr. and Nurse both assumed I was med seeking from the get go and simply asked "What do you want us to give you?" I said I don't know because the Darvocet the my Dr gave me isn't working so I'm open to suggestions. What I got was IV Benadryl and Reglan and the pain "Went Away".
I have a good Dr. that I work with closely to manage my pain and yes that management include opiates. The pain management doctor I see told me that Ibuprophen and Toradol don't have much effect on Chronic pain because they are anti-inflammatory and with chronic pain there is almost no inflammation to treat. The treatment of chronic pain is a very complex problem. The pain scale is subjective and what may be a 5 (My constant tolerable level) to be could likely be a 10 for someone else.
So let's get back to that addict detoxing on my psych ward shall we. Opiate detox is not considered and medical emergency and falls into the category of Psych. It is therefore not covered by most insurance. Long term inpatient rehab is almost never covered and is very expensive (sometimes
upwards of a $1000.00 a day. So it's $30,000.00 for a 30 day program. Believe me even people with means have a hard time coming up with that kind of money. Again most Insurance doesn't cover that. (Obama Care was supposed to fix this problem but that's a subject for another day) . In a best case scenario we can get someone into detox who is also acutely depressed and possibly suicidal on a 72 hour hold then based on their behavior on the unit can hold them over for 14 days of 5250. So that the drug is out of their system then send them off with a 30 day supply of anti-depressants and a handful of 12-step pamphlets. I am not denigrating the value of 12-step programs in fact they saved my life. But most addicts will always seek the "easier softer way". I have sat and held the hands of street addicts and little old ladies who were college professors as they sweated through detox (which by the way is also acutely painful) who thought they were going to die. Some never experience the miracle but when one does I get to go home with a feeling of vindication that I have helped just one.
I get feeling jaded by a population that by and large doesn't want our help but like another person here said we as nurses need to educate ourselves so that we do not fall into the trap of thinking that there is nothing wrong with these people. An addict is a very sick person both physically and mentally and needs to be cared for. Isn't that why we went into this profession?
Several of the hospitals I work for have a place to document the patient's behavior next to their stated pain level. One even asks for the nurse's "total pain impression."
On a 1:10 scale, if they say 100 and laugh. Guess what?
Specializes in Psych, Addictions, SOL (Student of Life).
Pain seeking
I don't understand this term - if we are ever going to have a meaningful conversation about pain/treatment/Addiction we need to use the right nomenclature. The term used in addiction medicine/detox is medication focused or medication seeking. I can't imagine anyone consciously seeking to be in pain!
I'm really disappointed in this content. To imply that opiate abusers are people with low levels of education perpetuates the notion of who abusers are. People with varying levels of education and finances abuse drugs. The type of drug abused and method may be different but there is no 'typical' abuser.
As as nurses we must work to stop stereotyping our clients.
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.
While at face value, this statement may be true - it's also REALLY bogus and comes across way more elitist and judgemental than you probably thought. Drug problems aren't even REMOTELY exclusive to people with no money and no education.
The reason you see poor dumb people as having the drug problems and apparently made the assumption that these leeches own the monopoly on drug problems is because the rich smart ones don't need to come to the ER to get their fix, they buy their cocaine or heroin (or whatever drug they feel like buying from their designer-suit-wearing drug dealer) with their gobs of money without having to even leave their offices.
That being said - no, the pain scale didn't contribute to a drug problem. If the numbered pain scale didn't exist, do you REALLY (I mean seriously, really...) think drug addicts wouldn't figure out another way? If you don't think they would just find a different direction to go, then you have no understanding of addicts at all.
The Joint Commission created standards for healthcare providers that promoted giving out pain medications like candy. This created more of a need for said medications, and the pharmaceutical companies profited. The Joint Commission then received large gifts from those companies, not at all unlike the street walker getting their (cough cough) "tip" for their services.
This is actually old news. When it broke, JCAHO was embarrassed and apologetic. Now the heat has died down and they are being defensive about it.
The standards that got them fined.................are still the standards we use for today's practice. Not much of anything changed after they were caught promoting addiction. For me, that is the scary part.
I don't know if pain scale contributes to opioid problem, some people are in real pain.
But I have my suspicions about writing / telling patients when their next pain med is due. I say that because what I have noticed is when you tell people its do...even though they are in pain they will remember the exact time pain meds are due. It's something I will not want to practice. If they are on multiple pain meds I would give them options and if they ask for the opioid before it's due I will just have to tell them that is not an option right now. I know - I can hear people tell me good luck with that
middleagednurse
554 Posts
NEW GRAD?
This comment has me laying awake at night. Canadian Abroad, your answer was actually an A+ answer, if you're in school taking a test. It's just that many of the other posters are looking at this situation from a different perspective, that of nurses who have to deal with this situation on a daily basis. In a perfect world your answer would make perfect sense, however we don't live in a perfect world.