Need help W/Difficult, complicated Pt. - page 2

i need some opinions on what to do with one of my home care pt's. i'll give you a little hx. first. female, mid 50's, lives alone,no willing family to assist. has chronic diagnoses but nothing... Read More

  1. by   rehab nurse
    Hi again

    Well, she seems to be on adequate pain meds. I am currently on even more pain meds thanher, but I don't work and I have a ton of joint pain, back pain, and leg pain. I am in pain 24/7. But even with the amount of meds I'm on, my pain rating hovers around a 5 to 6 on a good hour. I'm surprised someone has her on that much medication without a definitive diagnosis. But they must know her somewhat? Doctors around here wont just give people those kinds of meds long term without being on hospice, or having a pain management consult. Whatever the case, I feel for someone who has to deal with pain. I really do. It can really bring someone down because you can't "fix"it. Did she just start on the Duragesic? Just wondering because I tried that at one time, and when i first started on it, I was very doped up. however after a month's time, I got up past her dose and barely felt it. I had to quit in though because of some rashes, but I liked not having to take pills all the time.

    I agree with the other poster who thinks its a psychological disorder thats aggravating her condition. I can't imagine not having any family willing to even visit or be bothered with her. She must feel incredibly sad that no one cares (at least her family anyway, at least she has you!!).

    Maybe she does need some better psych care and meds? I don't know how to get her to move. If she says it hurts though when she moves, I don't blame her for not wanting to!! Who wants to be in pain? I wonder if PT could try some heat packs before she moves her joints? I don't know what the answer is, but I feel for you and her. I'm worried about her skin and all those areas that are going to be vulnerable due to her immobility. But you can't force her. Sad all around, I agree.

    Sorry I don't have any answers, but I would start with psych, even if she says she's not depressed. Just being in that much pain will cause chemical changes in the brain over time, and often times some antidepressants will be prescribed for adjunctive treatment, at least it's common in this area with the pain docs here.

    Good luck to you.
  2. by   Cattitude
    i see they moved us:roll . thanks for all the responses. i guess i just wanted to make sure i had tried everything and it looks like i have. the last thing i'm going to do is have our county psych team evaluate her. she is treated by our psychiatrist but may benefit a bit more from a full team. they have an md, social worker and caseworker and visit pt's at home weekly that are homebound.

    so that's it. a year ago, she chose to sit and not get up, that was her choice. sigh... i have to stop wanting to fix everything in life :d