Is current thinking on pain control creating drug addicts?

[GardenDove]

The current approach to pain control has been to believe the pt's self report of pain no matter what. Is this creating drug dependency, and or addiction, in emotionallly susceptible people? Should we be concerned? Is there going to be a backlash to what has been a more liberal policy towards pain relief in the past 20 years.

I bring this up for a few reasons. For one thing, our hospital let go one well liked doctor, the reason we heard being that she was catering to the drug-seeking community with too many prescriptions. We were all aware of her liberal attitude on this and that she was a soft touch in that dept, but when she was apparently suddenly fired, it was a shock.

The hospital clinic does happen to attract more of the misfit population btw. It's a small town, and there aren't too many docs that take new pts. The clinic tends to get more of the riff raff, if you'll pardon me using that term.

Then, our weekend hospitalist got paranoid. He actually told a nurse who called him for pain meds that he didn't want to be fired like Dr So and So was. I also noticed that he was being reluctent to give narcotic orders when I called him.

I was reading the new ANA magazine an article titled Improving Pain Management. It takes the approach of believe the pt no matter what, don't allow people to be in pain. One thing the article condemns is the use of placebos.

I haven't seen placebos used myself, but I personally think they might have a place with a certain type of pt. The reality of the situation is that there ARE drug seekers who are good at manipulating the system. Any nurse who doesn't see that in some people must have his/her blinders on, in my opinion.

So, how do we address that reality without punishing the many people who truly are in pain? Sometimes I think the whole pain control industry is a self-perpetuating machine, and a classic case of the fox minding the henhouse. On the other hand, I wouldn't want to go back to the old days when pts were expected to grin and bear it for fear they'd all end up druggies.

Any thoughts?

[dream'n, BSN, RN]

Unfortunately, I think the treatment of a patient's pain has more to do with the attending Drs. MO than the patient's symptoms. Some physicians I have worked with are very liberal with the pain medication, and some won't prescribe them in about every circumstance. I remember once when I got a large burn to the palm of my hand. I headed to a local UC (my hand in a pan of water the whole time, as it hurt like heck every time I took it out of the water) and the Dr. there took a quick peek and sent in his MA to put silvadene on and wrap it. When she began to wrap it, I told her I couldn't handle the pain when it was out of the water. She left and talked with the Dr., who according to her said, "it will quit hurting in a few hours, either let us dress it or leave." I then told her that I understood the reason for the dressing, but it really hurt, could he give me something, just ONE or TWO pain pills to last until it quit hurting in the AM? The Dr. refused to give me ONE pain pill! I left and cried all evening and night, until it eventually stopped hurting. Not only was I in pain, I felt angry and judged. Did he think I went from UC to UC asking for ONE pain pill, until I had amassed a whole bottle!? And then to keep up my addiction, go do it over again every couple of days? I mean really.....On the other side of the issue, a Dr. I have personally worked with almost without fail would always prescribe them. I have had to really get his attention (which isn't very easy) when things aren't 'above-board' and he continued to o.k. controlled scripts. We once had a fellow continuously wanting early refills of Ambien 10mg (I know it's not for pain, but it is addictive.) Come to find out, he admitted to taking THREE of them a night, along with other sordid and sundry controlled substances. We sent him to a specialist that switched him to Lunesta 3mg. Then the fellow wanted an early refill again of the Lunesta. Why? Because, again he had been taking THREE a night, only this time with the Lunesta. Dr. was informed and OKAYED the refill! I had to reapproach him, make him sit down and LISTEN, before he got it and denied the early refill. Sorry I've been rambling.

[Sheri257]

But you can't say that the meds for the migraines caused the addiction. She may have had an addictive personality anyway and would have gotten addicted to something else.

There's no way of ever proving that X person taking Y drug got addicted to Y because he or she could just have easily gotten addicted to Z if given the opportunity.

Rules like not giving adequate pain relief for fear of developing an addict don't prevent addictions. These people who were leaning toward that anyway will find something to be addicted to.

I see your point here ... maybe she has a addictive personality anyway.

But, by the same token ... if the drugs weren't so readily available to her legally, would she be still have become an addict? Would she, for example, start cruizing street corners for drugs instead?

Obviously I don't know for sure but ... it seems like the pattern here was: she needed more and more drugs for the migraines, then she couldn't sleep and needed something for that, then she had anxiety and needed something for that ...

Then she starts asking friends for pills without a script ... in a profession where this kind of thing can ruin your career.

I dunno ... I'm just wondering if she would have gone down this path if she didn't have such ready access to the drugs in the first place.

:typing

[GardenDove]

People do use drugs to cope with life. I wonder what the difference between drinking a couple of glasses of wine is and taking a pain pill? Really, what's the difference, other than that wine has been a part of our diets for thousands of years.

[tddowney]

I've got my two pennies in hand, so I'm ready to jump in.

As a nursing student, though an older one with personal experience in chronic substance abuse (etoh in my case), I've obviously not dealt with nearly as many cases as most here, so I'll just make a couple observations and ask a couple questions.

When assessing a Pt's self-reported pain, how does one view vague answers to the usual assessment questions, especially when the Pt reports high levels, 8-10, of pain? What about the absence of any physical or emotional manifestations of pain, or abrupt changes of affect and/or behavior when the subject of pain is brought up?

We live in a time when substantial monetary damages are awarded because, for instance, a railroad didn't do enough to keep some teens from climbing over a fence and getting badly injured by a train. Do you really think it will be long before lawsuits are brought against prescribers when a kid dies from a parents Rx pain meds?

Are we overly discounting the amount of harm addiction does not only to the addict, but his/her family? We often say we should err on the side of giving addicts drugs rather than denying them to a chronic pain sufferer, but on what measures of harm are we basing this judgement?

It seems to me that a Pt in pain would be interested in every method of easing that pain. If you have a Pt who is is not interested in learing non-pharma pain control techniques, should that be a caution flag? (Obviously here the Pt has to have the pain controlled well enough to be receptive to teaching.)

[ginger58, ASN, RN]

People do use drugs to cope with life. I wonder what the difference between drinking a couple of glasses of wine is and taking a pain pill? Really, what's the difference, other than that wine has been a part of our diets for thousands of years.

Oh please! Not only has wine been around for years but so have poppies and other plants.

I hope you're only referring to coping with life when you compare wine to a pain pill.

[GardenDove]

Oh please! Not only has wine been around for years but so have poppies and other plants.

I hope you're only referring to coping with life when you compare wine to a pain pill.

I don't quite get your sarcastic response. I think I bring up a valid point. Humans have been altering their conciousness for thousands of years. Why are some ways stigmatized and others not?

I hold the view that Modern Medicine is much like a religious system, with doctors being the priests, and medical boards the Magisterium, run by Doctors of the Church of Medicine. In order to alter one's conciousness, one must have the blessing of a priest, who follows the legal system set up by the High Priests, Bishops, Cardinals, etc.

[ginger58, ASN, RN]

I have a friend who just graduated with me from RN school. She has had terrible migraines but, now, I'm convinced the meds she's been taking has also made her a drug addict.

To me, the telltale sign was when she started asking friends for unprescribed meds, even though she's got scripts for at least four meds she's taking now. She now seems to need meds for everything ... going to sleep, anxiety ... you name it.

Of course, all of this is very dangerous as an RN ...:typing

If you can muster up the courage to talk to some one in authority please do. An ex-instructor or whoever. If she kills someone you're going to feel really bad and you wouldn't want to feel like an accessory to murder--over dramatic I know. Hopefully the facility she hires in at will do a drug screen.:Santa2:

Maybe your friend will get the help she needs. I don't think it's the system I think it's the individual doctor and her "friends" giving her meds.:Santa1:

[leslie :-D]

People do use drugs to cope with life. I wonder what the difference between drinking a couple of glasses of wine is and taking a pain pill? Really, what's the difference, other than that wine has been a part of our diets for thousands of years.

when people drink or take drugs, to allay psychological pain, then that is the makings of an addict.

people who take drugs to genuinely abate physical pain, will not become addicted.

they may build a tolerance but in order to become a full-fledged addict, there has to be a psychological dependence and benefit.

so if someone is drinking to dull the (mental) pain, then there would be no difference in someone else taking a pill to do the same.

but people drink for many reasons-not all become alcoholics.

not all prescription drug users become addicts.

leslie

[EthnicBeauty]

I have to say that I think if someone is in pain then they should get the necessary meds to relieve their pain. If someone is an addict then it will come out into the open at some point, no reason to make those in real pain suffer.

I have a serious problem in my neck, I've been told it's a herniated disc. It hurts like h*ll. When I had an X-ray (b/c that's all he would give me) the lady who did it said it was no wonder why I was in so much pain and she thought the doctor would send me to get an MRI. When I saw the doctor he said "There's nothing wrong with your neck, you should go for physical therapy''. Now if there was nothing wrong with my neck I wouldn't need PT, right? All he would give me was prescription IB profen. I have taken up to two 800mg pills and it didn't even touch the pain I was feeling. I even told the doctor that vicodin was the only thing that worked for me and he just shrugged his shoulders. The pain has been so bad that I've cried myself to sleep after laying there for hours because I can't fall asleep the pain is unbearable. So yes, I believe patients should be believed when they say they are in pain!

[PANurseRN1]

I suppose your doctor would rather you develop an ulcer from NSAID overuse.

Sorry you have such an uncaring PCP.

[ginger58, ASN, RN]

I have a serious problem in my neck, I've been told it's a herniated disc. It hurts like h*ll. When I saw the doctor he said "There's nothing wrong with your neck, you should go for physical therapy''. I even told the doctor that vicodin was the only thing that worked for me and he just shrugged his shoulders. The pain has been so bad that I've cried myself to sleep after laying there for hours because I can't fall asleep the pain is unbearable.

I am so sorry that this has happened to you. I had a disk herniated in the lumbar spine and that was painful. Norco/Vicodan didn't work and I sat home crying--here I am a palliative nurse and take care of my patients' pain and I can't get what I need for my pain.

I had a pt. that was admitted with the same and given morphine which did work for her. If this happens to me again I'm going to get what I need legally!

These docs needs to experience these problems, suffer a little, and then be only offered an OTC drug for their pain!

[ginger58, ASN, RN]

I don't quite get your sarcastic response. I think I bring up a valid point. Humans have been altering their conciousness for thousands of years. Why are some ways stigmatized and others not?

I hold the view that Modern Medicine is much like a religious system, with doctors being the priests ... In order to alter one's conciousness, one must have the blessing of a priest...

If I sound sarcastic I think it's more worry. We're now off the subject of people really needing pain medicine and those worrying about addiction. I worry that your patients won't get what they need for their pain. Especially the "riff raff" you mentioned.

People don't have to go to the "Church of Medicine" to alter their consciousness. Get some dope, alcohol, glue, etc. I thought we were discussing those in need not getting what they need because some health professional is worried about the person becoming addicted and those professionals that are loose with their prescriptions.