Isn't pain whatever the patient says it is???

dhudzinski · Jul 21, 2004

I disagree, It is not all that plain and simple. Chronic pain patients on a steady dose of opioid can and do drive and operate machinery safely. the operative word here is steady dose ie the same dose daily. Intermittant dosing does not qualify.

NARCOTIC is a legal term used in the court system to mean illegal drugs, street drugs and does not apply to opioid medications that are prescribed for pain. The pain community of specialists are trying to educate healthcare providers and the lay public that the medical term is OPIOID and the Legal term is NARCOTIC. as a term "Narcotic" has many negative connotations and stigmatizes pain patients. It is all part of the "judgement", "value" and labeling thing that goes on which gets in the way of appropriate care.

txspadequeenRN, BSN, RN · Jul 21, 2004

I am a LTC Hospice Medication nurse (dementia and alzheimers specific) and I have seen these patients with long HX of post neuro shingle pain and others that are very hard to combat. Try a starting dose of Neurotin 100mg Tid then increase accordinly. I have given close to 2400mg a day (and Im sure more has been given in one day) . Inceasing your oxycontin would work to some point , ever thought of adding ibuprophen to bridge that gap. Methadone has worked wonders in some of my patients,as well as routine roxanol to get ahead of the pain. Some patients I have actually keep "asleep " untill the pain was under control ( you didnt hear that from me) . Pain is hard to get in control, No one has to die in pain remember that . You sound like a caring nurse ,we need more like you !!!!:)

momcats3 · Jul 21, 2004

I must disagree as well. My experience with our palliative care patients has shown me again and again that you can indeed live a full, productive life - working, driving, living(!!) with the addition of meds such methadone as well as oxycontin. I believe chronic pain is seriously underestimated in this country. As one nurse described it to me "I have my life back again". Not something to be taken lightly!

:)

tiroka03, LPN · Jul 21, 2004

hi momcat,
what is your pt.'s dx for her to be in hospice? also, neuro pain is one of the more challenging types to treat. as for mcaffrey's "pain is whatever the pt. says it is", i have mixed feelings about. but since your pt. is clearly exhibiting textbook signs of pain, you are 100% correct in trying to get it controlled. it drives me crazy when nurses write in their notes, " no c/o pain" or "denies pain". that is such a crock for there are so many patients that will indeed deny pain for many different reasons. i would pursue any channels you must to get a scheduled regimen started, and document very clearly all pertinent data. you've done good....thumbs up to you.

I've had people deny pain, and I know for a fact they are having pain. But, I can't force pain pills down their throat. If they refuse to take the pill, what is your suggestion?

dhudzinski · Jul 21, 2004

If what the patient is saying does not correlate with the behaviors that you are seeing (ie pt is grimacing, guarding, refusing to move, irritable etc) then I usually have a little sit down with them and ask some more specific questions and share my observations. ex (You say you have no pain, but your body is saying something different to me. You are grimacing and guarding your movements and this says to me that you are in some discomfort. The pain medication that the Doctor ordered will take away some or all of your discomfort, would you like to give it a try.) Sometimes I will even ask them why they need this pain? It is amazing some of the answers you will get.

We don't want to force pateints to take meds and they do have the right to refuse any intervention without fear of retaliation but we need to be sure that they understand and are making an informed decision based on fact and not some myth or other false information.

lawrencenightingale · Jul 22, 2004

The problem with that is... what are you basing yourjudgement on? Pain is so subjective and the only one who can judge how much pain and when it is there is the patient. Pain assessment is absolutely important BUT it must be a thorough systematic assessment if it is to be of any value.
Judgement is a value statement. Assessing and then using Critical thinking to come up with a plan as to how you might best intervene...I know it is symantics and a bit picky BUT....

I'm basing my judgement on my nursing assessment. A nursing assessment is critical thinking which leads to judgement. Perhaps judgement is a value statement in your opinion. Judgement in my opinion is an intellectual process. A process that experts(neurologists,e.g.) agree is among the highest of human abilities. CATscans/MRI's show the seat of judgement to be located in the forebrain. Because of our large forebrains with it's capacity to judge, homo sapiens survived(according to anthropologists,zoologists,et al.,). It wasn't our size,strength,numbers,speed,fangs,claws,flying/swimming/camouflaging/envenoming ability but our capacity for cognition which is responsible for our existence today. Judgement is an attribute of cognition. It's a good thing. Viva la judgement!

leslie :-D · Jul 23, 2004

I've had people deny pain, and I know for a fact they are having pain. But, I can't force pain pills down their throat. If they refuse to take the pill, what is your suggestion?

i find the most valuable intervention is to establish a very therapeutic and trusting relationship with them, as is what i do w/all my patients. i've had many patients refuse to take narcotics because of unspoken fears/concerns. but it's very helpful if they trust you and what you tell them, and give them complete control over their decisions.

one lady i recall was in excruciating pain towards the end of her life. she ended up sharing w/me that she deserved this pain because of her perceived past sins. we worked closely together; we experimented via many discussions, trial and error and many md order changes. she died, free of physical and mental anguish. but it was a matter of being committed to the cause...it's not always easy but 90% of the time, it works. peace.

leslie

tiroka03, LPN · Jul 23, 2004

Say registered nut, and others :) who have replied to my question about pt refusing pain meds. I appreciate your replies. This has given me a lot to think about. Your answers are right to the point and I will start to use them right away. THanks

lawrencenightingale · Jul 23, 2004

i find the most valuable intervention is to establish a very therapeutic and trusting relationship with them, as is what i do w/all my patients. i've had many patients refuse to take narcotics because of unspoken fears/concerns. but it's very helpful if they trust you and what you tell them, and give them complete control over their decisions.
one lady i recall was in excruciating pain towards the end of her life. she ended up sharing w/me that she deserved this pain because of her perceived past sins. we worked closely together; we experimented via many discussions, trial and error and many md order changes. she died, free of physical and mental anguish. but it was a matter of being committed to the cause...it's not always easy but 90% of the time, it works. peace.
leslie

Couldn't agree with you more. Interesting that so many nurses,I'm one of them, feel dutybound and actually honored to persuade their patients to take a pain med because signs(physical criteria) indicate the patient needs a pain med - eventhough the patients repeatedly refuse a pain med. It is the judgement of these nurses that the pain is not being accurately reported(that the patient is wrong). The subjective patient accounts of pain in these cases are overridden by the objective assessment of their nurses. Rah! This is what we're supposed to be doing - in my view - provide objectivity(because we care). It also works the other way,folks. Patients err in reporting pain. Sometimes they exaggerate - just like they sometimes deny or minimize pain. Why is it okay to disagree with our patients when we sense they are denying or minimizing their pain but many of us,if this website is any indication, won't countenance the possibility of our patients exaggerating or inventing their pain? Our clinical skills are good enough for the former but not the latter? Doubt it. Does giving meds turn us on?

leslie :-D · Jul 23, 2004

and NOTHING gets my blood boiling more is when nurses chart "denies pain"...it is so NOT a one question assessment, i.e., are you in pain?

i've seen nurses chart, "pt. moaning and grimacing when repo'd. denies pain". :angryfire :angryfire :angryfire

just a little pet peeve of mine.

leslie

Angela Mac · Jul 24, 2004

I have posted this remark in regards to drug seekers.

Luckily- some medical centers and emrgency rooms have a system to fall back on when they are suspicious of "drug seeking personalities"- I worked at a medical center that had a RED BOOK. It listed the names of patients who frequently came in with PAIN. Other MD offices, the ER, and local pharmacies kept a record of those patients seen for PAIN. You would not believe how many RED FLAGS went up with the local pharmacists- who, in turn, called the MD back when prescriptions were called in.

ex: Joe Doe was seen in four different MD offices for knee pain & prescribed- percocet, demerol, & Lortab......all within a two week period.

This is handy. Most of the DSP patients paid in cash, with hopes that no records were being kept.

teeituptom, BSN, RN · Jul 25, 2004

I have posted this remark in regards to drug seekers.
Luckily- some medical centers and emrgency rooms have a system to fall back on when they are suspicious of "drug seeking personalities"- I worked at a medical center that had a RED BOOK. It listed the names of patients who frequently came in with PAIN. Other MD offices, the ER, and local pharmacies kept a record of those patients seen for PAIN. You would not believe how many RED FLAGS went up with the local pharmacists- who, in turn, called the MD back when prescriptions were called in.
ex: Joe Doe was seen in four different MD offices for knee pain & prescribed- percocet, demerol, & Lortab......all within a two week period.
This is handy. Most of the DSP patients paid in cash, with hopes that no records were being kept.

Trouble is it violates HIPPA