Legitimate Pain or no?

[MiaNursingStudent]

I have never been so angry or frustrated in my nursing school career!! Please correct me if I'm wrong because I've been banging my head against the wall to understand the rationale that was given to me-- and I really want to know if I am in the wrong, receiving incorrect information, or just SOL.

Today during clinicals I was assigned a "difficult patient"-- which I believe was an incorrect label to give this patient because she was actually quite sweet and polite. I got the report from the nurse who was assigned that patient and she said "just so you know, this patient is going to ask for her pain medication everytime she sees you". Sure enough-- I went into the room to do the daily assessment and obtain vitals and she asked me for her pain medication.

Background info on my patient: She has remitting-relapsing MS and was admitted for an abdominal abcess. Since her admission (89 days ago) she has developed 3 pressure ulcers- a Stage II on her coccyx and two Stage I on her heels. She also has leiomyosarcoma with metastasis to the kidneys. Her Meds: She gets a Fentanyl patch (25mcg/hr) q72h and a Lidocaine patch daily. She is also taking Ativan 0.5 mg t.i.d. and her prn pain med is Dilaudid (0.25-0.5mg IVP q2h prn for pain). That's her meds for pain.

When I checked her chart to see when the Dilaudid was last given it was 5 hours ago. The patient ranked her pain as an 9 and so I went to ask the nurse if she could get it out of the pyxis for me because I was in charge of total patient care (but don't have access to the pyxis system). She said that my patient was just a drug seeker, that she didn't have legitimate pain, and that my patient was just trying to manipulate me into giving her some pain meds..... Correct me if I'm wrong, but isn't pain whatever the patient states that it is? And since she has an order for Dilaudid prn and it had been 5 hours since her last dose that we could give it as needed for pain? And for the nurse to tell me that my patient didn't have "legitimate pain" simply infuriated me! She has MS and Cancer for crying out loud!!! And in my opinion, the Dilaudid dose seems so low that I was surprised that she didn't ask for it more often. The rationale that the nurse gave me for withholding the prn pain med is that the patient is "psychologically dependant on the pain meds" (even though there wasn't a psych evaluation done on her) and "is just trying to get her drugs".

Anyways, long story short, I had to fight to get pain meds for my patient whose pain level never went below a 7. I talked to the Pain Management Nurse about it and got her opinion about it-- she thought that the dosage of pain medication was too low and that the patient could be experiencing breakthrough pain---- but when I went to my Professor about it she said "I'm glad you're being an advocate for your patient but you really should choose your battles because working on a floor has its politics"....... first they tell me to always be an advocate for my patient but then they want me to compromise my quality of care so that way I'm liked by the other nurses?

I'm just a nursing student--- so if anyone with ANY type of experience can please give me some guidance, I am so angry, confused, and let down right now. I really feel like I did the right thing by standing up for my patient because I believe she was in pain..... I'm just so lost.....

[resumecpr]

If I were in the hospital for 80-some days, with pressure ulcers, and MS, an abscess, and cancer, I would want to be snowed out of my tree. I once had an oncologist tell me 2 things for a patient very similar to this:

1) There is NO cure for cancer pain

2) Give the patient Dilaudid until he is pain free or stops breathing

OP, you have every right to feel stiffled. Continue to advocate for this patient and her pain, she obviously hasn't been successful.

Best of luck!

I can't wait to hear the comments about my Dilaudid order!!

[Fribblet]

If I were in the hospital for 80-some days, with pressure ulcers, and MS, an abscess, and cancer, I would want to be snowed out of my tree. I once had an oncologist tell me 2 things for a patient very similar to this:

1) There is NO cure for cancer pain

2) Give the patient Dilaudid until he is pain free or stops breathing

OP, you have every right to feel stiffled. Continue to advocate for this patient and her pain, she obviously hasn't been successful.

Best of luck!

I can't wait to hear the comments about my Dilaudid order!!

Cancer, MS, and multiple decubs? I think we give Dilaudid WAY too much and for pain that doesn't warrant it, but if there was EVER a situation that warranted the magic D, this is it.

Hell, give that woman some perc-ilaud-ivan with a Benadryl chaser.

[grannyrn65]

If I were in the hospital for 80-some days, with pressure ulcers, and MS, an abscess, and cancer, I would want to be snowed out of my tree. I once had an oncologist tell me 2 things for a patient very similar to this:

1) There is NO cure for cancer pain

2) Give the patient Dilaudid until he is pain free or stops breathing

OP, you have every right to feel stiffled. Continue to advocate for this patient and her pain, she obviously hasn't been successful.

Best of luck!

I can't wait to hear the comments about my Dilaudid order!!

I think your comment about the dilaudid is right on point. I was a nurse for more then forty years. And I am sick and tired of nurses appointing themselves as the final arbitrator in determining if a patient has pain or not. Everyone copes with pain differently. A patient may be able to smile and joke and still experience pain at 10 out of 10. Or may not have the changes in vital signs that so many seem to rely on. Pain is what a patient says it is. You do not have a role of deciding in pain medication is warranted or not, especially when you use all the subjective signs that so many nurses do. If the patient is drug seeking, so what. You denying him a drug that is ordered is not going to suddenly make him stop seeking drugs.

If I sound like I have a vested interest, I do. I avoid going to the ER for any type of pain relief. I found out, a long time ago, my peers sit in judgement of anyone who comes into THEIR ER for pain medication. Unless they have a broken bone, multiple lacerations, with bleeding or an acute belly, they are going to be labelled as drug seekers. I suffered a badly broken ankle sometime ago. I fell in my home, had to scoot on my rear end out from my bedroom to my living room, to get to the phone to dial 911. Then I had to wait all most one hour for a rescue squad to become available. The local cops arrived shortly after I placed my call and they helped me to focus on things other then the severe pain I was in, thank them very much. The paramedics came, started a line, gave me MS and transported me. The physician head of the ER, ordered more MS, before having me transported for x-rays. I went home, in a cast and very mellow and not suffering from any pain until several hours later. Heaven keep my peers who think they can determine the degree of my pain, far, far, far from me. And other patients.

No, your comment is quite on point. As for those who believe they are the gate keeper or have some divine guidance in determining if a patient is truly in pain, hope you some day experience what you so freely dish out:yeah:

GrannyRN65

ducking down behind you-you make a bigger target them me:)

[classicdame, MSN, EdD]

there is so much ignorance on this topic. Please be a patient advocate. Spiritual and emotional pain can affect the physical pain. Pain is always what the patient says it is, and any nurse who has to make the patient PROVE the pain is legitimate needs to have THEIR head examined. When you ask the patient to describe pain you are asking them to compare what is going on now based on their own memories of pain. NOT YOUR MEMORIES. So a 7 means they are hurting whether you believe it or not.

[canoehead, BSN, RN]

GIVE the drug, GIVE the drug, GIVE the drug!

I am an old, jaded, ER nurse, and I wouldn't even hesitate for that woman. She needs good drugs, and as much as she wants, or can tolerate.

When you get your Pyxis pass you can make this right a hundred times over. If I get someone at night with chronic pain they have frequently underdosed themselves to stay awake and alert for docs and visitors. Just as frequently they are underdosed by staff. We all know that pain control is easier if you keep on top of it, but some people want to wait until it's 8-10/10 before giving prn doses. Anyway, I ask them if they want me to just give the prns overnight, but on the condition that they keep a moniter on. I'll hold meds for decreased RR or sats, we get on top of that pain cycle, and they get 8 hours of good sleep.

[OldNurseEducator]

I have just broken my wrist two weeks ago. the orthopedic surgeon put in pins and a plate. It is still very painful. I am still on Percocet every 4 hours. I can't imagine that patient's pain. I have been a nurse since 1973...some nurses are still the same. They feel like they own the narcotic keys! Good for you! Keep being a patient advocate! Way to go!

[leslie :-D]

and there is nothing wrong in asking that nurse, if cancer is not "legit" pain, then what is?

i'd be very curious to hear her response.

leslie

[mentalhealthRN]

I have found this to be a common issue everywhere I have worked with too many nurses to count. To be honest with you the whole "drug seeker" phrase just ****** me off and when I ran a drug detox I specifically asked my nurses NOT to use that term as they would say it right to the patients! All it does it make people mad and feel judged. I live with chronic pain almost every day and so I get it. No I don't take controlled meds--just excedrin and Ibuprofen daily but .......

this is the way I see the who concept. It is human nature to not want to feel physical pain. Is a person "seeking" to be free of pain? Yeah, of course they are. No one has the right to tell another person they are not having pain. This is nursing 101. Pain is subjective and pain is what the patient says it is. Period. Yet this seems to be the first thing that gets thrown out the window when they finish nursing school and start working. Its not up to the nurse to decide. If the pain is reported and there is an order the patient has a right to have the med. Yeah if the patient is too sedated to give it safely or something like that then this should be documented and reported to the doc.....the pain rating, the laocation and description and VS and concerns about giving due to safety. The doc can assess and make a reccommendation--but this is putting things in the docs hands and not practicing medicine as a nurse.

I have seen docs get irate (and justly so) when a patient reports that they have asked over and over for pain meds and they are denied by the nursing staff. If they order a med they expect that their order with be followed.

I must tell you that I once was a patient for 5 days--in for a GI bleed and well I got to see how it is for the patients. not so pretty. I was on a floor where they no longer gave ANY IV push meds due to a large number of "seekers" on that floor. So despite getting 2-4mg of Morphine every 4 hours in the ED for abdominal pain via IV push I got to the floor and my order was 1-2mg every 4 hours via piggy back. I was not getting releif with the change and was in pain. I was seeking to be comfortable thats all so hey maybe I was a seeker! lol Then they started a med incase it was Chrohns and that night and every night after I had horrible leg pain. I paced and cryed and was in a lot of pain, unable to move a lot with an IV in each arm. I asked all night for anything for the pain as they would not increase the morphine. I even said I would try a muscle relaxer incase it was muscle spasms. They refused and gave me nothing. On the day I was discharged and the GI doc came in to see me and stopeed that med--no Chrohns--I asked about the leg pain and he told me that this was a common side effect and that if he would have known he would have been sure to order me something for the pain. Yeah a little late--the nurses and residents thought I was just seeking and couldn't really have this "leg pain".

I feel like you--frustrated with it. It needs to change. Good for you for standing up for your patients.

[grannyrn65]

I have just broken my wrist two weeks ago. the orthopedic surgeon put in pins and a plate. It is still very painful. I am still on Percocet every 4 hours. I can't imagine that patient's pain. I have been a nurse since 1973...some nurses are still the same. They feel like they own the narcotic keys! Good for you! Keep being a patient advocate! Way to go!

You must have been taught the same thing I was 'pain magically disappears when the broken bone is set':lol2:. Unfortunately it was a big lie, as we learn :crying2:. Have faith, the pain will resolve itself.

GrannyRN65

[OldNurseEducator]

Nothing like being a patient yourself in pain to understand what pain is. Thanks grannyrn65 for your words of encouragement!

[kayern]

Pain is what the patient claims it is. The patient you described is ABSOLUTELY in pain. It is criminal not to medicate!

Let me vent about "drug seeking patients". One of the first things I learned in nursing school was not to be judgmental, who are we to doubt a patients report of pain. To these "drug seeking patients" they are indeed in pain,whether it be psychological or physical, they are in pain. Those patients that are addicted to pain meds +/or are drug seeking, we are not going to cure their addiction during an acute hospitalization, rather these patients need a drug rehab. Most of us are not qualified to treat the addiction. Instead of being judgement while withholding medication, medicate them and most of all ADVOCATE for them. Help them get the services they need!