Managing Pain in Addicted Patients

RNPATL, DNP, RN · Oct 2, 2004

One of my patient's for clinical tomorrow is a trauma victim who tested positive for benzodiazepines, cocaine, amphetamines, barbituates, and opiates.
She has a nasal fx, right radial fx w/sx repair, & a left pneumothorax w/chest tube placed.
Wondering how I can help her with pain. I ran across an article on Pain and a patients with addictive disease, but can only access the abstract. So any advice would be great. I can't imagine her 1mg Morphine PCA is doing the trick. Oh, she's also on methadone right now (surprise, surprise).

Does your hospital have a pain management department? It might be helpful to speak with a pain management nurse on specific strageies used by your hospital to deal with your specific situation.

Trauma Columnist · Oct 2, 2004

The trauma docs should be assessing her pain with the assistance of the pain management dept. You are right that her morphine 1mg PCA probably isn't doing the trick. However, during a trauma situation, weaning from meds isn't appropriate. Her pain control needs to be a group effort. Whoever handles her methadone would probably be a good person to start with. Like Patrick said - access your pain management clinic first.

wam79 · Oct 4, 2004

The pain management team should be consulted. Depending on the patients drug history I would be concerned about withdrawl. If there are benzos , opiates ect on the screen the drug history should be obtained . The pt is deserving of pain control r/t trauma. They will need to be told at the start that the meds will be titrated at a regular schedual due to the probability of the pt. asking for meds after the pain is controled. I tell my pts that the meds I give are for pain not for the brain.