Last Wednesday I encountered the reason for the sometimes crappy treatment I get in the ED concerning my migraines. I actually met a real life in the flesh migraine faker! :
I was waiting in the Ed waiting room, waiting for my boyfriend to get off work, and noticed a couple sitting across from me. They were chatting happily, laughing and pigging out on candy bars and chips and cokes. I noticed the hospital bracelet on the girl and after about 10 minutes, I couldn't help myself.... I asked her what brought her to the ED at 3:00 in the morning. She looked at me and says..."Migraine"
I'm in shock at this point but then I get angry!
I say" YOU have a migraine and you can EAT and DRINK? Isn't the light bothering your eyes? You do NOT have a migraine and you know it!"
I turn away disgusted. Well....guess what...she goes into "migraine mode". Gone are the chips, the chocolate and the cokes, and out come the dark sunglasses, the cold ice pack and she puts her head down on her boyfriend's shoulder and starts to grimace in "pain"
I start laughing out loud. :chuckle I could not believe it! I still can't!
I have to drag myself into the ED, feeling half dead, wishing I was, and I get the red flag because the staff encounters people like this girl!
When I finish nursing school I want to work in the ED and I'm guessing I can't do what I did Wed, but I think I'm going to have a hard time keeping my mouth shut.
Honestly, I never quite understood how the cynicism towards migraineurs came about until now. Another part of me can't see how the real thing can be confused with these obvious cases of faking it. A dilemna that shouldn't exist I suppose.
How do you handle people like this? Can you get your license taken away?
Sedation does not equal pain relief, contrary to popular opinion. Do a little research and you will see that reputable pain mgmt. authorities will say the same thing.
Please don't perpetuate myths/inaccurate info.
I agree with what you are saying, but still wouldn't you say that there are different types of sleep that may give you some indication of the degree of discomfort? If a person appears to be in a deep relaxed sleep, wouldn't you think there are more comfortable than the person who is tossing and turning, or merely dozing on and off?
I'm asking seriously if you think there is a difference, or if there's a difference that's observable, or measurable.
I have a chronic pain problem that's usually about an 8 on the pain scale if I have not taken medication, and during those times when I try to sleep I seem to never get to a deep sleep, I wake up every 15 minutes or so. If I've taken pain medication and can get my pain down to at least a 4 or 5 then I can sleep a more normal sleep.
Come back to reality my friend and get off thy high horse. If someone is sleeping, I would call that pain relief, regardless as to what your "reputable pain mgmt authorities" say.
If what you say is true, then the whole concept of conscious sedation would be ranked up with bloodletting, Lobotomy, and ECT without sedation. What I mean is when you perform conscious sedation (or whatever the PC term of the month for it may be), the person whom you are {reducing a fracture/dislocation etc...) will scream, writh, and shout while you are performng the procedure, yet whne they awaken, they cannot recall experiencing any pain, AND YET we inflicted some serious pain upon the patient while fixing the problem.
There are basically two type of patients seeking pain relief. One is too lazy or broke to drive down to the local corner to score a fix. The other is a person truly in severe pain and if you offer them a medicine "to make them sleep" chances are they will take you up on that offer, regadless if their pain is not totally relieved on some higher metaphysical level.
I don't agree with the overall attitude of your post. If what you are claiming is true then how do you explain my situation. I had an undiagnosed herniated disk, and other problems, for 4 years. My pain was about an 8, everyday. But of course at some point I slept, or I'd be dead. But the sleep I was getting then was nothing more than my body just saying "I'm outta here for awhile" and shutting down. It wasn't restful. Not everyone who happens to check out of the universe for a few minutes is feeling better, trust me.
When I was finally diagnosed, and eventually was prescribed pain medication, I took the first pill and quickly my pain was reduced quite a bit. I was so tired and worn out that the first thing I wanted to do was sleep. My first, post-narcotic night of sleep was like being in a coma. I slept like a rock until that first pill wore off, then I was right back to being in pain again. It took at least a week for me to get sorted out, where my pain level is kept in check and I'm sleeping normally again. So, I have to disagree with you and say that sedation does not equal pain relief. That's from personal experience, not from a book, or a case study, or research, it is from living it.
I envy anyone who can even barely FUNCTION during a migraine. I get these only once a year or so, but when I do, all I can do is lie in a cool, quiet room and pray for death........nothing touches the pain or nausea, the only way to escape at all is to take some Ativan and go to sleep. I don't go to the ER because I'm too ill to be moved, and anyway, I wouldn't want my co-workers to think the same thing some of the above posters think!
We all know there are drug-seekers in the world. However, we should also know that because we don't live inside other peoples' bodies, we cannot know how they feel........or judge how much pain they're in. Yes, I've given Demerol to patients who rated their pain 12/10, have taken enough drugs to kill me ten times over, and swear nothing touches it BUT Demerol.
But it's not up to me to change them, nor is it my job to determine how much pain they actually feel as opposed to how much they say they feel. I was taught in nursing school that pain is what the patient says it is, when the patient says it's occurring. I think that's a good principle, and until someone comes up with a better one, I'm sticking with it.
I think you put that very well and I wish I'd had a nurse that thought that way any of the times that I went to the ER in desperation. Back then I didn't know that people go to the ER to get drugs for the heck of it so I just thought that all the ER nurses were horrible and cruel. Thankfully, that's over now and my pain is controlled.
Additionally, I have 2 or 3 migraines a year and I know that they are no fun. I feel so sorry for anyone who deals with them regularly. I know from past experience that there's nothing that helps mine so I don't even try to do anything anymore, and just wait it out. It makes it worse to try to get up and get to the ER on the off chance that they'll find the magic combo this time. If I had them more often I might feel differently though. It's sad that anyone with a migraine can't just go to the ER and get prompt, courteous attention and relief because of the drug seekers who've made everyone suspicious. Even if you get a doc that grudgingly orders a shot of Demoral, or whatever, the looks, and comments that are caused by dealing with the drug seekers are hurtful to the patient in real pain. It's humiliating to be told "We don't do refills here, so when those are gone you're out of luck" or " I'll give you a shot right now but I'm not prescribing anything" as I've read others report happening to them. My personal favorite, and the one that I was told not so long ago when I went to the ER, " You know, narcotics are addictive and you can become immune to them and them one day when you REALLY need them, they won't work" Excuse me? When I REALLY need them? How much pain do I have to be in to qualify? sheesh
I have mainly worked nights over the last 13 years and to be honest, the patient's so called "Pain Managment " PMD either never returns phone calls, is not on call, or cannot recall the patient. Basically they are of no help.
Exactly...they are of no help to the patient either, which is why that patient eventually ends up in the ER. Think about it, if a MD can't be bothered to return a phone call to another doctor, or ER, do you think that MD is going to bother returning a call from a patient?
I know that's why I ended up in the ER the times that I went. You call and ask to speak to the doctor and are told he's busy, leave a message, no call back. Try again bright and early the next day. Nothing. Try at lunch time. Still nothing. At five mintes ti closing you're on the phone in tears with a less than caring receptionist who testily tells you to go the ER is it's that bad.
So you tell me what other choice the patient has. PMD doesn't give a %$#&! Insurance tends to regulate where they can go most of the time. Sometimes it can take weeks to get a new doctor and there's no guarantee that the new one will be any better. The ER is all we have sometimes mister, so until the WHOLE darned system is revamped to make some sense, you are stuck with us!
Don't laugh, my bad reactions to Benadryl landed me in the ER about 10 years ago. My heart races, I twitch, chest pains, it's awful. I was truly afraid that I was dying.
I didn't know until reading posts on here that drug seekers commonly claim allergies to so many things. I am so glad that those things never came up all of the times I was in the ER, I had a hard enough time without having to explain that I truly am allergic to a whole host of odd things. Starting at about the age of 20 I began to develop many allergies. Shellfish (which I love) is the most severe, followed by Benedryl, the sleep aid in Tylenol PM (forget the name), aspirin and motrin. My allergies are so severe that I must carry an Epi-pen. Also, since these allergies have all developed rather suddenly, my doctor is concerned that more allergies could show up without warning.
Now, I'd have to say that most who show up in the ER demanding narcotics and allergic to everything else are great big fakers, and knowing all of this now, I'm a little worried that if I ever end up in ER for any reason nobody is going to believe me.
We just have to figure out a better system, no question about it. Too many legitimate patients are suffering, and too many druggies are getting a quick fix. I think I'm going to make this my mission in life. Reform the whole healthcare system!
Come back to reality my friend and get off thy high horse. If someone is sleeping, I would call that pain relief, regardless as to what your "reputable pain mgmt authorities" say.
,
I find that Jarvis (2004), an up-to-date source, is right on when she explains (as has been my own case of attempts to relieve severe & excruciating cluster/tension headaches) the difference between acute pain and chronic pain. Persons with chronic pain often try to give little indication that they are in pain and therefore are at higher risk for underdetection. Sleeping is one way that persons behave in response to chronic pain in order to self distract and unfortunately clinical staff may inadvertently interpret this behaviour as "comfort" and then do not follow up with appropriate intervention. Other chronic pain behaviours include inactivity, movement, exercise, change in appetite, and others. And the person has had to adapt over time, but can't go on with life continually grimacing with diaphoresis. In my case, I found that the headaches stopped while I was outside shovelling snow!! But as soon as I came back indoors, they started again severely. I even went to a pain clinic for the injections into various areas of my head but they only made my head feel frozen. I could have given up - the headaches were that bad.
I recommend that you read Jarvis (2004) - short chapter on Pain Assessment - The Fifth Vital Sign.
Specializes in Geriatric/LTC, Rehab, Home Hhealth.
Come back to reality my friend and get off thy high horse. If someone is sleeping, I would call that pain relief, regardless as to what your "reputable pain mgmt authorities" say.
If what you say is true, then the whole concept of conscious sedation would be ranked up with bloodletting, Lobotomy, and ECT without sedation. What I mean is when you perform conscious sedation (or whatever the PC term of the month for it may be), the person whom you are {reducing a fracture/dislocation etc...) will scream, writh, and shout while you are performng the procedure, yet whne they awaken, they cannot recall experiencing any pain, AND YET we inflicted some serious pain upon the patient while fixing the problem.
There are basically two type of patients seeking pain relief. One is too lazy or broke to drive down to the local corner to score a fix. The other is a person truly in severe pain and if you offer them a medicine "to make them sleep" chances are they will take you up on that offer, regadless if their pain is not totally relieved on some higher metaphysical level.
Hi guys - I don't want to get in the middle of the heat BUT (I am a chronic migraine sufferer)and when I start vomiting from the pain I go to the ER and whatever Dr is there depends on what they give me -- I don't even ask because the pain is excruciating. Anyway, this one time, they gave me something that caused me to sleep...when I woke a few hours later I was at home (driven home by family) but still in terrible terrible pain...tried to "sleep off the pain"-dozed off and on in pain and finally broke down and called my Dr. Of all the Migraines I've had this has only happened once...I also remember an unusual tightening in my abdomen - have no idea what the med was though.
I agree with what you are saying, but still wouldn't you say that there are different types of sleep that may give you some indication of the degree of discomfort? If a person appears to be in a deep relaxed sleep, wouldn't you think there are more comfortable than the person who is tossing and turning, or merely dozing on and off?
I'm asking seriously if you think there is a difference, or if there's a difference that's observable, or measurable.
I have a chronic pain problem that's usually about an 8 on the pain scale if I have not taken medication, and during those times when I try to sleep I seem to never get to a deep sleep, I wake up every 15 minutes or so. If I've taken pain medication and can get my pain down to at least a 4 or 5 then I can sleep a more normal sleep.
I have suffered from migraines since I was 14 yrs. old and I am now 33. I have them very regularly I am on medication every day for them but still have break through. I will try all my prn meds, sleep, quiet,dark room, cool wash cloth and after suffering for 3-4 days I will go to the ER. They know me well. By that time I do demand demerol b/c I know from past experience and know what RX I have taken during the last 3-4 days. I have 3 kids and a family I can't afford to be down for 1-2 weeks with a migraine. I also suffer from a herniatted disk, slipped disk, pinching my siatic nerve.I have had 2 steroid injections last month, some relief but I can't do anything I want or use to do. 2 loads of doing laundry andI am in serve pain. I take Ultram TID, right now I have a migraine but the Ultram is just keeping it at the breaking point. I hasn't broke through, but it's still there. Sometimes as a mother, housewife, wife, student, you do what you have to do and be in severe pain and tears the whole day. I have been to 1 surgeon who said I don't qualify for surgery (long,long story) but I have to suffer. So yes I would be one that the ER would probably list as a FF but I am also and LPN and know what I am doing with my Rx, know the side effects and cautions. I always use ER as very last resort; but there are times when I just can't help it !!. I have to take 2 different kinds of sleeping med. prescribed by my psychiastrist and paid medicine just to be albe to sleep at night and on some noc I may only get 4-5 hours and that is it. b/c of the pain. Well just my from an experienced suffer of migraines, and chronic back pain as well as other conditions.
Come back to reality my friend and get off thy high horse. If someone is sleeping, I would call that pain relief, regardless as to what your "reputable pain mgmt authorities" say.
,
I find that Jarvis (2004), an up-to-date source, is right on when she explains (as has been my own case of attempts to relieve severe & excruciating cluster/tension headaches) the difference between acute pain and chronic pain. Persons with chronic pain often try to give little indication that they are in pain and therefore are at higher risk for underdetection. Sleeping is one way that persons behave in response to chronic pain in order to self distract and unfortunately clinical staff may inadvertently interpret this behaviour as "comfort" and then do not follow up with appropriate intervention. Other chronic pain behaviours include inactivity, movement, exercise, change in appetite, and others. And the person has had to adapt over time, but can't go on with life continually grimacing with diaphoresis. In my case, I found that the headaches stopped while I was outside shovelling snow!! But as soon as I came back indoors, they started again severely. I even went to a pain clinic for the injections into various areas of my head but they only made my head feel frozen. I could have given up - the headaches were that bad.
I recommend that you read Jarvis (2004) - short chapter on Pain Assessment - The Fifth Vital Sign.
GingerSue,
You are very bright, well informed, and thankfully still able to look at a subject objectively. Hope your employer realizes what they have.
Come back to reality my friend and get off thy high horse. If someone is sleeping, I would call that pain relief, regardless as to what your "reputable pain mgmt authorities" say.
,
I find that Jarvis (2004), an up-to-date source, is right on when she explains (as has been my own case of attempts to relieve severe & excruciating cluster/tension headaches) the difference between acute pain and chronic pain. Persons with chronic pain often try to give little indication that they are in pain and therefore are at higher risk for underdetection. Sleeping is one way that persons behave in response to chronic pain in order to self distract and unfortunately clinical staff may inadvertently interpret this behaviour as "comfort" and then do not follow up with appropriate intervention. Other chronic pain behaviours include inactivity, movement, exercise, change in appetite, and others. And the person has had to adapt over time, but can't go on with life continually grimacing with diaphoresis. In my case, I found that the headaches stopped while I was outside shovelling snow!! But as soon as I came back indoors, they started again severely. I even went to a pain clinic for the injections into various areas of my head but they only made my head feel frozen. I could have given up - the headaches were that bad.
I recommend that you read Jarvis (2004) - short chapter on Pain Assessment - The Fifth Vital Sign.
We aren't there in Jarvis yet but I read it anyways. Actually it was the first chapter I read when I bought it :) It's great to see pain actually being taught as part of the curriculum. Now all we have to do is get the doctors on the same page!
OK first off forgive me if my earlier posts seemed a bit smart alic.
What I think is being overlooked here is the actual role of an E.R. in pain management. First one must rule out life threatening illness, second, we can make the patient comfortable. Our job is not the job of Pain Management specialist. I have mainly worked nights over the last 13 years and to be honest, the patient's so called "Pain Managment " PMD either never returns phone calls, is not on call, or cannot recall the patient. Basically they are of no help.
And while it is not a law yet, we are under no obligation (yet) to relieve pain totally. This is what I was attempting to get at earlier, that if someone was truly in 10/10 pain and not someone who frequents the ER, chances are they would relish the chance to sleep. That's all I'm saying.
I've worked all over the country (over 25 E.R's) and it is RAPIDLY BECOMING a major crisis facing E.R.'s. You cannot fault your ER nurse to become jaded by the manipulators that all too frequent the ED's. If they choose to vent their frustrations on this board, that is their perogative. It doesn't make them a terrible nurse.
I also work w/ a local agency in a large metro area. I see the SAME Migraine patients (notice pleural) at 4 different ER's!!!!!!! Come on!!!! And it is all too ironic that they are allergic to NSAIDS, Compazine, tylenol, Phenergan, Talwain, Nubain, etc....
It is sad that these types of patients set a sterotype for the other patients who suffer w/ migraines and do not frequent the ER.
.Enough of my spewing.....
Well said! This is all similar to the "back pain" pt's that present to the ED. I had a pt. the other day who apparently had a previous back injury that he had been through physical therapy for. He had just finished physical therapy and conveniently had just moved to our area and did not have a PMD or pain management doctor. After given him a shot of toradol and some prescriptions for cyclobenzaprine, Naproxen and Ultracet and taking an x-ray he decided to debate me and the doctor because he said that he had not had any pain relief and that he had tried all of those prescription medications before without any relief. The doctor and I reminded him of the role of the ED to evaluate the pain to be sure that there was not any damage from his fall that day. We told him that he was welcome to get the prescriptions filled and he was welcome to get a second opinion at another facility if he wished but he would not be getting any stronger pain medicine from us. I love it when we have doctors that don't just give in every time!!!
:
from an experienced suffer of migraines, and chronic back pain as well as other conditions.
FutureNrse
138 Posts
I agree with what you are saying, but still wouldn't you say that there are different types of sleep that may give you some indication of the degree of discomfort? If a person appears to be in a deep relaxed sleep, wouldn't you think there are more comfortable than the person who is tossing and turning, or merely dozing on and off?
I'm asking seriously if you think there is a difference, or if there's a difference that's observable, or measurable.
I have a chronic pain problem that's usually about an 8 on the pain scale if I have not taken medication, and during those times when I try to sleep I seem to never get to a deep sleep, I wake up every 15 minutes or so. If I've taken pain medication and can get my pain down to at least a 4 or 5 then I can sleep a more normal sleep.