Drug seeking patients? - page 8
What do people think about the term drug-seeking patients? I guess I have a hard time with it because usually these people are complaining of pain and who are we to judge whether they are or are not... Read More
Sep 20, '05Quote from P_RNNor in my mind, having turned 60 this past August.Uh 60's not OLD anymore IMHO.
Oct 15, '05I will never forget an incident that happened to me a few years ago. i was vacationing in Fort Collins,Colorado when a muscle pull landed me in the ER at their hospital there. I was in such pain and had a history of undiagnosed pain for several years. I was placed in a room and a nurse stuck her head in a doorway and stated "Oh your the nurse from oklahoma". She was gone no sooner than she arrived and I thought to myself that the staff had a good laugh at my expense. The physician was wonderful. They drew lab as I had a history of pancreatitis and sent the results to my physicain at home. I also was given nausea and pain medication. But I never forgot the nosey nurse!!!
Even in the hospital i worked at, I made numerous trips to the Er for undiagnosed pain control. The docs were never very helpful and I finally made an appointment with a local internist and within a few visits I was diagnosed with fibromyalgia. I had never even paid much attention to this diagnosis befroe and had to do alot of research on it. I am now scheduled with a rheumatologist this week for a possible RA diagnosis.
All the above contributed to my demise as a hospital RN. I feel if I had really been listened to before and gotten proper care perhaps things might have turned out different.
My last job was inpatient rehab and it was the hardest physical job as a nurse I have had. Never enough help with all the heavy patients. I wore 3 hats each night. I was the charge nurse, staff nurse with a full load of 10-11patients, and had to assist the techs with the heavy patient care. I t was nonstop all night. I also had 4 children at home and a husband that drove a big rig and was gone alot. It all caught up with me and my health plunged.
The pain,depression, and loss of my carreer as an Rn has been devastating. I never ventured far from bedside nursing as that was my love and I was a great nurse. I was a typical type A. These type females are open prey for fibromyalgia and I also have autoimmune problems.
I feel like my employer failed me also. I gave 100% when was on duty. Did everything I could to advocate for more help, but it rarely happened. I drove home many mornings in tears from pain. But i kept on going cause noone seemed to interested in finding out what was wrong with me. I started having a major nosebleed one morning as I stepped off the elevator to go home. I went into the bathroom and grabbed some papaer towels and reported to the ER. I left the bathroom in a mess and told them as I went into ER. A coworker called me and told me that the housekeeper got in trouble about the messy bathroom!!!!I informed her i had told the er staff!!!
duh!! Did I really care!!!
I am getting off subject. Just remember to treat everyone with pain control issues. Chronic pain changes you. The longer one is in undiagnosed pain the harder it gets to control. People with fibromyalgia have pain amplification cause by a malfunction in the CNS. My internist put me on a high dose of Effexor which he explains helps with this pain amplification problem. I also have DDD of neck and lumbar spine and have had two knee replacements. I am becoming the patient rather than the nurse. Luckily
I have a doctor that is not afraid to give me the pain medicene I need. Some days I need just tylenol, some days nothing, or Darvocet some days and a back up of Hydrocodone for a particularly bad day with back pain.
I have not been to emergency room for over two years because of good pain control. While I can no longer work as a nurse, I joined this board so perhaps I will be able to add some insight sometimes. I love all the posts. Thank you for letting me vent a bit!!
Dec 30, '05I agree with MOST of the answers and comments here and it gladens me to see them - is our job not hard enough without making judgement calls?? Wheather or not a person is so called "Drug seeking" what has it got to do with us - sure we are in a real ****** profession, and by all means have an opinion, but don't you dare inflict that on the person who says they are in pain - remember pain is what the pt says it is - so come on girls, get out of this arena - you are not being asked to support an addicts habit, just treat their pain and get over the rest. IMP - what goes round comes around. How many times you heard, "they can't be in pain, look at them they just popped outside for a smoke" Who gives a contential - you want to get your Morphine, Management and Myths up to the 21st century and go with your patients perception of pain - treat the pain first and if you still feel they have a problem, treat that next.
Dec 30, '05first, i would like to address chronic pain vs. acute.
people that suffer chronic pain can have vitals wnl.
they have acquired adaptive behaviors over the years and therefore can appear 'normal'; until they overexert themselves or breakthrough pain occurs.
i had a hospice pt.
from an automobile accident yrs before, his limbs were so contorted that they were knee to chest. both hands were also contracted. he told me the amt of pain he was in (very private gentleman) but after yrs of experience, learned to keep it to himself since no one believed him or could find an etiology. the only med he was prescribed was a muscle relaxer.
the other nurses i worked with also disagreed w/my findings as they observed him to be sleeping (therefore not in pain :angryfire ) and he would sing the blues alot.
i had a long talk w/the medical director, who finally agreed to prescribe him a duragesic patch,75 mcg and vicodin hp 2 tabs q 4 hrs prn. the only way i could attain this was to have the pt share his pain with the md.
my heart really goes out to those who suffer chronically yet md's cannot find a cause. after going through every conceivable test, the md recommends you to a psychiatrist! what an insult. but just because a cause cannot be found amongst those who suffer w/chronic pain, does not make it any less real or tolerable.
as for the drug seekers? their stay in the hospital is ltd. if there's an order for a narc, i don't pass judgement. but i do confer w/the md where a referral is made to a detox facility at discharge. the choice is theirs. sometimes we really need to walk a mile in a sufferer's shoes before we become less judgemental.
Dec 31, '05Thank you Leslee and Sandrat. I am in complete agreement with you. I had abdominal surgery last Oct. and was being treated with Oxycodone for PAIN.Four months after that, my husband took me to the emergency room for pain that was not being alieviated by the Oxycodone. Now if I was looked at as a drug seeker who had used up all my Oxycodone, I would have been in major trouble.
Even after telling them my Oxycodone was not working, they kept giving me IV pain medication. It took three different meds until one finally worked. Now what if the nurse and dr. thought I was a "drug seeker" , gave me no pain relief, and sent me home? I happened to have needed emergency surgery for a blockage caused by adhesions, and I was in the hospital for a week.
That confirmed what I have always believed. If a patient says he or she is in pain, treat the pain immediately, and then diagnose what the problem is. If the diagnosis is that the patient is an addict, for goodness sakes -treat their disease of addiction. When a person says they are in pain, they are in pain! It may be physical or emotional or yes, they may be an addict. Either way, a person yelling in pain in an emergency room is sick. There is no room for judgements, and every diagnosis needs to be backed up with evidence.
In answer to Patma's question, addicts in withdrawal can die. That includes alcoholics. They can also leave the ED and get their drug of choice or worse off the streets and die too-of an overdose. These people in withdrawal can be in excrutiating pain, especially from Opiates Addiction and Alcoholism are diseases and need to be treated just like any other disease!
Dec 31, '05People in withdrawal can also develop hypertensive crisis, seizures...yes, it can be life-threatening.
Jan 9, '06I have had patients before that look like a textbook picture out of the "How to tell if your patient is only here for the drugs" guide. I have worked with nurses who have deliberately waited longer than necesarry to medicate their complaints of pain, justifying it by saying things like "I'm not going to support their drug habit", etc. I look at it like this: "Pain is whatever the person says it is, exitsting whenever the person says it exist", and if they have a legitimate doctor signed order for pain meds, they will get it.
Many people get hocked on pain meds because of pain in the first place. And quiting pain meds because they are hooked on them does not adress the pain that started the mess. They need professional detox and rehab to help them.
And no, an angry nurse refusing to give them the demerol they have an order for and cutting them off cold turkey is not professional rehab.
Jan 18, '06This is in response to those Nurses who have had, or have, some type of painful, chronic illness, but have had undertreated pain due to the misconceptions of others (usually co-workers who are have been blessed since childhood with wonderful health). I have had ulcerative colitis since the age of 11. I started to have severe abdominal pain and rectal bleeding, but for some reason, I did not want to bother my parents, so I told my best friend instead, another 11 year old girl. About 2 months after the onset of my symptoms, I passed out in my 6th grade Art Class due to severe blood loss. I was taken to a nearby hospital, and fluid/blood resucitated (my parents told me that I had "last rites,' a Catholic ritual for a person believed to be in extremis)...Anyway, missed almost the entire year of school because of wrong diagnosis, unresponsiveness to medications, etc. Not once was I given any kind of pain medicine, despite my quietly crying and having up to 40 bloody stools a day. I remember asking one of the nicer nurses if "someone could help me not have so much pain," and her reply was, "Sorry, we don't give pain medicine to children." At this point, all of my hair had fallen out from some type of chemo I was give, I weighed about 50 lbs and looked like skeleton! And I certainly was "drug-seeking," even though I had never heard of it.
Flash forward to year 2003.My gastroenterologist did not want me to have prednisone for a typical exacerbation of my UC, because a bone densometer test showed severe bone loss. Instead, I was prescribed a medication supposedly similar to prednisone (endocort) but without the risk of bone loss. The endocort did not work, but the GI dr said to "just bear with it."
About 6 weeks after the onset of my latest symptoms, I developed a fever of 105 and a very distended abdomen, with 25-30 bloody stools each day, and severe abdominal pain(which I had all along but it got much worse) My father drove me to the ER where I had been working for the past 12 years, and my friends/co-workers immediately jumped in to help me. My diagnosis was "toxic megacolon," and my GI dr was now making arrangements to send me to a big city hospital for a total colectomy. Blood and stat cipro IV
were hung. And one of my "best friends" told a another friend that "She couldn't really be in all that much pain...because she is smiling making little jokes with the staff, she is not even screaming in pain!" This "friend" even got into a side discusion with the staff, making sure that they understood that UC pain could not possibly be as bad as the migraine pain that she suffers from time to time! (fortunately for me, another friend and co-worker gave me the IV Dilaudid and compazine that was ordered, making my vomitting and severe "10 out of 10" abdominal pain much more bearable. I literally felt like I was going to die,especially when I had yet another bloody diarrhea stool. Thank God the dr treating me understood how very very sick I was and did not doubt my word that the pain was unbearable! And by the way, I have also suffered with frequent kidney stones/lithotripsies, since irritable bowel disease increases the risk of kidney stones. The same friend who did not believe that my UC pain was, well, painiful,recently described how her husband woke up one night with severe pain, which turned out to be a kidney stone, and berated him for being such a baby about a little pain!
All I have to say is, watch out, any caregivers who either have not personally experienced severe pain, or those who simply do not believe most people when they claim to be in pain, "because the patient is sleeping, or has a BP of 120/82, or is reading a magazine." Not every single person in pain is going to scream and cry: ask a Labor and Delivery Nurse!
"There by the grace of God go I."
Jan 18, '06Quote from fergus51You couldn't have put it better.I think we are horribly arrogant to think that if we (the medical professionals) can not find a reason for someone's pain than it doesn't exist. Just think of all the different conditions that didn't even exist 20 years ago. Diseases like chronic fatigue and fibromyalgia are still mostly mysteries.
I realize there are genuine drug seekers out there, but the term is used much too often. I knew a nurse who was convinced that anyone who asked for something for post-op pain was a drug seeker. Wait until she has her hip fractured and replaced! I am much more concerned for the people whose pain is not adequately treated because of our moral judgements.
Pain has long been my pet peeve. I have seen people in pain asking for help and being ignored by uncaring jaded nurses who should've retired years ago. My friend's mother was in the hospital for pain control using a PCA (because of terminal lung cancer) and her IV went interstitial. Instead of changing it the nurse left it for the day shift to do. My friend's mother went for over 2 hours without any pain control. I just don't understand how people (nurses) can be so cold and uncaring. Wait until they have pain without a "medical reason".
pain is a medical reason to be hospitalized.
I work in an area where everyone on the floor is in much pain. We know that, and everyone is medicated safely for their pain. When floats work the floor, that is the only time I hear the "pain seeker" phrase.
I always remember, no matter what reason they are there, it is their pain, not mine.
Jan 19, '06How can a nurse ignore a physician's order for pain control???????????
Many many people are put on pain meds for post surgical or other types of pain, and they get addicted to it. What are we as nurses to do, call them "drug seekers", judge them morally, ignore them???????????
It is our job to work with the doctors to figure out what to do. Do we keep giving them pain killers that they are addicted to? I think each case is different. My dad had terminal cancer, so it didn't really matter if he was addicted to the Oxycontin or not. He was in pain and dying. There are other cases where the person needs to be detoxed in a safe place and get services for the disease of addiction IF that is the case. There are other people who need to get off the pain killers, get detoxed safely, get addiction treatment, and gety reevaluated for pain control.
Each patient is an individual. It is a nurses's responsibility to figure out what is going on and what their patient needs in the form of HELP. It is totally unprofessional to say, "This is a drug seeker-no pain meds". I am comforted to read the last few posts and see that nurses are recognizing this.
How dare any nurse judge her patient. Even if the patient is strictly a drug addict with NO pain-the patient is still sick and needs referral to a rehab for safe detox and follow-up help. Krisssy RN MA MHPNP 2 be
Jan 19, '06I agree with fergus. I treat the patient's pain seriously and give meds as ordered/requested. Not for me to judge this one.
Jan 19, '06Holy Cow!Quote from HuganurseOxycodone:
In 1995 there was 1 death and 12 confiscations in the county I live in. In 1998 there were 17 deaths and 26 confiscations. Last year in 2000 there were 43 deaths and 73 confiscations.
Need more? The number of prescriptions of oxycodone increased from 316,000 in 1996 to 5.8 million prescriptions in 2000!!
Oxycontin has a street value of $40 - $80. each pill in our area.
This is a problem far greater than the problem of treating patients for chronic pain.