Pain Management Experts Have Caused A Lot Of Addiction

Specialties Pain

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First I'll define terms. When I say "addict" I'm including everybody who is physically dependent on opioids who isn't a terminal cancer patient. I don't see how physical dependence can exist independently of psychological dependence as one can't be physically dependent on opioids with also having a psychological need for them.

Pain management has become based on the absurd assumption that: "the patient's pain is always what the patient says it is".

In most cases that assumption is probably valid but we know, with certainty, that people will lie in order to obtain pain medications. Pretending that report of pain is an objective finding is absurd.

Much addiction has been caused by the current pain management theories. We've been overmedicating many people for years based on pain management theories. There is an underlying assumption in current pain management that treating complaints of pain with large amounts of medication doesn't really have a downside when the fact is that it has a huge downside......We've got a large population of addicts who didn't have to be addicts.

Let me be clear about how important it is to control pain. I'm not saying that nobody should get opioids. They are extremely beneficial if used properly. "

Without a doubt, Sir William Osler, renowned Canadian physician of the late 1800's, was justified by remarking that morphine was "God's own Medicine
" http://www.chem.yorku.ca/hall_of_fame/essays99/morphine.htm
Specializes in PACU.
drug seeking patients are the minority, and shouldn't affect how we treat the pain of non-addicts.

That is very true. Most patients don't have problems with opioids. There are enough that do to constitute a very serious problem.

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Anyway, the point of the post was to stop creating addicts... lol. I even got sidetracked. Addiction is pattern of behaviors that's hard-wired into the brain and isn't really awakened by taking a narcotic in a hospital. It's likely they were abusing drugs and/or alcohol before and will continue to abuse after until they reach a personal bottom that gives them the epiphany that maybe they should stop.

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Sorry. I got too mad and wrote some really angry stuff. My bad.

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If the experts were aware that people lie about pain they wouldn't assert that the "patients pain is always what they say it is". All it takes is one exception to disprove a statement like that.

Of course it does. Some people lie about their pain which means that the patients pain is always what they say it is.

A realistic approach. When someone who is just shy of a Dilaudid coma appears extremely comfortable and reports a pain of 10 that shouldn't be considered a pain emergency.

That's true. That doesn't mean we should use a false assumption (the patients pain is always what they say it is) as the basis for all pain control.

You seem to be of the opinion that it only takes one person lying about their pain to disprove the statement "patients pain is always what they say it is".

Patients self-reported pain isn't an absolute truth. I think that you're interpreting it way too literally when you attempt to disprove it by stating that x% of the patient population might/do lie.

Experts and other nurses aren't that naive. I'm sure everyone realizes that patients sometimes fib.

"Pain is what the patients says" is an approach to pain management that tries to prevent undertreatment of pain.

You didn't really answer my question to what the alternative is? Do you believe that pain is what the nurse says it is?

I will withhold pain meds if the patients vital signs give me serious cause for concern but not because of some suspiscion on my part that I'm dealing with a "seeker". Even an "addict" will experience pain, especially in the post-operative setting. I will not take the risk of under-treating pain, something that has historically happened to many patients.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Sorry. I got too mad and wrote some really angry stuff. My bad.
I admire your restraint. ;)
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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
. Percocet and other prescription pain medications comprise a growing percentage of the total number of substance abuse treatment admissions in the United States. According to the 2008 NSDUH, treatment admissions for abuse of prescription drugs increased fourfold in just 10 years. Unfortunately, the problem is not just a growing concern for adults. Percocet Abuse Signs, Symptoms and Addiction Treatment

As a PACU nurse I would think you understand pain control...I think pain needs to be assessed on an individual basis...prescription drugs can be bought of the internet and on the streets...to deny pain meds to those in pain on the assumption that they are lying is a slippery slope to malpractice.

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Specializes in PACU.
You seem to be of the opinion that it only takes one person lying about their pain to disprove the statement "patients pain is always what they say it is".

That isn't a matter of opinion. The fact is that if one patient lies about their pain the statement: "A patient's pain is always what they say it is" becomes untrue.

Patients self-reported pain isn't an absolute truth. I think that you're interpreting it way too literally when you attempt to disprove it by stating that x% of the patient population might/do lie.

I'm required to take that statement (the patient's pain is always what they say it is) literally. If it's found that I don't treat pain based on that statement I'd be in trouble at work.

"Pain is what the patients says" is an approach to pain management that tries to prevent undertreatment of pain.

I understand that. That approach has contributed to a massive overprescription of opioids in this country.

Do you believe that pain is what the nurse says it is?

It's not at all that simple.

I will withhold pain meds if the patients vital signs give me serious cause for concern but not because of some suspiscion on my part that I'm dealing with a "seeker".

I'm the same way. I believe all patients deserve to have their pain relieved and I work really hard at relieving pain in people with major tolerance.

You're missing my point. The point is that people are being harmed by overprescription of opoids.....They are victims of overprescription.

My point isn't that addicts don't deserve pain relief.....Of course they deserve pain relief. My point is that in many cases it's impossible to give them adequate pain relief because of their pill popping. There are consequences to pill popping and one of them involves experiencing more pain due to overactive pain receptors in response to chronic opioid use.

Please don't think I'm advocating undertreatment of post-op pain in addicts.......My co-workers consider me to be good at managing pain in people who take pills.

Pain control is a very serious matter and I'm not advocating punitive measures in the PACU. (Pain centers will quickly fire patients who abuse pain prescriptions but that's not what we do in PACU)

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Specializes in PACU.
As a PACU nurse I would think you understand pain control...I think pain needs to be assessed on an individual basis..

I agree completely about pain being assessed on an individual basis.....Blanket approaches, such as the ones we're now using, don't work.

In many cases talking to patients really helps them control pain. I can't tell you how many times I've had sweet little old lady pill poppers who very much need someone to talk to them about their lives.......In many cases I've made the LOL's feel 1000% better by getting them to talk about their lives.

My goal is to control pain in all patients.........Overprescription of opioids has, in many cases, made my goal unattainable.

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I'm the same way. I believe all patients deserve to have their pain relieved and I work really hard at relieving pain in people with major tolerance.

You're missing my point. The point is that people are being harmed by overprescription of opoids.....They are victims of overprescription.

My point isn't that addicts don't deserve pain relief.....Of course they deserve pain relief. My point is that in many cases it's impossible to give them adequate pain relief because of their pill popping. There are consequences to pill popping and one of them involves experiencing more pain due to overactive pain receptors in response to chronic opioid use.

Please don't think I'm advocating undertreatment of post-op pain in addicts.......My co-workers consider me to be good at managing pain in people who take pills.

Pain control is a very serious matter and I'm not advocating punitive measures in the PACU. (Pain centers will quickly fire patients who abuse pain prescriptions but that's not what we do in PACU)

As a fellow PACU nurse I thank you for the clarification. Seems like we agree on paincontrol in the postoperative phase.

I also agree that healthcare/the medical profession have in some instances by overprescribing opioids caused a future addiction. That is of course a tragedy for the individuals affected.

Luckily I believe that most health professionals working with pain management do not take a "monotherapy" approach but rather a "multimodal" approach to the treatment of pain.

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Specializes in Critical Care; Cardiac; Professional Development.

My biggest frustration in caring for chronic pain patients on opioids is how many of them admit they are not using their opioids appropriately/as prescribed. Then when they are hospitalized and we are bound to giving them their meds on the prescribed schedule and prescribed doses, their pain is unrelieved due to increased tolerance, even when meds have been increased to allow for chronic pain issues. so often even the increase is only approaching the patient's daily self treatment and therefore inadequate by far. This is not at all uncommon and has led to some very unhappy patients, frustrated nurses and MDs who are understandably reluctant to add more meds on top of the already high prescribed doses. It feels like an emotional tug of war, wanting the patient comfortable, wanting to educate, wanting the doc to cooperate, wanting the patient safe and, of course, wanting that nice, solid patient satisfaction score. It is such a no-win. It isn't just that the pain is what the patient says it is, it now is also now the whole experience of getting well is what the patient says it is. While I too wish for a better, more objective methodology for assessing and treating pain, that does not exist. We are obliged to work often with the lesser of two evils.

The danger in trying to change how pain is treated is that there is no better methodology out there at this time. Failing even one patient regarding pain control is abhorrent. Therefore we are indeed in a place where we set people up for addiction and tolerance issues. What else can we do? Often modern medicine, both for pain management and for treatment of disease, is a whacked out balancing act of choosing what to potentially harm in exchange for the potential of treatment of something else. To some extent the individual retains the responsibility, so long as there is adequate and appropriate education along the way. The individual maintains the choice ( assuming, of course, mental acuity is intact). This makes my job easier. As an example, I don't tell the patient what kind of chemo to take. The doc and the patient together make that choice and I administer, monitor, educate, advocate and comfort. Same with pain meds. I don't think anyone starts out thinking treatment with narcs will wind up the way it often does. They decide with their doc to take them. They have side effects, including tolerance and addiction as potentials. I am sympathetic to other kinds of side effects and work to be such to those as well, though admittedly the manipulative nature can make this challenging. But until modern medicine finds a blood test that can be done at the bedside and irrefutably give an objective reading of pain on a measurable scale, we are stuck. Therefore we treat the tolerance and addiction issues our flawed methods create and reman compelled by the nature of our chosen profession to do so objectively and compassionately and compelled by the almighty dollar to do so successfully and yet safely. And sadly all of those things can be greatly at odds with one another. It causes moral and ethical stress inside us.

I too wish there was a better way than "what the patient says it is". But there isn't. It is that simple.

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Specializes in PACU.
As a fellow PACU nurse

It's always nice to meet a fellow PACU nurse.

From what I can tell most PACU nurses think that the pain scale we're required to use often widely inaccurate. I've heard many patients who don't appear to be in any pain at all rate their pain at 10 and then say: "I'm ready to leave....I want to stop at a restaurant" (or something equivalent).

I take pain control too seriously to trust what the "experts" have dictated to us. I've argued with a couple of foremost experts in Nursing pain management and they showed themselves to be extremely ignorant about what's involved in pain control on a daily basis.......I mean to say EXTREMELY ignorant.

I assume that you know as well as I do that in some patients (not most) anxiety is a huge component in their severe pain. In many of these cases a Xanax habit has contributed to the situation. I'm talking about patients that are shaking with pain after receiving large amounts of Dilaudid.......In cases like these a bit of Benzodiazepine can be absolute necessary to control their pain.......I've seen it work really well many times. (most patients don't need Benzodiazepines).

I argued with a foremost pain expert about anxiety being a important component of pain in some cases and the need for adjuncts and was told that anxiety is never a factor and that adjuncts are not to be used ever........This "expert" knows nothing about pain control in the real world.

Many patients have thanked me for giving them Versed.......They tell me that their pain is suddenly quite tolerable and they are really happy about it......Pain control needs to be individualized.

That said most patients are easy as far as pain control goes......"I'll give you a little medicine and then more if you need it" makes them confident and they get adequate pain control quickly and easily.

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