Drug seeking or real pain? How do you tell? - page 2
I'm a new nurse on the list so please pardon my ignorance. I was quite interested in the pain links and explored several and probably will use some for staff training. I did not see any mention of... Read More
Jan 12, '04Joined: Sep '03; Posts: 1,214; Likes: 63And it is important to note that in ALL of those cases, we're looking at a patient who needs to be evaluated for PSUEDO Addiction.
Again, and I seem to be a broken record here.
It is not our job to JUDGE THEM. We are to treat pain based on the patients report.
Jan 12, '04Occupation: Nurse Consultant Specialty: 24 year(s) of experience in Obstetrics, M/S, Psych ; Joined: Jun '02; Posts: 3,105; Likes: 49Originally posted by MD Terminator
And it is important to note that in ALL of those cases, we're looking at a patient who needs to be evaluated for PSUEDO Addiction.
Again, and I seem to be a broken record here.
It is not our job to JUDGE THEM. We are to treat pain based on the patients report.
Jan 12, '04Joined: Sep '03; Posts: 1,214; Likes: 63I would have to assess each case individually. In some cases I would give additional medication, and in some I would consult an Addiction Specialist before making decision.
If they were stolen, ofcourse we'll need a police report. Lost in the potty? Well, this is harder to say. If they patient is in pain, then I will ofcourse treat it. Lost scripts. We'll, a "Fill only at" on the script. I can call the pharmacy that was selected and see if it is filled.
I'm not about feeding addiction, I am about adquately treating people who are truely in pain.
Jan 12, '04Occupation: Nurse Consultant Specialty: 24 year(s) of experience in Obstetrics, M/S, Psych ; Joined: Jun '02; Posts: 3,105; Likes: 49OK, Dave. I agree with you. Thanks for clearing my confusion!
Jan 13, '04Joined: Dec '03; Posts: 151; Likes: 4One of the first things you learn is if the pt says their in pain, tx them. Is it your problem that they are chemically dependant? Do you have to be the savior? Im sure you dont want to be sitting in a court room with 12 jurors and answering the lawyers when they ask you, how did you come to the conclussion this person was not in pain? then end up paying megga bucks because you didn't tx. Would you with hold pain meds to a chemically dependant person after mayjor trauma? No! then whats to say this person does not have pain. It always upsets me to see nurses who with hold pain meds to pt's when their in pain. Weather true or not, we should not judge! Tx them!
Jan 31, '04Occupation: L.P.N Joined: Jan '04; Posts: 10; Likes: 1I have been in both positions I have pancreatitis which causes me a great deal of pain and I am also Dr Rx addicted to oxycontin. So when I have had an attack I never got the pain relief I needed because I was labled "Drug Seeking" When you go to an ER and a Doctor tells you he will not medicate you because everytime I was seen in his ER it was for a painful condition and he also said I had used two different names with my correct info. One why would I go to an ER unless I was in pain. Two I had gotten married hence the two names. To top it off one year later I had a attack the Same ER different doctor said the same exact thing word for word. Now I am on MMT I could not get pain medication if I was dying. It is wrong but I am glad to see that many of you opt for treating anyones pain. Because people do not always Dr shop because they are addicted sometimes because of idiots like the ER doc that will not medicate or under medicate.
Feb 1, '04Occupation: LPN Joined: Sep '01; Posts: 227; Likes: 5Very interesting topic. As someone who lives in chronic pain and happens to be a nurse and a student, I find it educational to hear what others have to say about whether or not they think somebody is in real pain or drug seeking. Unfortunately, I have dealt with many physicians and nurses who have made it very difficult for me. When somebody puts down in ones chart, "drug-seeking".........."drug-seeking behavior" etc.......I wonder if they know what they are doing to that patient. Was I drug-seeking? I suppose that you can say yes. I was in severe daily pain and was let go by my surgeon when I told him, "No More Surgeries"....I have had many tmjd surgeries including implants and have had nothing but more pain since. I'm not going to get into all of my medical junk, but I was cut off from pain meds, just like that. I was not weaned off or given a name of another doctor and/or pain clinic. Back in the 80's, there weren't many pain clinics as there are now, so I was left just like that. So, yes, I was not only very angry, but I was in so much pain and in the beginning stages of withdrawel. I went to another doctor, waited forever to see him, and when I did, right off the bat I was told, "we do not give out narcotic pain meds here"........At that point, I didn't even get to what meds I was on. I was in tears, shaking, upset etc...........and most importantly I was in pain!!
So, now when I assess a patient, I believe that I do a pretty good job. I really hate it when a pt comes in to the office for their scripts and one of my peers says something like, "oh here she comes, she needs her drugs" or if a pt calls, it is often assumed that they are calling for meds. I try very hard not to prejudge anyone. don't get me wrong, I do see some pts who definately just want the pills and don't need them. I know that they are out there and I know that we can't just turn a blind eye to them. These are the people who are making it difficult for those of us who are really in severe pain and need pain control/treatment. Just like with Oxycontin............all the bad press about this med. Who died from it, who turned into a junkie blah, blah, blah.....Well, excuse me, but those who are really in chronic pain, like a friend of mine who is dying from cancer is not the one who is taking oxycontin and crushing it and snorting/shooting it. My friend finally has a med that helps her pain and now she worries that with all the bad publicity and lawsuits that they may stop making it or stop having it readily available. That's just not fair!!
I don't know what the answer is, but please, don't assume that because a pt is on narcotics that they are abusing them. I know that most of us understand this but there are some that really can make life miserable for those in chronic pain. So, let's continue to educate and learn how pain affects just about everything in the person who is suffering.
LOL, ok, I will stop now...As you can tell, this is a sensitive subject for me, lol............sorry if I ranted on here.
Feb 1, '04Joined: Oct '00; Posts: 8,740; Likes: 8,437Last night we had a woman who rated her pain at 10/10 through about 5 hours of 1-1 nursing, and lots of drugs. She couldn't move (literally couldn't move) without tears in her eyes. The doc had some reservations about her being a drug seeker and we spent 20 minutes on the phone negotiating a treatment plan that would give some relief. Kept the patient up to date on what was going on, and she did a lot of venting about people not believing or treating her pain.Finally was able to give some IV pain med ordered. The patient got up out of bed and walked downstairs and went home with no noticeable limping or weakness.
Found out later through the grapevine that she had been to at least on other hospital 25 times in the last month for narcs.
So after advocating with the doc, and takling the " she's in pain if she says she is" I got sucked in like a fool, and have lost credibility with my coworkers to some degree. What happens for the next person who may come in with real pain?
Feb 1, '04Occupation: Hospice clinical director Joined: May '02; Posts: 2,873; Likes: 26No one ever said you wouldn't get schnookered every now and then. But ask yourself, "Do I really want to take the chance of sending someone out the door in excruciating pain?"
Me...I'd rather get taken every now and then than not treat someone in pain. It would be nice if we had a magic wand like Dr. Bones on "Star Trek," but we don't. All we can do is use good assessment, pt input, and hope for the best.
(And who is to say the woman didn't have legitimate pain, but just didn't have a primary doc? Do you believe everything you hear through the grapevine?)
Feb 1, '04Joined: Oct '00; Posts: 8,740; Likes: 8,437Well she lied about previous meds and treatments for pain. She rated her pain 10/10 and inability to move and then walked out once she got her drugs. I'm one of the most ardent pain advocates in this hospital, but this patient sucked us dry for 5 hours, said she would sue if we didn't give her what she wanted, lied to the nurses about the treatment plan she agreed to in the ER, and did I mention that another patient was upset that she had to wait for HER meds because the nurse was in the other room trying to assist the faker?
I know- this should not affect how I treat my patients and I need to just walk it off. But will I spend time negotiating with the doc like I did in this case? Not without some physical finding, and a little less lip about suits from the patient.
Feb 1, '04Occupation: Hospice clinical director Joined: May '02; Posts: 2,873; Likes: 26Well, you didn't exactly mention some of this in your first post (not to be argumentative, but part of the story was left out). Even so, there are people who will exhibit those behaviors because they are afraid they will not be believed (I think McCaffery refers to it as "pseudoaddiction.)
There is no excuse for abusive behavior, and limits definitely need to be set when that occurs. I'm not sure what physical findings you're talking about though, as VS are not reliable indicators of pain, particularly in a pt with chronic pain.
Feb 1, '04Occupation: RN, CMSRN employed in a 600 bed Acute Care/Trauma Facility and CNA Instructor for a local Community College Joined: Mar '02; Posts: 459; Likes: 62I've been doing a good deal of thinking recently, in light of the numerous patient's I've cared for who were having difficulty attaining control of their pain. In many cases, their behavior pointed towards some sort of reliance on narcotics to alleviate their pain and the nursing staff had become very judgemental towards them.
My general routine with patient's, who are described as "seeking" or "clock watchers" or who "really like their pain medicine" is as follows: "Good morning Mrs. Smith, I'm Lori and I'll be your nurse today." In the course of my assessment, (if not sooner, as determined by the patient) I turn the topic to the subject of their pain level, where the pain is, etc. "I understand you've had some difficulty managing your pain while hospitalized. Would you care to tell me what seems to have helped your pain, what times your pain seems to be more intense and perhaps your history in the past with pain control?" After reviewing the information shared with me by my patient, I review with them their ordered medications, the frequency it can be administered and how shifts prior to mine were managing the patient's pain. In essence, I let the patient know I believe their report of pain and gain their trust. Almost invariably, I find that the patient has had at least one experience (generally far more) with nursing staff who under medicated this patient, were less than punctual when providing medications and had even spoken condescendingly towards the patient in regards to their pain and requirements for relief. In other cases, it wasn't so much this particular hospitalization, but previous ones that set the tone for how the patient perceived their treatment of pain now.
My point is this... Nursing (physicians too, for that matter) are very often to blame for how our patients behave when it comes to pain and pain relieving measures. At some point in their care, someone made them feel as if they didn't deserve appropriate pain relief, in some way downplayed the patient's report of pain or were only interested in treating a patient's pain when the patient behaved (ACTED) in such a manner as to EARN sympathy of their caregiver and THEN receive appropriate management of their pain.
I myself have had the humbling experience of being told to "suck it up" when I had a horrific case of strep throat a few years back. Antibiotics had yet to effect any relief and the pain was excruciating, in spite of judiciously dosing myself with tylenol and/or ibuprofen. I've never ever been prescribed any sort of narcotic or other prescribed pain relief previously... so there was certainly no reason to suspect I was inappropriately seeking alternative pain relief. All I was asking for was "something" to get me through the 24 hours I knew I would be in pain, while awaiting my antibiotics to work their magic. But because of unfounded prejudices (a nurse, asking for something "stronger" for pain) I was forced to endure an agonizing 36 hours.
How likely then is it for those thousands with pain, to have their pleas for relief cast aside... expected to also "suck it up" because health care professionals don't want the responsibility of prescribing/administering appropriate pain relief out of an unfounded fear of creating (or aiding and abetting) an "addict"? How many of our "problem patient's" are of our own creation because we've failed to intervene appropriately early on... instead foisting our prejudices on our patients... only to see them later with even bigger pain related issues, because we've taught them that, in order to receive validation they have to "act" the part? How many of us in the Profession of "healing" have cared enough about a person with pain related issues to find out when their problems in achieving pain relief or abatement first occurred... and have the presence of mind to reassure a patient that yes, they ARE entitled to receive unbiased assessment of their pain and receive the most appropriate (not necessarily narcotic) treatment to assist them with their pain... and then to go that extra mile and really WORK with a patient to help them find out what really DOES work? I would venture to say if people were appropriately managed early on in their pain again, not necessarily with narcotics, but with all the management tools (diversion, stretching, heat/cold application, posture, imagery) we have at our disposal we'd see many less "seekers" because we would have given our patients the tools they need to appropriately treat themselves.
In my experiences, I've found that when patients receive appropriate pain intervention during their hospitalization, they are far less likely to require a narcotic pain reliever upon discharge. During the time I'm caring for them, I ensure they receive enough medication to allow them to fully participate in their recovery... to ambulate frequently, to cough and deep breathe. We do a disservice to our patients when we give them only the miniumum medication they require early on... because their pain is never truly at a managable level. Research shows that the vast majority of people hospitalized who initially require medication to aid in the alleviation of their pain DO NOT become addicted and quite easily are able to cease the use of narcotics or other pain medications, once the initial reason for their pain (incisions or trauma, for example) has had time to resolve. However, if we fail to treat their pain appropriately early on... they most certainly do not fare as well and may indeed develop a chronic condition.
Food for thought: how many diabetics, anxious about their blood glucose ... have you heard described as a patient who is "just seeking their insulin"... how many hypertensive patients have you reported to the next shift as just "wanting their labetalol" (or other HTN medication)? You don't. Why? Because we don't cast judgement on these medical conditions. So why then, do we make these assumptions when our patients require treatment for pain?
Maybe... just maybe, if people were appropriately treated early on...(physically, pharmaceutically, emotionally, etc) we'd have fewer "problem patients" to deal with in our future.
My post in no way is meant to include those manipulative persons who do, in fact, permeate our Universe. But let's be certain we make every attempt to treat all patient's appropriately from the get go.
Naysayers need not reply.Last edit by Fgr8Out on Feb 1, '04
Feb 1, '04Occupation: Hospice clinical director Joined: May '02; Posts: 2,873; Likes: 26What a beautiful post!