Questionable Pain

RNinRubySlippers, BSN, RN · Dec 14, 2003

As stated by Mc Caffery in various literature "Pain is what ever the patient says it is and existes when he/she says it does"

I believe this to be true. Who are WE to judge because nurses hold the keys to the locked drawer.

Remember this...

Marie_LPN, RN, LPN, RN · Dec 14, 2003

We have a frequent flyer who winds up on our floor every other month who always rates his pain at a 9 to get his oxycontin. His diagnosis is "intractable pain".

Ironically, he can't tell you WHERE he hurts though, he thrashes around and wimpers in pain when you're in the room, but if you pull the door closed, and leave a crack in it JUST enough to see in, he IMMEDIATELY calms down and is quiet, arms folded up behind his head in a relaxed manner.

You only have to tell him one time that he can only have the med every 6-8 hours when he arrives on our floor (depending on the doc's order. Tell him this at 8 pm, it's a 110% guarentee that at 4 am on the dot he will ring for his next dose. This has gone on for over 3 years now.

But, pain is whatever the pain says it is. Not saying i don't believe him but as soon as the he thinks the door's closed, he's a 180 degree oppposite of while you were standing there. Maybe his mentaliy is that he must act like that to be believed, i don't know.

NurseStyles · Dec 17, 2003

As a nurse who is a recovering addict, I have been through many years of therapy, drug treatment, self help programs, nurse support groups, etc.

I wish to share my experience. If an addict was requiring say 250 mg of demerol or 20 mg of morphine to have any effect, even if they are clean for 1 month or 10 years, the tolerance remains. Addicts often say that the disease of addiction is doing pushups constantly so when an addict relapses or takes any narcotic for any reason be it pain control, or whatever, the person still requires as much pain medication as they did when they quit using if not more. So in that sense, addicts even those that are clean for many years, do require higher doses of narcotics than non-addicts.

Many addicts in recovery try to avoid taking narcotics at all costs as to not re activate the addictive trap that occurs, but yet we do not need to suffer any more than anyone else just because we have the disease of addiction.

There are current addicts out there for sure, still active in their disease who will abuse the system, and though sometimes it seems obvious that they are not in the pain they say they are, by law we must accept their pain for what they say it is.

I totally agree with the person who said that it is better to take the risk of providing the addict with drugs (he or she will get them somewhere somehow anyway) than to take the risk of not providing medication to a patient who is really suffering.

barefootlady, ADN, RN · Jan 3, 2004

Was taught that pain level is what patient stated it is. DO NOT judge, accept what they say. Most people with a Hx of addiction do require more meds. Accept it. I would rather give meds even if my personal opinion is that they are drug seeking, than have a truly ill patient, even with a Hx of drug addiction, not get the med and find out later they were truly ill. So sometimes a patient does a scam on the staff, what is new? We get scammed all of the time by administration, HN, docs and our own co-workers. I want to do no harm and do the best for the patient, I may not agree with it all of the time, but as a nurse I should be able to accept that my personal thoughts and my professional obligations are often different.

Dave ARNP · Jan 3, 2004

A patient with a history of abuse will MOST CERTAINLY require more medication. They will often get little effect from antagonistic drugs, and often NO effect from PO's.

Also, in refrence to "clock watchers". That would be more CORRECTLY identified as psuedo addiction, which is defined as patient using any means possible in order to ease the suffering they are having. It is a direct result from no or inadquate pain managment orders.

Read up on it before comming up with cute names. People could say we're monitor watchers, but we do that for a REASON.

Dave

jadednurse · Jan 3, 2004

Good points everyone is making.

Dave, thanks for defining that. I often wonder though, based on your definition of psuedo addiction...perhaps it's not just pain that's making them suffer. Perhaps there is an element of anxiety that is not being adressed. perhaps w/ the right emotional support/coping mechanisms, or heck even a prescribed anxiolytic, they might not need as much pain medicine. Just a thought.

angelbear · Jan 3, 2004

Just wanted to give a quick update to my earlier post about my TAH/BSO. Turns out the pain was not well controlled due to the fact that I had developed a hematoma which had to be surgically evac. Then they left a 4x4 gauze pad in the wound. YOUCH!!!!FOR REAL!!!

Dave ARNP · Jan 3, 2004

Jadednurse,

You are very correct. ALOT of things effect pain. Effective Pain Management is very complex, and can involve alot of polypharmacy. Anxiety, depression, psyc dx's.... just to name a few. It all goes hand in hand, and providers need to understand this when planning a treatment. You can't just order pain medicaiton, while in the same sense everyone in pain doesn't need Prozac and Valium.

Dave

Dave ARNP · Jan 3, 2004

I forgot...

Anyone know who we'd ask about getting a Pain Management Nursing Section on here?

I think it would be a great place to share ideas.

Dave

ainz · Jan 3, 2004

If they are in pain and the med is ordered, give it to them. If there is no med ordered, get the order for them. I doubt seriously we will trigger a raging addiction in the ER or during a stay in the hospital. If they exhibit signs of dependency, get them a consult for a chemical dependency evaluation while giving them the pain medication. As the recovering nurse said, if they are addicted they will get the med one way or another.

5150dx · Jan 6, 2004

Boy is it interesting to read these posts. I just finished school to become a Registered Nurse (A.S.) and am 14 days post head-on MVA which thankfully only left me with bruises and severe muscle strain in my upper body. Several years ago I repeatedly strained my lower back while working as an EMT on ambulance. During that time I used Vicodin (in increasing doses) to control the periodic episodes of acute pain. That finally resolved over a year ago.

With this pain I have noticed that it takes the max. dosage of Vicodin (2X 5/500) to effectively treat the sternal pain I have, though 4-800 mg. of ibuprofen works very well on the rest of the pain. My point is that even those who were not "abusers" can have a tolerance to the meds. I don't appreciate the raised eyebrows from several people involved in my care -- the pharmacist and office nurse as well as the physical therapist. Thankfully the sternal pain is now resolving and handled by the ibuprofen so I will not be asking for more Vicodin - it just frustrates me to confront such ignorance.

Thanks again for the posts!

:)

hjmcenti · Dec 9, 2005

Just read your posts about these "pain patients". I work in a large hospital where we have a GI doc who specializes in Diabetic Gastroparesis. This is a disorder in which the gut is somewhat lazy or even paralyzed due to the long term effects of uncontrolled DM 1. My usual patient is a 30 something white female with uncontrolled diabetes, pain of 10, and vomiting. They all have g-tubes for feeds and get Dilaudid 2-4mg q3-4 hr with phenergan 25mg SIVP. They are also on Methadone, Cymbalta, and Reglan. Some are even on Marinol for nausea. They are admitted at least every 1-2 mos for 3-7 days at a time for uncontrolled pain/nausea. This a very interesting and sad disease. It is hard on the patient and the nurse. These patients lead very difficult lifes and are addicted to their pain meds. It is becoming increasingly common (gastroparesis) and there are even gastric pumps or pacemakers that can be implanted to stimulate digestion. Just some info I though would be interesting and useful.