Pain Medication addicts

Columnist · Feb 1, 2013

Moved to Nursing and Patient Medications for more response.

corky1272RN · Feb 1, 2013

All the time, any nurse that has worked in the hospital has seen this time and time again. :yes: What is your question?

iluvivt, BSN, RN · Feb 1, 2013

Sure all the time. Are you thinking this is abnormal or something? I watched the clock post op as well as I was in so much agony I could barely wait to get my Dilaudid. Can you image being in so much pain that you cannot do anything else but cry,moan.roll around in the bed and watch the clock and pray you can make it until your next dose. I can say I was terribly mismanged after my surgery. I really needed an epidural but after 2 hours and several anesthesiologist they could not get it in so I suffered a lot!

Unfortunately, I still find many healthcare professionals have a fundmanetal lack of knowlege on how to effectively manage both acute and chronic pain and if I ddi not absolutely adore my specialty I would do something with pain management speciality.

eatmysoxRN, ASN, RN · Feb 1, 2013

Happens every shift. Welcome to nursing.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

amoLucia · Feb 1, 2013

All the time, any nurse that has worked in the hospital has seen this time and time again. What is your question?

Also in LTC's rehab/skilled pts that come to us from the hosp with their fresh surgeries. They're usually younger, walkie-talkies, who have an axe to grind coming from the hosp or with their MDs. So we get the short end of the stick.

I have NO problem with pts who really do have pain issues, and to that extent, I will most strongly advocate for those who may be under-managed. My discontent stems from the pts who seek the buzz or the LaLa Land oblivion to the detriment of their recovery.

Also, I am strongly annoyed with all the checks and balances that are required when signing out & administering pain meds, esp narcs. Yes, I know the reasons why; sadly, I agree they ARE necessary. But it makes a difficult situation even more annoying. So repetitive and time-comsuming. :madface:

KelRN215, BSN, RN · Feb 2, 2013

I don't think asking for one's pain medication when it is due for legitimate pain makes one an addict.

sharpeimom · Feb 2, 2013

There is so much misunderstanding about patients requesting their prn pain meds on a regular schedule. The only way a patient who has severe unremitting horrible pain has to gain any measure of relief and pain control is to take his pain meds on a very regular, almost to the minute schedule.

I had learned that as a student but it really hit home two years ago when my usually stoic about pain husband nearly lost his right lower leg and foot. Prior to his problem, I doubt that he had taken a total of a dozen Tylenol in his entire life. Pain that hovered around a 7 but often went as high as an 8.5 became the new usual. After trying almost every control pain med there is, what works best, is Tramadol 300 mg q6h plus Oxycontin at hs when it's really unbearable (which he hates and only uses rarely.) This regimen works for just one reason. His watch has an alarm, which he sets when he takes the last dose. If he doesn't and takes it even a half hour late, he plays catch up for the rest of the day and never quite catches up.

The humorous thing is that he takes Tramadol 300 mg and our elderly dog takes Tramadol 50 mg for severe arthritis. One is made to "people" standards and the other to canine standards and they're nearly the same color! Fortunately, the pills from the v-e-t come in brightly colored bottles!

dudette10, MSN, RN · Feb 2, 2013

Yes, of course, and over time, my perspective has evolved. The biggest reason it has evolved is a long conversation with one of my patients when I worked a slow night. She became addicted (her words) with post-op pain management gone awry. She didn't know this of course, but she had had the exact same procedure I had, and the pain is real. For days, but each day getting better if one is healing properly. I chose to grit my teeth and not schedule my pain meds, and she chose to schedule them, but I don't blame her one bit for that. It HURT! She became addicted because no one helped her taper off. She voluntarily went into rehab and told me she felt that the inpatient doc abandoned her after her discharge, so she relapsed.

Unless there is a discharge plan to help someone into pain med addiction rehab, and I advocated that for her--something she was amendable to try again--there is absolutely no sense in patients chasing pain (those with high tolerance to pain meds and need them for chronic pain management) or withdrawal symptoms (those who need the drugs to manage withdrawal, but there is no chronic pain to speak of) while inpatient for other conditions.

And, yes, I have also had ONE patient who used fake names at many different hospitals and was a true drug seeker. It was very early in my career, and I just pushed the drug. The docs discharged him as fast as they could. The fact that he was able to drug shop attests to the fact that we, as healthcare professionals in an acute care setting, often do not know what to do with the true drug seekers. We also don't know what to do with the pain med addicts (NOT those with chronic pain who have a high tolerance--different category) who need and want help to kick the habit. It's a sad state of affairs.

MunoRN, RN · Feb 2, 2013

This is common, but in my experience that vast majority of patients who ask for meds "on the dot" do so because we failed them. We didn't adequately assess or control their pain, so they become paranoid about getting behind their pain and realize they need to take the lead on their pain control because we aren't stepping up.

Orange Tree · Feb 2, 2013

Pain is easier to control if you're on top of it before it gets extreme. When I have patients who are in a lot of pain, I will ask them if they'd like me to wake them up and give them a dose of medication as soon as allowable, or in some cases, before I leave for the day. Then I set my timer. The patient has to be stable and rousable, of course.

It irritates me that so many nurses do not want to give pain medication for various reasons. They think the patient is lying, watching the clock, drug-seeking, not acting like they're in pain, etc. It seems to be a control issue for at least some nurses.

MunoRN, RN · Feb 2, 2013

Something to consider is that the time frequency that pain meds are ordered are partly based on the time in which the medication will likely become ineffective, which would also be the time we should be planning to assess pain. If patients are constantly having to initiate this assessment then there's a problem.