Pain relief without fostering addiction

Mavrick, BSN, RN · Mar 12, 2015

While I understand where you are coming from, heron, I disagree about discussing it. Part of patient teaching is educating on the danger of these medications and to not do so because some people are having addiction problems and therefore to suggest this person could as well....the idea that talking about that is somehow harming them...I just....that is like saying there has been a tornado here and therefore we don't talk about tornadoes because it might make us less likely to treat their personal disaster adequately. It makes no sense. They are at risk of tornadoes too and need to know about that.
Nobody is being punished when we discuss the potential for abuse, tolerance and/or addiction when sending people home on narcotic medications. Deaths from OD have more than doubled in the last 15 years. ER visits for prescription drug abuse problems are up 123%. The United States has 5% of the world's population but uses 75% of the world's prescription drugs. This IS a conversation that needs to happen. People are being put on these medications more than ever before. Talking about the propensity for abuse is far from wrong. It is imperative.
Popping Pills: Prescription Drug Abuse in America | National Institute on Drug Abuse (NIDA)
CLAAD.org Â» Prescription Drug Abuse Statistics
CDC - Facts - Drug Overdose - Home and Recreational Safety - Injury Center

I think you may have missed the word solely.

Both pain relief and addiction are potential outcomes of taking narcotics.

I really fight that battle in my PACU practice. Addicts can have acute pain and I'm not about to deny them adequate pain relief in any kind of attempt to educate them on the hazards of addiction. I had no problem giving my post op patient 63 mg of Dilaudid IV in 1 1/2 hours. They left my unit discussing what they were going to order off the dinner menu.

I really appreciate the comment about people being addicted prior to entering the healthcare system. (came that way) Pain relief sometime requires the enabling of the addiction in the short term. Yep, I'm gonna let the "addict" win.

Emergent, RN · Mar 13, 2015

I feel encouraged to be a little easier on myself. I've been denying myself needed pain relief, paranoid that I'll run out, stressing from my painful, hourly PT exercises. I have most of my pills left.

It's hard to find the right balance in life, everyone is so individual.

ComeTogether, LPN · Mar 13, 2015

Narcotics affect individuals differently. I 'discovered' this when I was the nurse supervisor at a chemical dependency hospital.
I've taken Lortab or Vicodin, got a terrible stomach cramp, got not-unpleasantly woozy and then was constipated for a week. It wasn't worth it, but I had a corneal abrasion and they wouldn't send me home with those WONDERFUL anesthetic eye drops! The doctor said "Go ahead and fill the Vicodin script, you are gonna need them." So I had that experience of my own and then bore witness to the alternate experiences from people who had become addicted to them.
Almost to the person, Vicodin (or other narcotic tablets) gave a burst of 'energy', like caffeine only more joyous. Several women told me they'd pop extra Vicodins and get to house cleaning. Or before a long, boring task, pop a Vicodin and instantly there was plenty of 'energy' and the boring, dull task was even more pleasant.
I had patients admit they could be in the WORST possible mood, depressed and hopeless, and after taking a narcotic it's as if the entire world changed, from a place of despair to a place of hope.
I heard similar stuff about alcohol -- the shy person who became extroverted and social, the life o' the party.
I wonder if certain individuals have slightly 'different' mechanisms of uptake of opioids in their brain, that may predispose them to addiction?
Another 'difference', obviously, is taking narcotics to alter a mood or 'give pleasant energy' as opposed to taking them as prescribed for pain. There was one gal who had dental surgery, and 'really liked' the Percocets. She started stealing scripts from the doctor's office she worked for about a year later, after she'd 'faked' a couple of injuries or persistent 'headaches' in order to get Percocets prescribed. She was a mother, wife, a medical assistant with no job problems and a supportive (but clueless and confused) husband. She denied depression, but did have childhood abuse issues and traumatic memories. She'd actually been very depressed without realizing it. Her life was good, but she felt 'bad' and the Percocets became her best friends because they made her FEEL happy, which she didn't feel and didn't know why.
I think as nurses we can't prevent people from misusing or becoming addicted. It may not be a matter of education. I think certain individuals have metabolic differences that predispose them, and all we can do is provide teaching (and encourage colace lol), and emphasize how important it is to use narcotics for brief periods of time. I'm not including those who need to take them regularly, that is a different story.
If anything, this is an educational matter for NURSES as much as for patients. But I don't think nurses can do very much harm, if it turns out that narcotic addiction is a metabolic issue. We ought to be ready to identify possible misuse versus 'tolerance' and legitimate 'dependence' when a person suffers chronic pain.

This is exactly why we need to treat addiction, even before it becomes addiction. (How, I don't know....) The fact is that addicts have a different chemical makeup and become addicts because they are self medicating a problem that could have been addressed long ago, had it been discovered.

heron, ASN, RN · Mar 13, 2015

Emergent, it's inappropriate - and against TOS - to give medical advice, but if you're denying yourself pain relief out of worries over addiction, please talk to your provider. If you're like me and know yourself to be vulnerable to addiction - that is using the med for the buzz instead of for pain relief - it's really important to have a plan and adequate support.

If you're just worried on general principles, be aware that using an opioid to prevent pain, rather than suppress pain that is already severe, usually results in using less medication over time. It's a learnable skill.

Unrelieved pain can cause problems of its own: depression, delayed healing, sleep disorders, as well as slow your progress in PT. Don't be a hero.

Emergent, RN · Mar 13, 2015

No, not prone to addiction actually. This has been such a stressful time, lots of anxiety happening. I've always viewed myself as such a strong person. Really causing me to reexamine my world...

I'm going to be ok.

mmc51264, BSN, MSN, RN · Mar 13, 2015

I am one of those that get more focused on pain medication. It is like the anti-Ritalin. It has been shown that tramadol can have a serotonigenic (bad spelling-sorry!) effects. I recently was in the hospital and had IV dilaudid for the first time. It was awful!!!! I cannot understand why people like it so much. gave me the worst cotton mouth EVER. Not for me. Even oxycodone, that I have taken for post-op pain makes me nauseous. So far vicodin works the best for me without the nasty side effects.

I work in ortho and obviously pain is an issue, we have two types: those that want all the meds they can get and the ones that are afraid of becoming addicted. We constantly are educating that taking pain meds for a short time as prescribed should not be an issue.

The ones that kill me are the ones that come in, they have legitimate chronic pain, but the pain clinics might have them on 90 mg of oxycontin Q8H. That is insane. And they are not sedated or anything. We use ketamine occasionally (research says that it is supposed to "reset" pain receptors) but that doesn't seem to fix the tolerance issue.

Very rarely do we see "addicts" and if they are admitted to acute care, that is not really the place to detox them.

I went to a conference and there was a presenter that was there form the state version of the CDC and he was showing us data where they were cracking down on some of the pain clinics. The prescription narcotic use was going down, but guess what is going up? Heroin use. I guess users are going to use.

roser13, ASN, RN · Mar 14, 2015

I don't over-think it. I advise my patients to take their pain meds as prescribed, while paying attention to keeping ahead of the post-op pain, rather than chasing the pain. My influence is brief as a post-op pain manager, and I cannot afford to plant addiction suggestions into vulnerable patients.

Emergent, RN · Mar 14, 2015

Lots of great comments here. Thanks for wonderful input!

Doctor and PT warned me that I'd have increased pain at this point due to scar formation. Need that therapy more than anything! Proceeding forward toward recovery!

pockunit, ADN, RN · Mar 14, 2015

I have high (hah) hopes for this. It would be a complete game-changer, at least for back pain.

Experimental Opioid Could Reduce Addiction Problem | MIT Technology Review

Phase 3 is in process Nektar Announces Start of Phase 3 SUMMIT-07 Study of NKTR-181 in Patients with Chronic Low Back Pain - KUSI News - San Diego, CA

mmc51264, BSN, MSN, RN · Mar 14, 2015

Also NEVER underestimate the power of tylenol!!!! I get such push back from people who think it doesn't do anything. If it can get you an extra hour from having to take a narcotic... I know that OTC have their own issues, but usually the NSAIDS are contraindicated in some post-op situations, although we use Celebrex in ortho pts, but we get some float nurses that will give me report that pt had "pain issues" overnight and I see that they didn't give the scheduled tylenol at midnight b/c they didn't want to bother them.

Emergent, RN · Mar 14, 2015

Oh, I'm taking round the clock Tylenol and Ibuprofen as directed. Couldn't do without it!

allnurses Guide · Mar 14, 2015

How can we, as nurses, encourage adequate pain relief, yet help our patients avoid the pitfalls of addiction? Let's face it, many people get their first encounter with narcotics after surgery. Some have a hard time weaning themselves off of them afterwards. It's a real problem that can destroy lives.
We don't want to cripple our patients' recovery and rehab by discouraging pain relief. But, there's definitely a lack of forthright communication in the medical field regarding the real dangers of narcotics.
Since I'm wrestling with this subject myself, recovering from a painful surgery and rehab, I've been giving it a lot of thought. I'm having a hard time finding a balance, and probably too paranoid. Yet, I've seen the horrors of narcotic dependence too.

Hi recovering addict nurse here!

I am going to tell you a story on how addicts and normal people are different. I you take a guy to the ski slopes and break his leg and give him a ten day supply of vicodin and tell him to see you in a week. The addict comes in with an empty prescription and says I need more of that. The non-addict says I have a lot of these left because motrin does the job just fine.

I have been clean and sober for 15 years except for two major surgeries when my physician and an addictionologist agreed that it would complicate my recovery to go without pain relief. I had no problems because I stayed tight with my 12 step program and turned it all over to my Higher power.

The point is that it is not a nurses job to worry about if the patient will become addicted. A patient who is in acute pain following accidents or surgery needs to have their pain treated. A patient in pain doesn't need to hear about the pit falls of narcotic therapy? less than 1 percent of all patients who are given pain meds become addicts and now that Vicodin requires a triplicate physicians have more accountability.

Nuf said

hppy