Pain Seekers

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I am just wondering if other hospitals have the same colossal amount of pain seekers? I feel like every single day I work I have a patient who only wants IV dilaudid mixed with IV phenergan mixed with IV benadryl mixed with IV ativan with a roxycodone to top it off. I just recently cared for this woman who I was giving pain medication every 2 hours and her pain never got any better; mind you I gave her 8 mg of IV dilaudid in about 10 hours as well as 3 doses of Percocet. I am just so tired of being a legal drug dealer, just to give these people their fix. No, I don't believe that their pain maintains a constant 10/10 when they are given this amount of pain medication and when they look high as a kite. And we just support this behavior! Because controlling patient's pain is so important and pain is subjective so we must believe them. This is not why I became a nurse and I am just wondering if this daily occurrence is just at my hospital or if its all over the country.

I work in North-East Maryland----between Philadelphia and Baltimore---a prime area for drug dealers etc. There are many drug seekers in this geographical area, it is hard to treat them equally as those pts who are physically ill, but they are ill also. However, to protect your legal obligations, you should be monitoring not only whether their pain has been relieved, but how their vital signs are responding. Are they maintaining their SPO2?? Also, they should be referred for a psych evaluation. I would bring up the amount of narcotics that are being ordered, given etc. to the nurse manager's attention. Is your floor certified for the amount of narcotics that are being given, does the designation of your floor need to be changed to a Behavioral Health Unit?? It could change the focus of what your floor is about and perhaps if there is that much drug seeking going on it needs to be brought to the attention of upper management. JACHO may not look kindly on a surgical or medical floor full of psych patients. Are they being followed properly for discharge planning with out patient psych services??

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This is a daily thing for me on my job to deal with drug seekers. It bothered me at first but now I too realize that I can't change their behavior and I just give them the meds the dr has ordered. I still struggle with taking them seriously tho, I have to put my nurse face on ;)

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Specializes in SICU, trauma, neuro.
Ive never had anyone complain of itchiness, and they specifically ask for phenergan. most seem to refuse zofran or compazine. Both those relieve nausea, but aren't sedating.

Last time I was given Dilaudid I got itchy, and with one of my deliveries I had a fentanyl/bupivacaine epidural that made me want to claw my skin off. (A very unfortunate sensation when you're numb from the waist down, but I digress). It was so bad I decided I preferred the pain of a natural delivery to the itching of a pain-free one, and delivered my fifth naturally. But anyway, I was given Benadryl IV to combat the itching.

True about the phenergan being unnecessarily sedating though. Actually I haven't seen an Rx for it in probably 10 years. The MDs usually start w/ Zofran and then add Compazine if that doesn't work.

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Specializes in Pediatrics, Emergency, Trauma.
I'm going to get on my soapbox again.

Part of the problem is how so many of us view "drug seekers". If they ARE addicts, they have a disease that needs treatment. Are they going to get that treatment in acute care? No, but maybe compassion and good information from a rockstar nurse will help them along their journey. Maybe if we didn't make them feel like pieces of crap for something they can't control, they would seek help.

OP, I understand what you're saying. I would encourage you to try to look at it from a different angle. They have some kind of pain, whether it be physical, mental or emotional. Look at it as a possible first step in their treatment, even if all you do is show them kindness and compassion, while earning their trust. Who knows, maybe one day you will get an addict to open up to you and you can refer them to rehab.

Also, know that there is no way every patient you think may be a drug seeker actually is.

PPS, Ladyfree is the least aggressive person on this entire board, so I promise that she was being genuine.

Aww... :inlove: I appreciate this! :up:

Most people make it personal...instead of taking a step back, a breath, and click on the poster to see "what they are working with." ;)

I always try to point people in the right direction on this topic, because I am passionate in managing acute and chronic pain; I have learned from my formulate nursing years taking care of patients with SCI, TBI, and trauma, some in positions where they were not a random victim, they have been shot or stabbed or in a situation where they were a precipitating factor in those situations; these pts stayed with me AT LEAST up to almost a YEAR; sometimes seeing them consistently 3 days a week, sometimes for 16 hours straight, as much as they have been in the most of the year; at least nine-twelve months; depending on the severity of the injuries and the rehabilitation process.

I will share a story and hope not to reveal too much of the pt identifiers or myself on the board.

One of my pts in the rehabilitation had a severe drug problem; he could be surly, had a atrocious girlfriend that was addicted herself that would walk naked around his room and use it to shower; the would perform sex acts where other pts would see and complain-however, I would not have it factor into my care when I had him; he treated me with respect; because I honestly said to him "I will treat your pain, but if you are falling out of bed, I can not give it to you because it is not safe." There were times he was zoned out; he would get upset, but because it was me, he knew that we had an agreement, so he would simmer down and take the lump for the night, and STILL treat me with respect.

Then one day, he went out on a pass and was gone before I got there, but was supposed to be back during my shift; it was the first of the month-code for: disability check time-and he was supposed to be back at an arranged time. As soon as that clock hit one after; I notified the nursing sup that I was signing off from the pt, and I was absolving responsibility for a pt who is a KNOWN drug abuser and had no idea where they were at and escalated the situation for the supervisor to handle, because 1. I have no idea and wasn't going to be responsible for handling a pt that basically eloped; and 2. there was NO WAY I was going to be handling the situation that was to come because if and when he came back; I knew he was going to be under the influence, and it would NOT be FAIR to my patients that I would be concerned about someone who certainly didn't care about me. :sniff:

I did a double that day; I had shifted in my assignment; but that pt came back 12 HOURS after the time he was supposed to come back-and that's when the pt, with that notorious girlfriend, came waltzing back with him, slumped in a wheelchair; he certainly had a positive drug panel and UDS; he (finally!) was kicked out.

I had patients after that that expressed known drug problems; they were so much milder than dealing with that particular pt that I found a way to handle, and when necessary, utilized my resources in ensuring to handle situations when they wanted help; to many, their addiction is a way of life; and when you understand the medical and holistic complications that arise when someone, chemically, affected their pain receptors that even when they are physically hurt, or emotionally hurt, that same portions of the brain drive relief; some need their chemical, or any chemical at that point; others when injured, what we give them will NEVER be enough, this needing pain relief from medications like gabapentin, along with antipsychotics that help release chemicals in the brain to mimic pain relief. Most are somewhere in between; so I assess with safety in mind and go from there.

Personally, as I expressed before in previous posts; as I have had a MAJOR traumatic injury-I was shot seven times and survived in which CRPS devolved from it; the saving grace is most of my pain is resolved with a fluid bonus, toradol, and if needed, zofran-The.End.

I also have had migraines since 8-12 with auras-so for over 16 years, I have known what I have needed to help; down to the last medication. 15 years ago, unless I was actively vomiting, I wasn't taken seriously AT ALL; I remember being discharged from a hospital during my first stint in nursing school, and went home still under the effects of IV pain medication and don't know how I got home after taking two trains and a bus home to my house; they discharged me like that.

That experience alone made me MORE unlikely to seek medical condition unless I was near vomiting in order to be taken seriously; after all the medications and the Excedrin for Migraine and Aleve and my pain is still through the roof; it's like clockwork that by the time I'm in triage, as soon as they put that BP cuff on, I'm vomiting.

The only saving grace for my pain management is nerve pain medication; and having a fabulous neurologist that specializes in pain management.

My experience as a child, a DV survivor in the middle of my pain and PTSD after the shooting in which I had pain made me very cognizant, NOT defensive in helping people understand pain, chronic pain, and the psyche that can come along with it; the pt suffers when we don't take all those issue into consideration-and I am speaking not to anyone in particular; I am stating the honest truth in my experience-which mileage may vary; but I will tell you it has been some mileage!

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Specializes in SICU, trauma, neuro.
jrwest, i think you need to use an alternate pain score system. the facial ones, etc. then you can score them while they sleep.

there are various ones, with numbers attached.

Good idea! I was actually just thinking about this last night. I remembered that on my first job's flowsheets, they had a space to write what pain scale we were using--e.g. the VAS, FLACC, faces, etc. That's probably better than having a revolt. :)

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Specializes in Mental Health, Gerontology, Palliative.
No one asked you to apologize for anything.

This little gem is purest bull-pucky:

You obviously didn't get the ain't-it-awful hate fest you seem to want, with addicts as the target. But don't mischaracterize the posters who tried to share what works for them. We tried to acquaint you with the nuances of sorting out caring for patients with addiction and/or chronic pain. If that offends you, I don't know how to help you.

what heron said

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Specializes in Mental Health, Gerontology, Palliative.
I completely disagree. "MOST POSTERS" here are not saying that AT ALL. Go back and re-read the responses. They ARE saying they would give the meds as ORDERED IF vital signs and patient condition are safe enough to do so.

Thats pretty much what I was saying

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Specializes in Mental Health, Gerontology, Palliative.
Are you saying I am not allowed to have my own personal opinion? You have your own personal opinion regarding my personal opinion...are you trying to tell me you yourself shouldn't have that personal opinion of my personal opinion?

I mean (cant speak for anyone else) dont allow your personal opinion to impact on how you deliver your nursing care.

I believe that if a person holds the personal opinion patients who can articulate what works for them in terms of analgesia must be drug seekers, or time wasters, will be a barrier to delivering effective nursing care

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Specializes in ICU.
I mean (cant speak for anyone else) dont allow your personal opinion to impact on how you deliver your nursing care.

I believe that if a person holds the personal opinion patients who can articulate what works for them in terms of analgesia must be drug seekers, or time wasters, will be a barrier to delivering effective nursing care

Maybe it's just because I had way too much customer service experience before I went into nursing, but I treat everyone the same. I've got a pretty good poker face regardless of what I think of the patient. And believe me, I think some of my patients are horrible, selfish, manipulative human beings. I still talk to them like I talk to the more pleasant ones and I still get them whatever they ask for.

I am sure there are probably nurses out there who do allow their personal beliefs to guide their nursing care, but at least give the rest of us the benefit of the doubt. I'm not going to treat someone differently just because I think they are seeking.

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Specializes in Transitional Nursing.
Aww... :inlove: I appreciate this! :up:

Most people make it personal...instead of taking a step back, a breath, and click on the poster to see "what they are working with." ;)

I always try to point people in the right direction on this topic, because I am passionate in managing acute and chronic pain;

OMG I just want to Hug you and hug you and hug you. I wish everyone understood it as well as you do.

You're amazing, and I 100% agree. I just want society to stop treating drug addicts like bad people. They're not bad people, they have problems. ALthough, there is certainly another group who aren't addicts but abusers, and they are in their own category IMO, but of course if you abuse a drug long enough it will change your brain chemistry, which then makes you an addict, kind of..... Its sure not an easy topic to understand.

I have had experiences with chronic pain also, although they pale in comparison to your experiences. I've been treated by nurses like a seeker and it's awful. I will never forget how it made me feel, and due to my nature the feeling didn't leave me for a LONG time.

I didn't get better after a surgery, there turned out to be a very good reason for it, (hardware where it didn't belong) and the nurses at the surgeons office were telling me to try ibuprofen and ice, clearly not taking me seriously when I would ask for a refill for my pain meds. The last time I called they wouldn't even relay my message to the doc, simply said "try ice".

I started to believe that I was imagining the pain, was I a drug seeker? Did I just like taking the medicine and the pain was in my head? It really messed with my head for awhile. So, I decided I would do just that. Take Ibuprofen and try Ice. I would NOT become a statistic, I guess people just learn to live with it.

So, I stopped the narcotics and popped ibuprofen like crazy. Limped everywhere I went and figured it would get better or I would get used to it. Then I tried PT but couldn't do it. Literally, was not physically capable. FInally a doc I knew from my job that I'd lost as a result of all of this told me I needed a second opinion. My symptoms weren't normal.

Long story short, I got that second opinion and the surgery that I had, had failed. I had a big ol' screw where it didn't belong. (Can't give specifics, someday soon I can tell the whole story). So, it wasn't in my head, I had a damn good reason to be in so much pain, and I suffered for awhile there when I didn't need to because I thought something was wrong with my brain.

Anyways, I just think it's important to give everyone the benefit of the doubt, even though we THINK we know they're drug seekers, they may just have under-treated pain, or a screw where it doesn't belong ;-)

Addiction is such a fascinating thing, really. I can only hope that in the coming years we will start to understand it better and treatment will become more widely available.

If we handled addiction like we do depression, and made it known that its NOTHING to be ashamed of, I really think we'd see less of it. (go untreated)

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Yes, it happens a lot in my town. It gets to be more about patient satisfaction than anything. One doctor told me that a patient seemed drugged with dilated eyes and all but proceeded to grant her request for more drugs before discharge. He mentioned that if he didn't do it, she would go elsewhere and who knows what that doctor would give her. It makes me angry because I don't feel like it helps the situation in our community. It keeps the patient happy though, and that is what healthcare seems to be more about these days, patient satisfaction. The hospital won't get reimbursed if they don't get perfect scores on their follow up surveys. Never mind that we aren't always promoting health anymore...just satisfying a customer and granting wishes even if it isn't for the patient's benefit.

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kind of a late in the game observation, but the title of this thread makes it sound like its about patients who are "seeking pain".

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