Pain Seekers

Tenebrae, BSN, RN · Feb 11, 2015

Me too

I recall as a student I had a patient with a mostly blocked abdominal aorta who as a result experienced severe pain in their legs.

This patient had a hx of high ETOH use. The consensus among many of the nurses caring for them was that this patient didnt need extra pain relief. It was never said that it was specifically related to their hx of alcohol misuse however the implications were there.

The differences between controlled pain/uncontrolled pain in this patient was remarkable. When the pain was controlled, this patient was sitting up, reading their book, talking to the neighbouring patient. When the pain was uncontrolled this patient was hunched up, not moving and grimacing

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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.

JoseQuinones · Feb 12, 2015

When I broke my toe and had to have the nail removed I specifically instructed the doctors and nurses that I did not want any pain meds (except for the local block to take off the nail). They put me on IV antibiotics and gave me a couple injections. A few minutes later I was flying high. Sure enough, the doctor had prescribed me dilauid and Tramadol, AGAINST my wishes. I do not have a drug problem, but I was angry that they ignored my right to refuse treatment. I wonder how many recovering addicts get automatic injections of opioids?

jtmarcy12, BSN, RN · Feb 12, 2015

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.

When I was in nursing school in the mid 90's our class had a white nurse who spoke to our class. This nurse went on to explain how she and other nurses were taking care of this sickle cell patient and how she and the other nurses would say things like" oh she wants her pain meds, oh how it must hurt". This patient who was 15 yrs old, later died. This nurse had tears in her eyes when she was telling us this story. She realize she was wrong and she decided she would never judge another patient about their level of pain. I too decided if the doctor ordered pain medication I would administer the med and not pass judgement. It so easy to pass judgement. Sure there are some who are pain seekers but we just cannot judge. Sure I have had patients who wanted the same "cocktail", I admister as the doctor ordered. My suggestion if you hate giving pain medication to patients who you feel does not "deserve"the medication, it is best to switch to a department where pain medications are not administered. God Bless

ScrappytheCoco · Feb 12, 2015

After just two years in the ED dealing with this day in and out, I just don't care anymore. I used to be really gung ho about not giving in to the manipulation. If they express a desire for narcs, I have an MD who will order it, their vitals will tolerate it and they have a ride home, bombs away. In the South, however, we have a ton of EDs who are going to a system where pts cannot receive narcs for chronic pain in the ED if they are in pain management or have had a certain number of narcotic scripts filled within a certain time frame.

forgivenfaith119 · Feb 13, 2015

I have chronic pain. I can talk easily even when I'm in pain. So, a patient may not always present the way you would expect. I have adjusted to my pain.

rpalthoff · Feb 16, 2015

I call Bulls**t on the pain scale and have done so since it came out in the late 1980's. It is so subjective and the drug seekers use it as a tool to get drugs. The key is to look at the person and not listen to just the words. Someone that is NARCOTOXIC will have pin point pupils and shouldn't be given more drugs. I worked 18 years of critical care and have been in Corrections for 16 years and see drug addicts every day. It is so easy to spot the behaviors. I have no problems giving high doses of narcotics to people that need them. REAL pain burns off narcotic and there is no addiction. I have had patients on a morphine drip at 15 mg an hour waiting for surgery and they can sit up, talk to you without slurred speech or pinpoint pupils. After surgery, they don't need that much and can be cut off without withdrawal. On the other hand, a heroin addict can't get enough med. Of interesting note, when a heroin addict can say the word "PAIN" and their whole face twists and contorts, they are a seasoned drug user. I have looked in a mirror and tried to mimic this and found out only a long term herion user can do this. The main DR I work with has no sympathy with addicts and she makes the statement that "NOBODY HAS EVER DIED FROM PAIN" This is true as as real pain is an indicator for something wrong and people can die in pain if something is really wrong. In the mean time, addicts are stealing and not just from others to support their habit. They STEAL time from other patients in the ER's, clinics and doctor's office. I simply let them know that they won't get their "FIX" thru me and it doesn't take them long to figure out that it is time to leave. On the other hand, I have had so many people thank me for recoginizing their problem and fixing it so they weren't in pain. Narcotics are a tool and not a crutch. LTC (Ret) RN,BSN,MMS,USA/USAR

ComeTogether, LPN · Feb 16, 2015

When I broke my toe and had to have the nail removed I specifically instructed the doctors and nurses that I did not want any pain meds (except for the local block to take off the nail). They put me on IV antibiotics and gave me a couple injections. A few minutes later I was flying high. Sure enough, the doctor had prescribed me dilauid and Tramadol, AGAINST my wishes. I do not have a drug problem, but I was angry that they ignored my right to refuse treatment. I wonder how many recovering addicts get automatic injections of opioids?

I'm sorry that they did that to you, but as someone who had this surgery, you wouldn't have wanted to feel that sucker without pain control....

morte, LPN, LVN · Feb 16, 2015

I'm sorry that they did that to you, but as someone who had this surgery, you wouldn't have wanted to feel that sucker without pain control....

but that is not the point, and the poster did have a block....this was plain and simple ASSAULT.

Anonymous865 · Feb 19, 2015

When I broke my toe and had to have the nail removed I specifically instructed the doctors and nurses that I did not want any pain meds (except for the local block to take off the nail). They put me on IV antibiotics and gave me a couple injections. A few minutes later I was flying high. Sure enough, the doctor had prescribed me dilauid and Tramadol, AGAINST my wishes. I do not have a drug problem, but I was angry that they ignored my right to refuse treatment. I wonder how many recovering addicts get automatic injections of opioids?

It's kind of nice to know this happens to medical people too.

I was scheduled for surgery. I met with the MDA (definitely MDA not CRNA) prior to surgery. I asked if Versed was necessary to sedate me or if it was given just to reduce anxiety. (A CRNA friend had told me Versed was just given to reduce a patient's anxiety and to make the patient forget any unpleasantness.) The MDA told me it was just to reduce a patient's anxiety. I asked that they not give me Versed or any other benzodiazepines, because I wasn't anxious and that I have a paradoxical reaction to them. They actually cause me to feel absolute terror. He said, "No problem. We just won't give you Versed." They gave it to me as soon as I reached the OR. Then when they didn't like my reaction to the Versed, they gave me Ativan which didn't help.

I assumed it was beause the MDA thought I was just a dumb patient who didn't know what I was talking about. Apparently they don't listen to nurse patients either.

When I complained to the CMO, I was told that it was my fault this occurred because I hadn't listed benzodiazepines on the form under "Allergies." I pointed out that I had an adverse reaction to benzodiazepines not an allergy. They said that they still want you to list adverse reactions under the Allergies section. When the nurse reviews the allergies with the patient, they will document the reaction and they will know if it is an adverse reaction or an allergy. I responded that if they want patients to list adverse reactions in that section then their form should ask patients to list allergies AND ADVERSE REACTIONS. :banghead:

JimmyDurham9 · Feb 19, 2015

I too despise the term "drug seeker." You don't get to cherry pick who you help, anyone that comes through the door you treat them with the respect, dignity, and care that is deserving of a human being. It's been my experience that all the complaining, judging, whining, and sneering that cynical healthcare providers do in the course of dealing with someone who reports pain is what wastes time. We are at our posts for one reason only: help people anyway we can. These so called "seekers" seem like they monopolize the time because of all the hemming and hawing and judging that the nurses and doctors do.

It is a simple concept: the patient reports pain, this pain should be addressed and interventions implemented according to professional guidelines set forth by our professions and orders from MD or other providers. There should be no quibbling over whether or not the pain is "real" or if the patient is exaggerating it. Help them. Send them on their way. That is the extent of your involvement.

The worst thing we can do (outside killing them) is make our patients feel judged and contemptible, and some of the approaches to patients shared in these posts do just that.

I was reading a study recently (I'll locate it for specifics) that found that a majority of patients for the most part felt their pain was not adequately addressed by healthcare providers even when it was reported. That's shameful. There seems to be this mindset among some nurses and doctors that "this patient won't get one over on me" when it comes to treating pain, and guess what? Doc doesn't adequately address or treat the patient's pain (He/she wins cause they weren't fooled!) and a human being suffers and a cycle is reinforced. Congratulations you were wise to the seeker! Give me a break. Everyone of these patients deserves respect and dignity. No one wakes up and says "Hmmm there's nothing good on t.v. so I guess I'll go get addicted to narcotics."

We're not here to judge or feel taken advantage of- it's not like we're formulating the treatment out of the manes of unicorns found only in the magical land of Brigadoon. It's not about us. It's about getting the patient the help they need at that time. Move on.

morte, LPN, LVN · Feb 19, 2015

you do realize that you were assaulted, yes?

It's kind of nice to know this happens to medical people too.
I was scheduled for surgery. I met with the MDA (definitely MDA not CRNA) prior to surgery. I asked if Versed was necessary to sedate me or if it was given just to reduce anxiety. (A CRNA friend had told me Versed was just given to reduce a patient's anxiety and to make the patient forget any unpleasantness.) The MDA told me it was just to reduce a patient's anxiety. I asked that they not give me Versed or any other benzodiazepines, because I wasn't anxious and that I have a paradoxical reaction to them. They actually cause me to feel absolute terror. He said, "No problem. We just won't give you Versed." They gave it to me as soon as I reached the OR. Then when they didn't like my reaction to the Versed, they gave me Ativan which didn't help.
I assumed it was beause the MDA thought I was just a dumb patient who didn't know what I was talking about. Apparently they don't listen to nurse patients either.
When I complained to the CMO, I was told that it was my fault this occurred because I hadn't listed benzodiazepines on the form under "Allergies." I pointed out that I had an adverse reaction to benzodiazepines not an allergy. They said that they still want you to list adverse reactions under the Allergies section. When the nurse reviews the allergies with the patient, they will document the reaction and they will know if it is an adverse reaction or an allergy. I responded that if they want patients to list adverse reactions in that section then their form should ask patients to list allergies AND ADVERSE REACTIONS.

Here.I.Stand, BSN, RN · Feb 19, 2015

Um...no. In the chart or not (which I wouldn't expect it to be, since you're not allergic), you specifically told him no benzos. How fast would an RN get thrown under the bus if s/he made this same med error--and against the pt's specific wishes?

That victim-blaming you received from the CMO is shameful.

When I complained to the CMO, I was told that it was my fault this occurred because I hadn't listed benzodiazepines on the form under "Allergies." I pointed out that I had an adverse reaction to benzodiazepines not an allergy. They said that they still want you to list adverse reactions under the Allergies section. When the nurse reviews the allergies with the patient, they will document the reaction and they will know if it is an adverse reaction or an allergy. I responded that if they want patients to list adverse reactions in that section then their form should ask patients to list allergies AND ADVERSE REACTIONS.