Pain Seekers

missswiss44 · Feb 8, 2015

TU RN, out of all the responses to my post I think you understand what I was trying to get across the most. People who have addiction problems are very time consuming and many times take up a huge amount of my time; I have other patients who need my nursing care as well, perhaps for something like cleaning bodily functions off of them so their skin doesn't burn away. I have had patients who sign out AMA because the doctors stopped their IV pain medication as well, which is unfortunate. Thank you for the post.

missswiss44 · Feb 8, 2015

LadyFree28, you just sounded very aggressive and defensive and I did think you took it personally. This is the last time I will respond to you.

LadyFree28, BSN, LPN, RN · Feb 8, 2015

LadyFree28, you just sounded very aggressive and defensive and I did think you took it personally. This is the last time I will respond to you.

If that's you felt like you needed to "read" into, so be it; if anything, I was trying to help clarify things, but I feel you are taking things VERY personally while people, including myself are actually trying to help you be the best nurse that you can be by NOT taking things personally.

Best wishes!

rnmaybe · Feb 8, 2015

And how do you know it is safe to give the pain medication?

The only behavior you can change is your own. Stop taking it personally, give the ordered pain med if it is safe to do and move on.

dirtyhippiegirl, BSN, RN · Feb 8, 2015

And how do you know it is safe to give the pain medication?

Level of consciousness and vital signs.

ICURN3020 · Feb 8, 2015

And how do you know it is safe to give the pain medication?

Ummm...use your nursing assessment skills. As mentioned already...LOC, VS, etc.

canigraduate · Feb 8, 2015

I understand that you have problems with the manipulative behaviors, but here is a scenario I want you to consider.

You have a huge headache behind your left eye. It is constant. It is an 8/10 on a good day.

Your doctor is trying to treat it, but because you are not a dramatic person, he doesn't believe you are in that much pain. You have been going through the system, getting neurology consults and tests, but nothing has been found so far.

You have been in pain for so long that your vital signs have adjusted. When you first went to the hospital and were admitted for your pain, your VS were significantly elevated, you writhed in pain, you were diaphoretic, you were pale, and you actually looked like you hurt. Now, a few months later, your VS are WNL. Your body can't maintain that kind of reaction for that long, so you don't look like you hurt. You have developed some coping mechanisms so that you can function. You have had enough practice dealing with the pain that you can carry on a conversation, eat your meals, and make it through your day with nothing more significant than irritation.

You have learned through many encounters with healthcare professionals that you have to ask for the drug that works for you because they will try to give you Tylenol. You have learned that many healthcare professionals don't believe you are in pain because you have learned to function with it.

Now, insert a judgmental nurse. This nurse doesn't believe your pain rating. This nurse tells the doctor that you must be faking it because you are functioning. This nurse believes that since you know the name of Dilaudid that you must be a drug seeker.

How are you going to deal with your pain and this nurse?

1) You are going to be angry with her.

2) You are going to tell any lie that she will believe so your frigging head will stop killing you.

3) You will use anyone around you to manipulate this nurse so that you can get enough relief so that you don't want to kill yourself to end the pain.

This is the mindset of a chronic pain patient who has had to deal with too many people who don't respect them. You are way more likely to deal with this kind of patient than an addict.

Also, if you are dealing with an addict, remember that you are dealing with learned behaviors. You are not going to change them in one encounter.

Frankly, it is better to communicate with the patient to find out what their expectations are and try to work with that. You will develop a good rapport and they will feel better. If you try to help them out while maintaining your professional boundaries, they will be much less of a PIA.

I hope this helps.

BuckyBadgerRN, ASN, RN · Feb 8, 2015

I THINK you mean patients are complaining of pain and SEEKING DRUGS?

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.

martymoose, BSN, RN · Feb 8, 2015

i got it that someone wants pain meds. What I dont understand is the need for phenergan, benadryl, etc to make sure the person is snowed into oblivion. Does phenergan, benadryl, ativan, etc potentiate the actual narcotic? Or is it that the "seeker" wants to be unaware of their surroundings, as opposed to getting pain relief?

I've had "seekers" get angry that I woke them up ( to see that they havent crossed that line past moderate sedation) because now I ruined their "relief" of 19/10 from 20/10.( What I am usually told)

missswiss44 · Feb 8, 2015

i got it that someone wants pain meds. What I dont understand is the need for phenergan, benadryl, etc to make sure the person is snowed into oblivion. Does phenergan, benadryl, ativan, etc potentiate the actual narcotic? Or is it that the "seeker" wants to be unaware of their surroundings, as opposed to getting pain relief?
I've had "seekers" get angry that I woke them up ( to see that they havent crossed that line past moderate sedation) because now I ruined their "relief" of 19/10 from 20/10.( What I am usually told)

Yes, I believe all the other IV medications potentiate the narcotic as they can (benadryl, phenergan, and ativan) cause a sedated effect. What is funny to me is when people ask me to give them together and then push the dilaudid fast. I have had patients get mad at me because I won't give them IV pain medication when they are falling asleep talking to me and their blood pressure is in the toilet.

nurseprnRN, BSN, RN · Feb 8, 2015

I guess what really gets to me about the drug seekers is the manipulation that comes with it; I don't appreciate it because I feel they are taking advantage of people there to help them.

A few thoughts:

If you feel that way because you don't know how to treat someone with a long-standing history of drug use (note: I did not say ABUSE) for his pain, then you are the one taking advantage of your position and control of his pain.

Someone who uses pain medications for chronic pain and needs a lot more than opioid-naive people is not an addict. Furthermore, addicts are also habituated, but can also have pain and need pain meds on top of whatever they need to prevent withdrawal.

You need to understand the concepts of habituation and tolerance. Many folks on methadone or other opioids take regular doses that would make us opioid-naive folks stop breathing, so why is it that they are still alert and well-ventilated?

It's because their bodies are habituated (used) to that level of the drug and so they tolerate it.

If you can take a prn tramadol or oxycodone dose on top of your baseline opioid level (presumably zero) without risk of hypopnea, so can they, and for the same reason. There is no justification whatsoever for making them wait some arbitrary period to prevent a complication that will not occur, and for the same reason that no one should make you wait for prn pain relief if you ask for it when you need it. To do so is punitive and unethical.

Unethical, I tell you. You need to back off this attitude and do some serious studying on this. There are a number of threads on AN that could assist you. Your patients depend on you for safe practice, and your current attitude is unsafe.

I understand, now having read the entire thread, that you were mostly just venting and you think you do give adequate pain relief as prescribed. But seriously, I think your attitude is not helpful either in managing these patients or in caring for them. Do recalibrate.

klone, MSN, RN · Feb 8, 2015

If a blog is going to be this aggressive I think I may not participate anymore.

She was not aggressive. If you found her words aggressive, maybe not participating would be a good idea (or maybe lurk for quite a bit more before participating).