Pain Seekers

[missswiss44]

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.

[Anna S, RN]

On the other side of things- I am a nurse with chronic pain. I am in pain 24 hrs a day, and never get adequate treatment for it. So many docs are afraid to really treat pain now, and think everyone is a seeker.

[Tenebrae, BSN, RN]

how do you know if they have abnormal liver and kidney function? What if they have abnormal kidney function?

Drugs are generally excreted via the liver or kidneys.

If someone has decreased liver or kidney function, they cant process things in the same way and the doses will need to be adjusted accordingly

[Tenebrae, BSN, RN]

Emotional topic. I see a lot of projecting onto the OP things she never said.

Not remotely correct.

Nurses labeling a persons response to pain as drug seeking is not remotely helpful to ensuring safe effective healthcare.

[FineAgain]

I get that part too, but we are audited on a daily basis for reassessing the pain number exactly one hour after it's given.

We are too. Nine times out of ten, mine are "nonverbal" "Patient sleeping, appears comfortable and in no pain". The other is "medication not appropriate at this time" and other interventions listed such as repositioning and distraction. Which I do.

[DYS NP]

It helps to realize manipulation is a symptom of addiction, another chronic disease these patients have in addition to the illness they're being treated for. It's far too complex a disorder to file under lack of character. It's a comorbidity.

https://dcc2.bumc.bu.edu/alcoholnewsletter/archive1.aspx

[Here.I.Stand, BSN, RN]

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.

Possibly because they don't want to be itchy or nauseated?

[SmilingBluEyes]

I think drug dependence, tolerance and addiction are hugely misunderstood in the medical professions, nurses included. If I had my way, EVERYONE would have to take continuing education on these issues, so they can better understand what they are dealing with and handle it appropriately. It would start in nursing school and a continuing requirement to keep licensure would be a mandate for all practicing nurses (and doctors, midlevels too). OP, you have a lot to learn. Try getting some CEU coursework on pain management, addiction/tolerance/dependence soon. It may open your eyes.

[Here.I.Stand, BSN, RN]

I get that part too, but we are audited on a daily basis for reassessing the pain number exactly one hour after it's given. We are given warnings when we don't do this( have a re-score)

Whose brilliant idea is this?? Do they not realize the importance of protecting sleep as much as the pt's condition allows? Interrupted sleep increases the risk of the pt developing delirium. Our EMR has an option for "sleeping" in the reassessment field.

I know you didn't ask for advice, but I really see this as a patient advocacy issue. I'd find some research articles on the risks of interrupted sleep, and encourage colleagues to refuse practices that are not best for the patient. We nurses should be using EBP, not charting driven practice.

[nurseprnRN, BSN, RN]

how do you know if they have abnormal liver and kidney function? What if they have abnormal kidney function?

Seriously?

Check the labs. Know what the normal route of metabolism and excretion is for all their medications. Use your critical thinking skills to figure out what all that means taken together.

[BrandonLPN, LPN]

I have a hard time with the pain patient who is relaxed as can be on her cell who tells me her pain is a 9 out of 10.

And that's where the whole "pain is subjective" bit comes into play. Just because you don't see objective signs/symptoms of pain doesn't mean her pain isn't the level she says it is.

And people with chronic pain tend to learn how to go about their daily lives in spite of the persistent pain. So I don't think someone being able to talk on their cell necessarily equates with "they're not really in pain".

[heron, ASN, RN]

OP, I want to acknowledge that you never wrote that you withheld pain meds or were tempted to do so based on a pt being a "seeker". Your vent was a very normal and healthy reaction to being manipulated and the disrespect it shows for the people who are trying to help. We have the ideal articulated by other posters, then there's the reality of how it feels to be on the receiving end of addiction behaviors. It's infuriating, fer shur!

It illustrates the point I've tried to make in the past, that professional caregivers are human, with human emotions. When we, as professionals, are dealing with addicted people, we need as much support as anyone living with or related to an addict. Personally, I think a support group similar to Al-Anon is needed for nurses who are hit with this on a regular basis. Maybe you could start one for nurses on your unit or at your facility?

That being said, I would suggest - if you have time - searching out the many other threads here on the subject. It would give you some insight into why some of the posts here seem critical ... many of those posters have been in the same spot as you and have worked their way into a more professional approach to dealing with patients with addictions. It usually entails learning how to step back from the emotions triggered by the games, thinking through your therapeutic objectives and how to set appropriate limits on the foolishness so you can get your job done.

And there is a lot of foolishness. Addiction behaviors are all centered on getting the substance of choice any way possible. To an addict, you and the docs you work with are the targets of that behavior ... it isn't about you, it's about the chemical they need to either get high or avoid getting dopesick. Which is why you need to avoid taking it personally. That leads to power struggles, which is what makes it all soooooooo draining. Learn to observe the behavior the same way you observe physical signs and symptoms, then you can start to think clinically rather than react emotionally.

If you have a psych nurse in your department, s/he can be a big help in both understanding and dealing effectively with problematic behaviors, including addictive drug-seeking. Get acquainted with concepts like staff-splitting, enabling, transference and co-dependance (that's a big one with nurses). Pick the brains of those who seem to be able to cope without losing their cool. Learn how and when to use humor to blow off steam, but don't let yourself fall into the trap of stereotyping people. As other posters have pointed out, many coping behaviors can mimic addiction but are actually serious attempts to get help with pain that's becoming impossible to live with.

I've never worked in the ED, but I put in 11 years on a dedicated AIDS unit populated almost exclusively with addicts living through the final stages of their disease ... lots of pain in people who were also in all the different stages of addiction ... I know how intense and emotional and just plain hard it can get trying to sort it all out.

[classicdame, MSN, EdD]

don't know what dept you are in, but it is possible to have pain that drugs does resolve. It may be an inconvenience for you but it is vital to them. Do they need to have a Pain specialist consult? If the vital signs are stable and the drug is ordered, give it