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.

Specializes in Dialysis.

Just curious about something. Your profile says you are Pre Nursing? How are you giving nursing care?

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... or perhaps this accounts for the relative naivete in the OP? Good spot. I felt like that when I was 17 too. :)

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Specializes in PCCN.
Possibly because they don't want to be itchy or nauseated?

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.

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Specializes in ICU.

I have lots of people in legit pain and I have had lots of people that I was quite sure just wanted to get high. Before anyone gets me about that, searching a purse after a known I-Want-My-Dilaudid passed out and was incontinent very quickly after only the first dose and finding a nearly empty bottle of both Ativan and Percocet filled within the last few days, which should have had 30 or so pills in them each, is usually a pretty good indicator that they're looking for a high. If you want to be snowed to the point that you are incontinent I am probably going to assume you're an addict - most people in chronic pain that I have run into actually care if they poop the bed or not, and will usually get sleepy and uncomfortable but not zonked into oblivion. I am talking about an A&O mid 20s female with perfect neurological and musculoskeletal function in this case. It's pretty sad.

However, whether or not the pain is legit, whether or not the person is an addict or in chronic pain... these people are frustrating! Even when they like you! I go out of my way for these people for two reasons - 1. they obviously feel better, and 2. they are not as evil to deal with when their pain is under control. I have had several people tell me that they had the best pain control of their entire hospitalization during the time when I was their nurse, that I was the only one who cared enough to make sure their pain was under control, blah, blah, blah... However, when I have Dilaudid ordered q1h and I give it q1h, and I give the q4h Percocet, and I give the q4h Oxy, and the q6h Flexeril, and then the q4 Phenergan, and the q6h Benadryl... it's just really too bad for the septic patient dropping his pressure next door, isn't it? It bugs me when we spend all the time all the shift with the "healthier" patient and the really sick one next door gets shafted. I think we ought to just put these A&O chronic pain patients on a PCA when they're hospitalized and let them control their own dosing, because these people are the least sick but most labor intensive people on the floor and it's not fair to the people who are actively trying to die. That's what gets to me.

Oh, and we do have a pain protocol that allows for q15 minute IV fentanyl pushes... just try getting anything done if you are literally giving pain medicine every 15 minutes. Fortunately, after several q15 doses we can just start a fentanyl drip per protocol, but you do have to go through the motions of the q15 minute dosing for a bit to get to that point.

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You (OP) sound like someone who hasn't experienced chronic pain. I'm not sure that you (or a lot of healthcare providers for that matter) are able to differentiate between drug seeking as the result of chronic pain, and drug seeking as the result of a substance abuse problem. And even if you are, what's the plan? There's nothing you can do to fix the problem while you have this patient. Is that what is bothering you, that you're sending the patient away with a problem that hasn't been addressed?

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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)

If we weren't hounded for that, I'd let "the sleeping dog lie"

I'm used to pissed off patients now

LOL! It's too bad you're used to pissed off patients.

What I do is chart "patient resting with eyes closed, no apparent distress" and move on from there. I second what another poster said about advocating for your patient. If you're giving someone q2h pain meds, it's just cruel to wake them up in between.

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If they patient comes in through the ER what are you judging by? Those labs are not frequently drawn on patients presenting with chronic pain. What if they have poor kidney function and they complain of a 10/10 scale of pain. Do you give the drugs or with hold them? Is there a narcotic you would prefer if they have poor kidney function?

1) See the pee. Make sure you have an adequate amount and the right color.

2) Check your BUN and creatinine (kidney)

3) Check your LFT's (liver function tests)

If the kidneys or liver are compromised, it takes longer to metabolize the meds, which leaves them in the body longer and increases their effect. This can lead to seriously poor outcomes.

Also, one of the main adjuncts to narcotic treatment is tylenol, mostly in the form of combination drugs such as Norco and Percocet. Tylenol can kill your liver quickly. If you already have poor liver function, you shouldn't be getting NSAIDS.

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If they patient comes in through the ER what are you judging by? Those labs are not frequently drawn on patients presenting with chronic pain. What if they have poor kidney function and they complain of a 10/10 scale of pain. Do you give the drugs or with hold them? Is there a narcotic you would prefer if they have poor kidney function?

Not sure why you are fixated on this. Perhaps you could start a thread on the student forum.

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We'll ask what research the poster has done before we do her homework, though. :)

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Because pain medications like all drugs can have bad side effects and pushing narcotics can have unintended consequences that most posters on here are not aware of. Most posters on here seem to think it is just fine to push pain medications if the patient is having pain and totally ignoring the potential consequences.

Not sure why you are fixated on this. Perhaps you could start a thread on the student forum.
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Specializes in LTC Rehab Med/Surg.

My personality is not equipped to handle people who lie to me, and think I'm stupid enough to believe those lies. It's hard for me to determine who's using me, and who really needs help.

In the past I found myself falling into what I call my default mode. Everybody asking for Dilaudid is a liar, a cheat, and a loser. That just makes me a loser too. So I squash my personal beliefs and observations and try to get whatever the patient wants. If that means several calls to the MD, that's what I do. If that means watching the clock as closely as the patient, and delivering on time, that's what I do. As the nurse I try to make no judgments when it comes to care. I let the MD do that.

It's all about control. The patient who'll do anything to get what they want need to control me.

In this situation, I simply bow to the reality that they do.

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Because pain medications like all drugs can have bad side effects and pushing narcotics can have unintended consequences that most posters on here are not aware of. Most posters on here seem to think it is just fine to push pain medications if the patient is having pain and totally ignoring the potential consequences.

Actually, most of the posts are about giving pain medicine if the patient needs it and can tolerate it, which implies assessment and use of nursing judgment. If you want to educate people about unintended consequences, that's an interesting topic, for another thread.

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