Pain Seekers

ontheway2crna · Feb 9, 2015

Drug seekers are annoying, and when you have one in your group of patients, they will be the most time consuming patient of the day. If pain meds are prn q 2 hours on a Med/Surg floor, I would ask the doctor to change the order to q 3-4 hours, or order a PCA pump. The way I found to be most helpful to dealing with them is to anticipate them calling for the med and bring it to them before they even call. At least you can schedule it in for yourself and wont be thrown into a tizzy when they call again, on the exact minute that it is due.

Don't discount their continued complaints of pain, however, and report it to the doctor every time they complain of pain, even if the doctor tells you not to bother them with it. I had a well-known frequent flier and drug seeker who kept complaining of chest pain. I knew he had pain , however, because he was not simply asking for pain meds, he was stating that he had pain. I kept calling the doctor, and the doctor told me to stop calling her. According to her, this is a drug seeker and she is working on discharging him. I called her 2 more times after she told me to stop and she said, "ok, lets get an echo on him". The echo showed pericarditis and he was in the hospital for 4 more weeks receiving IV antibiotics after this. The poor guy, just because he is a known "drug seeker", who was homeless, probably would've been back on the street and back in the ED very shortly after leaving because he was truly sick.

I was sick with pancreatitis twice in nursing school. I can tell you from experience, pancreatitis hurts worse than child labor and worse than kidney stones. I had a stent placed in my pancreas and was in SEVERE pain afterwards, so severe 50 mcg of fentanyl 5 minutes apart did not touch it. My pain was not addressed further after I told them it did not help. I was sent back to my room and put on a PCA pump. This did not help. My lipase levels finally started to go down after the stent was placed. However, since they were poking around in there, I was still in severe pain. Since my labs were "trending down", I suppose the nurses and doctors assumed I should magically be out of pain. They had me do a tox screen for them because I kept asking for more pain relief and even asked for a different nurse because I was not getting my pain relieved and I was quite adamant about it too, because I was in severe pain. So I probably looked like the biggest drug seeker they ever did see, probably appeared manipulative etc because I was advocating for myself. So my point here is, just be compassionate because you really don't know if they have pain, drug seeker or not, and even if they are just trying to get high, anticipate a call light going off, so that you are in control of your day instead of having them control your day.

rnmaybe · Feb 9, 2015

an assessment is more than just respirations and vital signs.

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.

canigraduate · Feb 10, 2015

an assessment is more than just respirations and vital signs.

Obviously. Are you trying to make a point or just trying to stir some imaginary pot?

I'm tired of playing this game.

SeattleJess · Feb 10, 2015

Thou shalt not disbelieve thy patient's pain report.

We are nurses, not judges or gods.

missswiss44 · Feb 10, 2015

Apparently I have brought up a very controversial topic...which really was not my intent but I can clearly see how people have read my post in a variety of ways. Needless to say, I am not an evil witch of a nurse that believes all patients with pain are drug addicts. I understand that when you have your body sliced open that you will have pain. I understand that if you use opiates often that you will need a higher dose than most to achieve pain relief, and I will administer any pain medication as ordered...as long as it is safe. I care for a lot of people who have opiate addictions and I feel I am very generous in providing them patient care; I never feel like I am some supreme being with a power trip, holding pain medication hostage from the patient. I give my patients the pain medication they require, which in turn sometimes wears me out because 1) people with a high pain level that is never brought down is tiring since it requires almost constant pain medication administration, 2) people can be very emotionally taxing because their pain is never controlled and I do not want them to be in pain, 3) SOME of these people I am describing are drug addicts, with or without legit pain, that are manipulative and two-faced and, yes, make me angry. Am I a bad person for feeling like this? I don't think so. However, many of you are correct; I take it far to personal. Also, notice I vented on an anonymous nursing blog instead of involving the actual patient. To all the people who do not allow themselves to be affected by manipulative people who request all sedating IV medications to be given together and pushed fast, when their pupils are pinpoints and they are falling asleep in mid-conversation, I envy you that you have that you have built that wall that allows you to simply do your job without a second judgement. However, it is a known fact that the United States has an ever-growing problem with prescription pain medication abuse and I personally and morally do not wish to be a part of condoning this behavior. So yes, either I suck it up and just deal with it or I find a job where I am not administering the medications. I understand that in an acute care setting one cannot fix a patient's drug addiction because 1) it is an ACUTE care setting and addiction is far from acute and 2) the patient is the only one who can control their addictions and if they do not want help, there is not much we can do for them. I also won't apologize that I do not agree with an addicts way of life, which mind you, I know addicts personally and they are not bad people per say, they are just controlled by their addictions; drugs will ruin the nicest person and make them steal from their own mother. It takes a lot of courage and strength to overcome addiction. I know this. So, again, when I deal with an addict for 12 hours straight and feel completely worn out not only physically but emotionally and mentally, yes I do get upset. I do have my own judgements, I will not deny that, but I try very hard to give every one of my patients the care that they deserve, regardless of what I think. Now, many of you may say I should not judge, but I am human for crying out loud, not some robot that walks around all day. And just to point out many of the posters who disagreed with me also seem to be a slight bully. And yes, this is the first blog I have ever participated in. So, thank you to all the posters who gave me advice; I really did take the time to read what you had to say and I appreciate the time you put into typing that response post. Also, thank you to all the posters that made me know I am not the only one out there who gets fed up with certain patients...that is why I wrote on a nursing blog. To all the people who took my post the wrong way and/or tried to degrade me, I apologize.

Omaapecm, ASN, RN · Feb 10, 2015

We had this problem in our local ER. They ended up instituting pain policy. This consists of any patient coming to the emergency room who is on a pain contract with another pcp they must inform there pcp within so many hours. They also are only given enough pain med for a day or 2. I don't work in the ER but I get it on the other end with the clinics. It sounds like it really has helped our ER. From what I hear they are getting a lot less pain patience than before with this new policy. Unfortunately, it is not our duty to judge. We must do our best to put our feeling and frustrations aside. You never know what someone is feeling or what there pain may or may not be. Don't get me wrong I deal with a lot of pain management patients who take pain meds for a bunion, not really but you get what I'm saying. Either way, you can't really say what ones pain is, you have to take them at there word!!!!!!but I guess that's easy for me to say because I'm not on a busy med surge floor or ER. Maybe talk to your department on a pain policy

AmyRN303, BSN, RN · Feb 10, 2015

CPOT for non intubated patients is a great pain scale that can be used if a patient is non verbal or asleep. (Or CPOT for intubated patients if they are, in fact, intubated!)

Glycerine82, LPN · Feb 10, 2015

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.

klone, MSN, RN · Feb 10, 2015

However, it is a known fact that the United States has an ever-growing problem with prescription pain medication abuse and I personally and morally do not wish to be a part of condoning this behavior .

Actually, narcotic abuse/addiction has gone DOWN in the US in recent years. One of our docs was just published in a journal with an article about it. I'll find it if you're interested.

And this isn't a blog. It's a message board.

heron, ASN, RN · Feb 10, 2015

Apparently I have brought up a very controversial topic...which really was not my intent but I can clearly see how people have read my post in a variety of ways. Needless to say, I am not an evil witch of a nurse that believes all patients with pain are drug addicts. I understand that when you have your body sliced open that you will have pain. I understand that if you use opiates often that you will need a higher dose than most to achieve pain relief, and I will administer any pain medication as ordered...as long as it is safe. I care for a lot of people who have opiate addictions and I feel I am very generous in providing them patient care; I never feel like I am some supreme being with a power trip, holding pain medication hostage from the patient. I give my patients the pain medication they require, which in turn sometimes wears me out because 1) people with a high pain level that is never brought down is tiring since it requires almost constant pain medication administration, 2) people can be very emotionally taxing because their pain is never controlled and I do not want them to be in pain, 3) SOME of these people I am describing are drug addicts, with or without legit pain, that are manipulative and two-faced and, yes, make me angry. Am I a bad person for feeling like this? I don't think so. However, many of you are correct; I take it far to personal. Also, notice I vented on an anonymous nursing blog instead of involving the actual patient. To all the people who do not allow themselves to be affected by manipulative people who request all sedating IV medications to be given together and pushed fast, when their pupils are pinpoints and they are falling asleep in mid-conversation, I envy you that you have that you have built that wall that allows you to simply do your job without a second judgement. However, it is a known fact that the United States has an ever-growing problem with prescription pain medication abuse and I personally and morally do not wish to be a part of condoning this behavior. So yes, either I suck it up and just deal with it or I find a job where I am not administering the medications. I understand that in an acute care setting one cannot fix a patient's drug addiction because 1) it is an ACUTE care setting and addiction is far from acute and 2) the patient is the only one who can control their addictions and if they do not want help, there is not much we can do for them. I also won't apologize that I do not agree with an addicts way of life, which mind you, I know addicts personally and they are not bad people per say, they are just controlled by their addictions; drugs will ruin the nicest person and make them steal from their own mother. It takes a lot of courage and strength to overcome addiction. I know this. So, again, when I deal with an addict for 12 hours straight and feel completely worn out not only physically but emotionally and mentally, yes I do get upset. I do have my own judgements, I will not deny that, but I try very hard to give every one of my patients the care that they deserve, regardless of what I think. Now, many of you may say I should not judge, but I am human for crying out loud, not some robot that walks around all day. And just to point out many of the posters who disagreed with me also seem to be a slight bully. And yes, this is the first blog I have ever participated in. So, thank you to all the posters who gave me advice; I really did take the time to read what you had to say and I appreciate the time you put into typing that response post. Also, thank you to all the posters that made me know I am not the only one out there who gets fed up with certain patients...that is why I wrote on a nursing blog. To all the people who took my post the wrong way and/or tried to degrade me, I apologize.

No one asked you to apologize for anything.

This little gem is purest bull-pucky:

To all the people who do not allow themselves to be affected by manipulative people who request all sedating IV medications to be given together and pushed fast, when their pupils are pinpoints and they are falling asleep in mid-conversation ...

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.

SmilingBluEyes · Feb 10, 2015

OP it is much easier to read your posts if you use paragraphs. I am dizzy reading your responses here.

SmilingBluEyes · Feb 10, 2015

PS: Of course you have judgment, but you really would do better to leave morality out of it and just treat your patient. Also, you need to remember addiction is a disease in and of itself, and you are not going to fix it in an acute care setting. Again, get some education about the disease of addiction, and drop the moral judgments.