patients on methadone plus PRN pain meds

Nurses Medications

Published

Hello,

I have seen several patients on methadone maintenance that are also ordered PRN pain meds such as tramadol or oxycodone. How often do you typically have them wait after administering the methadone to get a PRN pain pill? I'm worried about the interaction of respiratory depression. Thanks!

Specializes in Mental Health, Gerontology, Palliative.

I saw that in action while on clinical placement on a medical ward. This person had a history of alcohol misuse and judging on his non verbal indicators of pain, grimacing, scrunched up into a small ball suggested that this persons pain was not being well managed. Interestingly enough, when their pain was well controlled, they were sitting up in bed, reading a book and talking to their neighbour

They taught us in nursing school "a persons pain is what they say it is, until time proves otherwise

This is a perfect example of patients on chronic methadone/suboxone maintenance being undertreated for pain. Just because someone is recovering from an addiction doesn't mean she can't have real pain.
Up Vote Up Vote ×
Specializes in Mental Health, Gerontology, Palliative.
I'm have a differing opinion here. I don't have any sympathy for addicts. Maybe if you were a trauma pt or something... but having a baby? No. I'm not empathetic.

Reality is that femaie addicts get pregnant. Tell me is it safer for that little person in the making to be inside a body that is withdrawing from one of the hardest drugs around with all manner of physical emotional and physiological symptoms. Or perhaps having mum on the methadone program with steps that can be taken once baby is born. Sure, mum might be a dead beat parent, as a health professional, I also have an obligation to that little person in the making and ensuring they are protected as much as possible

I'm pretty much not empathetic to the whole culture of "controlling all your pain and your pain is what you say it is". I think that is one of the major things wrong with healthcare today. When we started pushing pain meds on everyone we've created a society of "nothing is ever going to hurt", and that's just not true.

If a patient asks me if something will hurt, I dont lie to them. I tell them that there is a chance that what ever i am about to do may well cause them horrible pain.My logic is that if I lie to a patient and say its not going to hurt and it does hurt, they'll never trust a nurse again.

Sure, there is a difference between a kid who is sitting up in bed talking to his mates and rates pain 12/10 and the little old lady who is scrunched up and begging us not to touch her. Ones most likely over stating the pain, and the other one is probably in so much pain there is no way in hell that we can take away her pain

The problem I have with your attiude is that every one handles pain differently and may require different levels of analgesia to manage that pain. And why the hell should someone have to suffer through in pain because the nurse has an attitude of 'they are fine, they dont need any pain relief they had ibuprofen and parcetamol 2 hours ago'

We can lesson your pain, but not take it away all together. People don't seem to understand that.
I have serious issues with any health professional who says 'they can make a person pain free. Sure thats what we aim for reality is that it wont always happen. I had a palliative patient a few weeks ago that I spent most of the night trying to get on top of their pain, didnt work and they spent the last few hours of their life suffering and their family did to...

Anyway, having just had a baby is not something the vast majority of people need to be all drugged for to get through. I just disagree.

Again, what works for one person may not for others. And as a registered health professional we need to be aware of that and refrain from imposing our person opinions and beliefs onto how we practice nursing

Up Vote Up Vote ×
Specializes in Addictions, Adult Psych.

How unfortunate that there is a nurse on here who has no empathy for the disease of addiction. Luckily your opinion does not matter. I hope your patients can't feel your ignorant judgments. Please educate yourself.

Up Vote Up Vote ×
Specializes in Med Surg, Perinatal, Endoscopy, IVF Lab.
How unfortunate that there is a nurse on here who has no empathy for the disease of addiction. Luckily your opinion does not matter. I hope your patients can't feel your ignorant judgments. Please educate yourself.

Yeah, you're right, I have no empathy for the disease of addiction. None at all. Thank God I'm not a an addiction recovery nurse, right? You know what I am a nurse for? All the babies that these addicts pop out, that we spend six+ weeks weaning from all the drugs mom used, only to have her take the baby home and kill it with neglect and abuse. Yeah, these babies didn't ask for this and I have tons of empathy for them. The Moms? No... I think they should all be in jail. So I guess you could say I'm judgemental.

Up Vote Up Vote ×

Chronic pain patients KNOW they are never going to be completely pain free. We..yes Im one of them, know that and accept that. All we ask IS for a LITTLE less pain. Even a little less gives us a quality of life that most people either take for granted or would hate, plain and simple. It sucks to hurt every single day. (8/10) It sucks to know that even though we use pain meds appropriately we will still be judged by SOME (thank GOD--few) Nurses and Doctors who care for us.

Ive had over 25 major surgeries in as many years. I have titanium pins, plates and screws all over, Ive had a broken back twice and most recently a fractured neck from an MVA that was not my fault (I got ran off the road by a semi driver). Ive been one of the few who has a relatively dream team of docs and nurses who have been great in dealing with my pain. I had ONE nurse...years ago who hated anyone WHO TOOK pain meds for more than 48 hours and it showed. I had had total reconstruction of my right shoulder. She came in to give me pain meds, begrudgingly from how she acted and what she said. WHen she injected it (demerol and phenergan) she went to the very inside of my right thigh / leg, up as FAR as she could go in the real fleshy part of the leg (picture the inside panty line) YES....inside of the thigh up high and she slammed the needle in hard and deep. I dont recall any shot ever hurting like that did...it bled, it bruised something fierce and hurt for days. I had a huge lump for along time. ALL she had to say afterwards was...with a snide smile was "be sure to call me again when you need an injection"

That was in 1998 and I still remember it vividly to this day.

Please remember....even chronic pain patients deserve compassion, they deserve pain meds on time....they deserve respect unless or until they give you none. We hurt, a lot, all the time...we know what others are thinking....and saying behind our backs. Please remember it isnt always true. Sometimes we do just hurt and seek a little relief.

Up Vote Up Vote ×
Specializes in NICU, PICU, Transport, L&D, Hospice.
Yeah, you're right, I have no empathy for the disease of addiction. None at all. Thank God I'm not a an addiction recovery nurse, right? You know what I am a nurse for? All the babies that these addicts pop out, that we spend six+ weeks weaning from all the drugs mom used, only to have her take the baby home and kill it with neglect and abuse. Yeah, these babies didn't ask for this and I have tons of empathy for them. The Moms? No... I think they should all be in jail. So I guess you could say I'm judgemental.

How unfortunate that such a judgemental attitude is associated with nursing at all.

Many of us might hope that you never work outside of the newborn nursery where you might have to care for someone who is not righteous enough to deserve your empathy as a professional nurse.

Up Vote Up Vote ×
Specializes in Med-Surg, Tele, Ortho-Trauma.
So true! I have a friend who is a recovering heroin addict who is on Methadone. He fell and broke his hip, requiring an ORIF. He said that his pain was insane b/c the doctors didn't want to give him anything due to his past drug abuse and current use of Methadone.

This is criminally negligent behavior on the part of the ortho surgeon. If I was your friend I would be contacting a lawyer and filing a malpractice claim.

Up Vote Up Vote ×
Specializes in Med-Surg, Tele, Ortho-Trauma.
I'm have a differing opinion here. I don't have any sympathy for addicts. Maybe if you were a trauma pt or something... but having a baby? No. I'm not empathetic. I'm pretty much not empathetic to the whole culture of "controlling all your pain and your pain is what you say it is". I think that is one of the major things wrong with healthcare today. When we started pushing pain meds on everyone we've created a society of "nothing is ever going to hurt", and that's just not true. We can lesson your pain, but not take it away all together. People don't seem to understand that. Anyway, having just had a baby is not something the vast majority of people need to be all drugged for to get through. I just disagree.

Just because you personally "disagree" with the need for pain medication while delivering a baby does not mean everyone else should not be able to access medically accepted treatment for pain. I hope you don't go around spouting your opinion off to your patients. I take methadone to manage a chronic pain problem ( I was injured while caring for patients) and I am tired of people who automatically think all methadone users are only taking it for drug maintenance. There is already this huge stigma attached to taking methadone, and opinions like yours simply add to its negative connotation. It is very tiring and is definitely not the attitude a compassionate nurse should have. Perhaps you have been caring for too many patients that have addiction issues and it is starting to cause some burnout. I don't know. But because I am on methadone and happened to be having a baby would you say you don't "believe" that I deserve pain medication because I also take methadone, so I must obviously be one of those people that thinks " nothing is ever going to hurt?" Cause let me tell you, I know pain, and having to adapt to chronic pain is one of the fastest ways to have a very clear understanding of the fact that stuff is going to hurt. Probably a lot and most of the time. You also say you can "lesson (sic) ...pain, but not take it away altogether" why would I believe that if I was your patient and you just told me that you don't believe having a baby warrants pain control for the vast majority of people?.

Up Vote Up Vote ×
Specializes in Med Surg, Perinatal, Endoscopy, IVF Lab.
There is a vast difference between those that take meds for "chronic" legitimate pain and drug addicts/users or past history users.

^^^ This. No sympathy for your pain if you are an addict/user. You made that choice. We will manage your pain like we would anyone else's based on the trauma/surgery/condition. No, we will not feed you Perc 10's every two hours because you just had a baby. Sorry, you'll get our gold standard and nothing more. You might want to be comatosed, but that's not how we roll.

Up Vote Up Vote ×

I can understand feeling very resentful of women who abuse drugs during pregnancy and cause their neonates to suffer withdrawal syndrome. Who wouldn't?

On the other hand, condemning all 'drug addicts' outright is really a choice you are making, rather than a legitimate, educated judgment that 'any' nursing professional would make. Condemning them is an easy out, you can shut the door in your mind and never have to 'go there' again.

But if you care for the little ones, I'm not sure how you can NOT care for their mothers, because those mothers will deliver more drug addicted/exposed babies. The hope is to stop these babies from being born in such a state. People do not use drugs OR even get addicted (in the street sense) to them on a lark OR as a 'choice'. That would be evidence of ignorance to know it any other way. This does not absolve a mother from what she's 'done' to her child, but it explains it in a way that opens doors to help prevent the situation that breaks your heart at work.

I'm not really addressing you who have this hard-line judgment against drug abusing mothers with this, you can believe what you want and in the end, it's you who suffer from such judgmentalism. It's important for new-er nurses or those without this experience to see an example of the more COMMON attitude amongst nurses, which leans more toward compassion (even if just a bit) than condemnation.

Up Vote Up Vote ×
Specializes in Mental Health, Gerontology, Palliative.
Yeah, you're right, I have no empathy for the disease of addiction. None at all. Thank God I'm not a an addiction recovery nurse, right? You know what I am a nurse for? All the babies that these addicts pop out, that we spend six+ weeks weaning from all the drugs mom used, only to have her take the baby home and kill it with neglect and abuse. Yeah, these babies didn't ask for this and I have tons of empathy for them. The Moms? No... I think they should all be in jail. So I guess you could say I'm judgemental.

Why dont some nurses ever stop to think that if they were less judgemental of people whose lifestyles they dont agree with the people concerned might actually reach out for help as opposed to suffering in an dangerous situation that if left dealt with ends up in the death of the little one

Up Vote Up Vote ×
Specializes in Mental Health, Gerontology, Palliative.
^^^ This. No sympathy for your pain if you are an addict/user. You made that choice. We will manage your pain like we would anyone else's based on the trauma/surgery/condition. No, we will not feed you Perc 10's every two hours because you just had a baby. Sorry, you'll get our gold standard and nothing more. You might want to be comatosed, but that's not how we roll.

This statement is just wrong.

The problem with treating an IV drug user like everyone else, is that they arent like everyone else in regards to pain management. A patient who is opiod naieve will need a much lower dose of morphine (for example) than the person who has a history of opioid abuse.

To give both patients the same dose of pain relief and expect both patients to have their pain adequately managed is just wrong

Up Vote Up Vote ×
+ Add a Comment