CathySweeney

There is another problem that people with chronic pain must face and that is the look when they ask for pain meds in the hospital. It is a look and the manner that says you are drug seeking. I do not use any meds except those prescribed for me but almost every time I visit the pain doctor I have to give urine for a drug screen. Every year I must sign a contract that says I will only take what is prescribed and if another doctor orders something I will report it. The latest indignity was completing a survey that was part to see if I am depressed and part to see i I am misusing my meds the only narcotic I am currently taking is Vicodin for breakthrough pain but need to do these things to prove I a not drug seeking. I feel that I am not believed although as a nurse I know that these things are required by law and my doctor does not doubt me because she feels that I need to take the Vicodin more often. Most of the conversation in this thread is about not believing the patient which has never been what I do but I will guess that most people do not know what has to be done as a patient in a pain clinic or practice here in New York. If people with long term pain were seen by "pain" specialists the overuse of narcotic would decrease and maybe I and patients like me would not have to feel like they are addics.

I have read what was written. I was taught in hospice, in my ELNEC training and in maany classes taken that a person may be sleeping and still have pain. The quality of the pain may not be good but sleep may be present anyway. I can tell you that when I am having a bad pain day sleep helps me get through. Yes I am on meds to control my pain and also have hydrocodone and apap for break through pain but like to avoid the use of the opioid. When pain is bad I will take the opioid about every 5 hours with no more then 4 a day. Sleeping when I can sometimes because I have found a position to decrease the pain but movement will bring the pain up to 8-10. I move very little when I sleep unless things are really bad and then I toss and turn. We need to find a way to assess if a person is abusing opioids or in real need of them so we can believe our patients. Until that day I will believe my patients and discuss any doubts with the team (doctors, nurses, social workers and pastoral care) to form a plan to make any changes. Using opioids as a first line pain medication is not the best way to go unless the person is dying. We had an axiom in hospice "start low and go slow" to provide pain management for most patients.

In reading the many comments about pain management and chronic pain all I see is the use of narcotics. Good pain management is not about narcotics only. The use of other types of meds in conjunction with narcotics is crucial to pain management. Anti-seizure medications such as Gabapentin for nerve pain, anti-inflammatory meds such as ibuprofen for bone pain can make a huge difference. I have seen people whose narcotics were just not working get relief from adding one of these meds. I have chronic pain and have managed my nerve pain for years with the use of Gabapentin or Lyrica (rotated) and Cymbalta (anti-depression meds work for nerve pain) with a back-up of Vicodin to be used when necessary. When hospitalized I am very concerned that someone will change my pain meds and will not allow that to happen. I have been seeing a "pain" doctor for years and we work together to manage my pain with minimal use of narcotics. It can be done by seeing the right doctor.

First {{{{HUGS}}}} You may now feel that you are coping well with this but do not be surprised if it comes back at some time in the future. The next code, a young patient, someone in a similar position can set it off. It is okay to feel this way and their may be others on the unit that feel the same way. Maybe you could have a unit memorial service for all the patients from the last quarter so that everyone who may need to express themselves can. Is there a pastoral care person on the unit or a social worker who could lead it. Being a hospice nurse I have had my share of attachments and need for memorial services. If you cannot have a memorial service find your own why to let him go, release a balloon. place a rock. send a paper boat on it's way. Anything that will help you works. We are human and will get attached , what we need to do is learn how to handle it. I know I certainly had my problems by was lucky enough to work with people who would help me by reminding me if they notice you doing so, helped me many times. I could see me getting attached to this patient.

Athelet2bnurseBSN If your niece died 4 hours after the morphine was given, it was not a factor in her death. The morphine was probably not working any longer. She died of the pneumonia as it was meant to be. As a hospice nurse I feel I can say this from experience.