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Seeking Narcotics or Chronic Pain?

I just recently graduated from nursing school and will be starting a GN position at the end of the month. I am still currently working as a tech in the hospital until I start the position.

Last week I worked midnight shift and was placed in the ER for one of the nights. A young woman came in for severe abdominal pain. I knew this woman from working on the other floors, she has crohn's disease. All of the nurses were disgusted and talking about her being a drug seeker, both in the ER that night and when she was on the floor I had remembered the floor nurses saying the same thing.

It kinda bothered me (and maybe I am being niave) because people who have chronic conditions with exacerbations will be going to the community ER for help, and they will be admitted at times. So the hospital nurses will know them, and because Crohn's can be a painful condition, the patient may be looking for relief.

I just thought a couple of the nurses were not treating her fairly or with respect, which made me feel bad for this young woman.

Do you think that sometimes people with chronic conditions that can be painful are sometimes labeled as drug seekers? I just don't think it is very fair.

Oh, it's very common. Go to any ER and all the chronic pain pts are considered drug seekers. While some of them are indeed drug seeking, most are not. However, because they take larger than normal doses of narcs, they get the label too.

YES! I thought about that too! The larger doses of drugs. I just really didn't like what I saw. She was last on the nurses list to be seen or have any of her concerns addressed. I thought pain is one of a nurse's top priorities.

Pain is a priority, but every ER nurse has been burned at least once. When that happens we tend to be very skeptical of anyone.

Hey,

It is not my job as a nurse nor anyone elses to judge anyone for anything. I am their to treat my patients. Pain is what the patient says it is-period. The only time I withhold pain meds is resp.depression, if the patient is sleeping of course, or an adverse effect has occured, other than that-they get it when it is scheduled or when they ask if it is within my orders from the Dr. I am sure that I have had some patient's whom were seeking, but i have had far more in intense pain. Karma has a funny way of working and God forbid it be me or a loved one in their shoes and the staff withheld or labeled because they "assumed" I was seeking. Remember everyone acts differently to pain, so just because they appear fine to you, does not mean they are. Kutos to you for observing and learning what not to become.

a21chdchic specializes in Hospice, Med Surg, Long Term.

Pain is always what the patient says it is. It sounds like this patient needs to see a Palliative specialist to manage her pain. It's our job to advocate for our patient and at least ask the PCP for a consult.

a21chdchic in AZ

bopps specializes in Nothing but ER.

Pain is 100% what the patient says, and under no circumstances should a nurse withhold a pain medication order. However the nurse should be aware that confused people exist who do abuse the system. One case stands out in my mind. The young man presented with acute CP, he informed us he was a cancer patient from out-of-town. His head was bald and he stated he was either VRI or MRSA resistant(I can't remember which one). My fellow ED nurses were quick in getting him back to a isolated Trauma room. He was promptly wired to an EKG and a line was started to administer meds through. The docter wanted to hold off on the pain meds though......He called the Pt's M.D, and found out that the young man was not a cancer pt. in any way shape or form. So the cancer story was a farce but was his CP? The ekg was fine-the doctor refused to give him any medication, and gave him a thorough lecture. The pt.left a few minutes after that. Too bad for him, he was minutes away from recieving his coveted Morphine. He had a drug seeking history as well. So should we as health care professional's help support an addiction? Absolutely not? However we can't stereotype anybody either. That's what makes nursing such an art form. One has to think critically not judgementally or nievely. And we always have to work as patient advicates to assure our patient's comfort.

I think Crohn's is an awfully painful disease. The way I judge whether or not someone is drug seeking is by nonverbal cues. For example I had this one pt who was 47, refuses to do any of her own personal care like bathing even though she is capable, refuses to get out of bed, refuses to do physical therapy, doesnt follow her ADA diet, wont use the commode or walk to the bathroom - insists on a bedpan. She was admitted two months ago for back pain, then a hip replacement and now an infection in the hip....probably because she refused to do physical therapy at rehab. She will press the call light five minutes before her next oxy is due and demand it. She wont even let you do an accucheck until she has all of her pain meds including an prn's she can have. THIS is drug seeking behavior, addiction to painkillers and depression. She needs seriously help....

Someone with crohn's may just be in chronic pain....

I get suspicious when 30 seconds after getting a shot, the pt suddenly feels relief. Or when I hear, "My ride's in parking lot", but we can't seem to find him.

rehab nurse specializes in rehab; med/surg; l&d; peds/home care.

This is a great question!!! But unfortunately, I have found it to be a very touchy subject among health care professionals. But to answer your question very quickly, YES a LOT of chronic pain patients are labeled drug seekers.

Yes, Crohns disease is very painful. As you probably know, narcotics are very constipating. This is the only side effect that continues for as long as a person takes them (whereas other s/e usually wane after time, such as nausea, vomiting, dizziness, drowsiness, etc). Crohn's patients often have trouble with narcotics for this very reason, and they may take a lot longer to find the right medication regimen that works for them.

I do not work as a nurse anymore, because I am dealing with cancer. However, before that, I had some severe back problems. Problems so bad that after 6 years I was put on long-term opiates. I am afraid to say what or how much, and I actually am afraid to even post this here. Let's just say, that I am on a large amount, probably similar to levels that made some of the other posters say nurses cringed at in their departments. Since my cancer occurred, my pain has gotten much worse, but I have refused to increase my doses, despite the weekly offers from my doctors.

Chronic pain is such an misunderstood problem. Even acute pain is sometimes not always treated adequately in hospitals. I can say from my own experience, that nurses don't always understand how to treat pain in a patient like me. When I needed surgery, the doctor wrote for me to be started on my "regular baseline" pain med dosages after surgery. However, the nurse on duty refused to give it to me, thinking the IV PRN doses would "cover her pain, because she is on WAY TOO MUCH!!!". Thankfully I had my best friend at my side, who tried to intervene, asking why I hadn't been given my regular meds. Despite being ordered them, the nurse simply refused to give them. Well, I had my own bottles, and I eventually took my own. When my doctor came around to check on me, I informed him what had happened, and he was furious. I don't know what happened, but I did get my regular meds after that. I did need a couple extra "rescue" doses on my first post-op day, but after that I did without. I didn't like the rolling of the eyes, the sighs, or the nasty looks when my nurses came into my room. I heard from a friend later on, who worked PRN on that floor, that i was the subject of many "she's an addict" discussions.

I'm in no way saying every nurse is like this, or even most nurses. Just saying that they are out there (just as there are pharmacists, doctors, PA's, etc who think that way). I know some people ARE addicts, but I am not. I never self-escalate doses, I see my pain doc on schedule always, inform any doc who treats me what meds I am on, etc.

Sometimes, what seems like "drug-seeking" behavior is actually because patients are under-treated for pain. It's not incredibly common, but it does happen. Those cases usually resolve when an adequate regimen for pain is found (and that doesn't always just mean pills...can include PT, interventional pain techniques, etc). It's sometimes referred to as "pseudo-addiction". Just because someone takes opiates on a long-term basis does not make them an ADDICT. Addiction is a complex disease, and people who suffer with it cannot control their intake of their drug of choice. However, those who ARE on long-term opiates do go into withdrawal if they abruptly stop their medications, just like an addict would.

I will stop babbling here, but you asked a wonderful question. I almost regret posting all this on here, as I have gotten some nasty pm's before for posting about this. If you want to learn about chronic pain management, it would be a great asset to you as you start in nursing. They require different management then a person who does not take long-term opiates. If you google opioid dependence, and also addiction, I am sure you will find some great information. If you are very interested, you could pm me and I can tell you some good references.

I wish you much luck on your career in nursing...I wish I could go back myself. However, I don't think it's in the cards for me.

Altra specializes in Emergency & Trauma/Adult ICU.

YES! I thought about that too! The larger doses of drugs. I just really didn't like what I saw. She was last on the nurses list to be seen or have any of her concerns addressed. I thought pain is one of a nurse's top priorities.

Your account of this particular patient highlights some important issues. However, you'll gain experience prioritizing ... and I suspect you'll find that pain comes after the ABCs and other unstable situations ... all of which abound in the ER.

Realize too, that every ER has a group of frequent flyers w/chronic conditions who do not follow up, period, no matter what options are given to them. This is a personal choice. What a drain on ER resources this becomes when Patient X can be counted on to show up twice a week w/increased pain but refuses to follow up. Obviously, I have no idea if this applies to that particular patient -- I'm just giving you some other things to think about.

DoubleblessedRN specializes in cardiology.

This is a great post. I'm not a nurse yet, but I have a condition which is known to cause severe pain. Chronic pain is devastating. I haven't gone to ER's for pain because I have been to the same Dr for years, we have a good rapport, and he helps me with my pain to the best of his ability. I cannot have ASA or NSAIDS because of a gastric condition, and if I were to go to an ER complaining of pain I know that they would immediately label me as a drug seeker.

caroladybelle specializes in Oncology/Haemetology/HIV.

As someone with IBD, yes, it is painful.

And, yes, pain is an important thing to treat.

That said, the ER is the worst place to get adequate treatment for pain, especially that arising from chronic conditions. One should judiciously utilize one's pain specialists/PCP/GI for that. Because many pain meds can seriously exacerbate the problem or mask complications of the disease.

The other issue is that the ER is for emergencies. And while pain is important to treat, it is generally not a fatal lifethreatening issue. And much of what is in the ER is.

I also have dealt with some fellow IBDers that do not take proper care of themselves and do "no-no's" that exacerbate the disease - leading to the pain issues. Or that have serious co-dependency issues - friends and family that feed into the "poor little X" syndrome. Any little ouch, gas attack, or diarrhea s/p "popcorn at the movies", and it is treated as a fullblown attack. This can get rather wearing on the nerves, after repeated ER trips w/the full range of required tests showing 'negative", or minimal disease.

Yes, we should take pain at what the patient says it is, but after you have your "10 out of 10" abdominal painer, come back with not using their meds for the last week (it's so inconvenient, or they make me fat), that was crying one minute and then 2 minutes later, dancing around the room (you know that the med takes longer to take effect), you get a bit jaded. Especially, after remembering when you were last in the ER, you had bled to a Hgb of 6.5 and lost 15 lbs in less than a week.

It's good to hear a refreashing view point from a new nurse. Sometimes as ER RN's we get tainted from sooooo many pt's that want pain meds. And I too have had those pt's who had "cancer, chrones, etc ,,,,etc,,,) and come to find out that it's not true or they have gone from hospital to hospital , DR to DR getting narcs. Most pt's don't doup us but there are many that do. I would have to know more about the pt's HX. , It would be interesting to know her allergies. ER staff always like those Toradol, motrin and compazine allergies. That's usually a big red flag. And as others said, has the pt followed up etc... Ohio has a wounderful tool through the Ohio Board of Pharm. that, a pt's narc prescriptions can be looked up. Boy is it ever an eye opener. I have to say, It's always a feather in our cap when the Dr can go to a pt's room and say, "so I see you have gotten 4 scripts for percocet in 3 weeks, is this true. Because if it's not, someone has your name and SS # ,and maybe it is a case of stolen idenity. So it's our duty to notifie the police of the possible idenity theft of medical records. ". However if they find that you have been going from DR to DR., that would be a feloney offence " I 've seen this happen 3 times in the last 2 weeks. You should see how quick the pain goes away. :eek:

I am probably very jaded on this subject. I am a nurse I have set behind the nurses station and heard the mean and hurtful things that nurses who are suppose to be the so called pt advocates say about their pts. I also happen to suffer from chronic pain and have been the pt in the bed. Personally I think chronic pain pts are and most likely always will be miss treated by the majority of healthcare providers. This has been my experience anyway. I hope it will change but I am not holding my breath. It is a shame that every nurse doesn't at least once suffer with untreated pain under the care of judgemental healthcare providers just one day would probably do it.

gr8rnpjt specializes in Case Management.

I do not work as a nurse anymore, because I am dealing with cancer.

((((((((((((((rehab nurse)))))))))))))))

I will remember you in my prayers(((BIG HUGS)))

LilPeanut specializes in NICU/Neonatal transport.

Just a quick question: Why does a compazine allergy raise red flags? I can't take compazine or phenergan, I get extra-pyramidal symptoms. It's not entirely uncommon, so I wonder why that's a warning sign

In my opinion, pain is what the pt says it is. Period. If I notice their respiratory rate is too low or if they are hard to wake up, I won't give the pain meds, but if they say they're in pain, I'll give it as ordered. I deal with mostly post-op pts, so I am pretty darn sure they're in some type of pain. A lot of them also have neuropathy, which is very difficult to treat for pain. My mom has MS and she has chronic pain, but I would not consider her a drug seeker by any means. There are plenty of drug seekers out there, but I believe there are way more people with real pain. Keep in mind that I don't work in the ER. That's a whole different world!

rn undisclosed name specializes in Telemetry, Oncology, Progressive Care.

Just a quick question: Why does a compazine allergy raise red flags? I can't take compazine or phenergan, I get extra-pyramidal symptoms. It's not entirely uncommon, so I wonder why that's a warning sign

It's not those particular drugs (I believe) that raise the red flags. It's that coupled with certain narcotics.

Certain patients come in demanding narcotics with certain other medications such as Benadryl and Phenergan (I think) which enhance the effect of the narcotic. Can someone please explain how this happens? I'm curious.

rgroyer1RNBSN specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

Ok guys this is a touchy subject, I have crohns and it is painful but I also have a GI doc who is great and I follow up when Im supposed to every three weeks and if I need pain meds he gives me scripts for the Vicoden, phenergan, and toradol, and bentyll because thats the regimen it usually takes but I do everything Im supposed to. Generally when Im having a severe attack I usually call him and he admits me he prefers to bypass the er completely because they always try to label his crohns and colitis pts. has drug seeking. And whats up with the compazine Im allergic to it, it puts me in anaphylaxis and Im not kidding about that. Im also allergic to morphine and codiene, so you know Im not seeking because they have to be careful what they give me usually if Im having a severe attack its either demerol or nubain, phenergan, toradol, and bentyll and thats how it goes.

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