what you think about this???

Pain control is a difficult subject. Pain is what the patient perceives it to be. We as nurses cannot decide someone is not in pain. It is whatever the patient perceives. The major reason patients are undermedicated is because of staff placing their own values. Most patients who are in pain require more pain management than they are given. If your hospital has a pain management nurse, I would suggest contacting him/her with your concerns. He/she can perform a pain assessment on this person and perhaps come up with some different type of pain medication. The medication depends on the type of pain a person is having such as muscular, visceral, bone, etc. Hope this helps. Please don't think of patients as junkies. Less than 1 percent of patients taking pain meds ever become addicted to them.

lilcajun, I understand exactly what you are saying, we have one in particular that comes in every month, third week of the month. The day the checks are to be in the mail,pt. checks out ama, regular as clock work. I won't go into any details, but, I feel YOUR PAIN.

I do get that pain is what a pt perceives it to be, but, it that is also abused terribly. There are people out there that have learned how to work the system and are experts at it.

Please don't flame me for these statements, I'm just relating what I have seen in my own facility time after time after time.

I have a bigger issue with MDs that do not write therapeutic orders for pain meds, for patients with clearly legitimate pain issues.

Well you guys are lucky you only have a few frequent fliers that abuse the system these days. In the 1980s, before DRGs, and the upgrading of pain management protocols, you would have a whole house full. These were mainly women in stressful abusive home situations. It seemed like they used the hospital like a vacation resort. Now, at least, DRGs prevent them from getting it more than 3 days on any given month and force the doctor to be more creative with their chronic pain. Imagine what their abscessed muscles and phlebotic veins would look like without a stop date. I remember those days, you couldn't find an IV access (before the 2 sticks your out rule) or inject an IM pain med without it flowing right back out. It was hard to take care of them because you had an overwhelming feeling that they were abusing the system. I mean alarm clocks set every at every 4 hours. and if they dont have one calls to ask the nurse when the next dose is due. It was an osteopathic hospital where many of the admissions were chronic back pain and migraines. There pain was real and poorly managed and with all pain completely subjective with very little medical proof.

YEP, I feel your pain. What else is the doctor to do. These patients are master manipulators with a purly subjective complaint.

depending on the type of patients you have sometimes a pain meds is better scheduled than prn, with intervals lengthen and then prn

this is esp true of patients post surg or perhaps something like k stone

some docs are unsure if the pt is really hurting or in need due addiction

some as mentioned are the opposite and they don't don't give enoough to keep the pt comfortable, sometimes i think they like the control

I agree Chatsdale, with some of our docs, it's either all or none.

Hi Lilcajunnurse,

Unfortunately, this is the world we live in. These "junkies" have a level of tolerance of pain meds as they are used to having the drug in their system until we have to increase their doses for them to get relief. PO pain meds actually give a longer duration of action rather than IV meds. As a fifth vital sign, pain is now to be addressed. Believe it or not, I have actually given Fentanyl 1000 mcg IV over 1 hr and pt was still even screaming of pain (pt was not at all intubated). I guess pain, we should not judge our pts sometimes because people have different tolerance to pain and some people just have a large supply of natural opiates in their system, that is why they have higher tolerance to pain as compared to others. Thanks.

Well you guys are lucky you only have a few frequent fliers that abuse the system these days. In the 1980s, before DRGs, and the upgrading of pain management protocols, you would have a whole house full. These were mainly women in stressful abusive home situations. It seemed like they used the hospital like a vacation resort. Now, at least, DRGs prevent them from getting it more than 3 days on any given month and force the doctor to be more creative with their chronic pain. Imagine what their abscessed muscles and phlebotic veins would look like without a stop date. I remember those days, you couldn't find an IV access (before the 2 sticks your out rule) or inject an IM pain med without it flowing right back out. It was hard to take care of them because you had an overwhelming feeling that they were abusing the system. I mean alarm clocks set every at every 4 hours. and if they dont have one calls to ask the nurse when the next dose is due. It was an osteopathic hospital where many of the admissions were chronic back pain and migraines. There pain was real and poorly managed and with all pain completely subjective with very little medical proof.

YEP, I feel your pain. What else is the doctor to do. These patients are master manipulators with a purly subjective complaint.

We used to get all these folks at the ortho hospital I worked at back in the early 80s. Don't forget those ppl who had skin like leather from so many IM's that you literally couldn't get the needle in!!!!

These were mainly women in stressful abusive home situations.

what was done about this?

what was done about this?

Well I don't know how abusive it was for them. A doctor told me something like that "abusive, intolerable," can't remember. He did say the word vacation. I HAD asked if he thought our treatments really helped them. I really don't think we addressed the underlying problems of why they required pain injections and retreat from their home situations.

Unfortunately, we do not have a pain management nurse. And we do assess pain every 2 hours . I am very compassionate when it comes to someone in pain, but I guess my point was these pts. are not being taken care of. They come in frequently and request the meds they want, the route they want them and the frequency. Then when nothing is found wrong, (and this is after severval days of routine pain meds) they simply walk out of the hospital. What are we doing to these ppl. when we don't taper down the dose of meds. before they leave or when we allow them to leave with no dx. This is the problem I encounter. And it is only 2 docs that allow it. Believe me, I do know pain is different for all pts. and we use a pain scale of 1-10. This particular pt. was told for proper care she needed to be transferred to her urologist at another hospital, she refused and for 4 days she took pain meds and went home on po pain meds. and no dx. She has been instructed to follow-up with her urologist for further testing but doesn't.

Anyway, I appreciate all the comments and hope i wasn't perceived wrong. I want my pts to be pain free and I have no problem administering pain meds. But I would also like to know what dx. I am treating. Then good education can be taught and maybe help.