Treating pain/anxiety in polysub patients

[Simply Complicated]

I'm just wondering the experience others have with their doctors, and the treatment of patients with a history of drug abuse? I work as a float in an acute locked unit. We have 4 units in our department, with 6 doctors total, although one is the director and rarely has patients. Obviously we get a lot of patients who have dual diagnoses. It seems frequently they will wean these patients off all benzos and narcs over a 4 day period, and then offer them next to nothing. They frequently act out, and then it's just said Oh they are drug seeking.

I was taught in nursing school that even if a person has an addiction, it does not mean their pain is not real. Does the same not go for psych patients? Doesn't mean their anxiety/agitation is not real and deserves to be treated. I feel like they are frequently blown off when they report the Vistaril ordered is not working. A few of our doctors also frequently will D/C the pain meds they have been on for years, because they have a hx of polysub.

I am sure some of them are drug seeking, and it is obvious at times that the behaviors are intended to get them meds. But then others seem they truly need something.

Just wondering others views, experiences??

[Davey Do]

It seems many Doctors and Nurses who with hold controlled substances from known drug abusers do so in order to either punish the Patient or save the Patient from themselves.

Your thread identified some truths, Simply Complicated: Patients with a history of ontrolled substance abuse feel real pain like anyone else. Sometimes those substitutes, like Vistaril, don't deal with the problem.

Too often, we as Professionals attempt to weave personal beliefs into our professional duties. It's as if we say, "I don't use controlled substances, so neither should you." Or something like, "Since you've been irresponsible in the past, you deserve to feel the pain of doing without that which could make you feel better. And that pain and subsequent revelation will make you a better Person".

One little trick I've found to help Patients with a history of controlled substance abuse who are in pain is to give them acetaminophen and ibuprofen prn concurrently. I learned this from a Nurse who worked in a Prison. It works. I think it may be because of the different mechanisms acetaminophen and ibuprofen they work by. Whatever the reason, I've had good results.

Dave

[Whispera, MSN, RN]

I agree with the acetaminophen and ibuprofen concurrently idea. Something else that's worked for me is to alternate them at 2-3 hour intervals. So, I'd give ibuprofen first (always ibuprofen first) and if the pain isn't gone in two hours, I'd give acetaminophen, and so on.

One thing to keep in mind with acetaminophen and NSAIDS is that people with lots of pain can take bigger doses than other people take.