Treating pain in ER

[Butterfly0328]

Do you nurses typically see patients undermedicated in the ER for pain? I had the worst experience this past weekend. I have suffered chronic pain for about 10 years and at one time was on 600mg of oxycontin a day for about 5 years. I have weaned myself off of the oxycontin and now am on 120mg of roxycondone. I recently learned I have spinal stenosis in my lumbar, along with chronic kidney stones and neuropathy. So early sunday morning, after waiting over 8 hours for the pain to let up, I finally went to the ER. The ER doctor would only give me toradol and phenergan for nausea/vomiting ( I was also vomiting blood ). Finally he agreed to give me 1 ml of dilaudid (what a nice man. gag) which literally only took the edge off of my pain for about 15 minutes. Worst experence ever. I left in about the same pain I arrived in, only not vomiting. I made it a point to tell the Dr that I unfortunatelly have a high tolerance to pain meds, but he didn't care. Said chronic pain isn't treated in the ER. I thought if someone comes into the ER in chronic pain it must be treated, regardless of the cause. I wasn't asking or and RX or narcs, as I already had that at home, just wasn't working with this severe pain. Now I know the addicts probably mess things up for us who really need the relief, but shouldn't the doctor be able to tell the difference? Just curious about what you ER nurses see with regards to the subject. Thanks

[Anna Flaxis, BSN, RN]

In my opinin you are all saints for the work you do.

Well, I wouldn't go *that* far.

[Butterfly0328]

I read your post. You said that if you were a drug seeker you would have taken the Diluaded.

Based upon your logic, drug seekers take Diluaded. You took Dilauded. Ergo...

(The point, because I don't think you'll be able to figure it out, is that your logic is bad.)

This is the second time you have insulted my intelligence. Is that really necessary? You have also personally attacked me and have made referance to me being a drug seeker. Why??? I never ever insulted any of you. I only asked you to not be so judgemental. For the reasons listed I will be fileing a complaint.

[Butterfly0328]

Well, I wouldn't go *that* far.

I would and did. LOL

[Music in My Heart]

Well, I wouldn't go *that* far.

Hey, speak for yourself.

I'm polishing my halo and waxing up my wings as we speak.

[Butterfly0328]

I know but she is going to go to school or is in school......I just wanted to give her a peek as to why we feel the way we do.....If you're going to enter a field you need to have some insight as to why we feel the way we do...and maybe change the way we are percieved to change the way we are treated...

I totally appreciate your insight... Thank you. I do understand a bit better but as I said never had an issue with the nurses. Thanks again.

[Butterfly0328]

Hey, speak for yourself.

I'm polishing my halo and waxing up my wings as we speak.

LOL . You crack me up.

[Fribblet]

This is the second time you have insulted my intelligence. Is that really necessary? You have also personally attacked me and have made referance to me being a drug seeker. Why???

I'm pretty sure, I didn't. "OP excluded" was added because I was going a tad off topic and figured you'd get defensive and assume the post was about you.

Appears I was correct.

I never ever insulted any of you.

Also, you did insult us when you began telling us what our jobs are and are not and intimated that we are judgmental. I'm pretty sure that counts, by your standards at least, as a personal attack.

If I can mention drug seekers in a thread you started and you take it as a personal attack, then you can reference a nurse being judgmental and I can take it as a personal attack.

You have gotten irrationally angry when it's been mentioned that the ER was not the place for your pain to be treated. You've berated actual nurses by telling us what our jobs are when it's been mentioned that your PCP is NOT doing a good job of treating your pain. It seems like the very opinions and information you asked for makes you unreasonably angry.

But, just to reference a remark of a personal nature that you've made:

You said to wwfd:

If you are being driven out of the ED by people like us then I suspect you don't belong there in the first place.

Pretty judgmental on your part wouldn't you say?

Then you said:

But most of them are so cocky with their heads up their ass.

Kind of insulting, yes?

I only asked you to not be so judgemental.

For the record, it's "judgmental."

You did not ask us to not be "so" judgmental. You told us it wasn't our place to judge, thereby assuming that we are judgmental.

Let me help you out. You said:

You know, seriouosly, you are there to treat-PERIOD!! Not pass judgment etc.

That's a pretty jerky thing to say. As nurses we do more than just "treat." It would appear that you have a lot to learn.

For the reasons listed I will be fileing a complaint.

Knock yourself out, Pot.

Love,

Kettle.

[Fribblet]

I know but she is going to go to school or is in school......I just wanted to give her a peek as to why we feel the way we do.....If you're going to enter a field you need to have some insight as to why we feel the way we do...and maybe change the way we are percieved to change the way we are treated...

It seems that most students and patients that post on these forums, especially in regards to the ER are really only interested in pointing out the ways they perceive the ER has failed them.

I have said before, and I still maintain, that there needs to be a private forum that students and lay people are not privy to.

[Butterfly0328]

I will touch on one thing very quickly as I have to be to work at 4:00am. The quote you made "but most of them are so cocky withe their heads up

their ass" is me referring to some doctors - not nurses. I will address the rest tomorrow. Oh, BTW-why must you correct my grammar?? Have you never made a grammar mistake?

[Medic2RN, BSN, RN, EMT-P]

The thread is open again. Please stick to the topic at hand and no personal attacks/ rude remarks.

I appreciate the compliance. If the thread goes south again, it will be closed.

Thanks!

[tewdles, RN]

And could I suggest that perphaps since according to your listed experience you have never worked in the ED...so you probably don't have a very good sense of what my job is like. I also view your comment as a personal attack and will report it as such.

Now please continue to enable each other on this site.

I will only comment, after the cooling off period, that it is not wise to make assumptions about an individual's professional experience. For instance, it might be easy to assume that because I do not specifically have ED/ER in my allnurses profile that I am ignorant of that nursing role and the specifics related to it, or that I have never worked in that department as an RN. Those assumptions would be easy to make but would be incorrect and is further evidence that it is not a good idea to assume.

For instance, one could not easily discover, simply by looking at my allnurses profile (which has limited space) that I have worked in the ED, have been a flight and ground transport nurse, have functioned as a school and camp nurse, have lectured and taught in the university setting, have functioned in management as well as at the bedside, etc, etc. Nonetheless, those things are true and they color my experience and perceptions as a professional nurse.

In my experience, when nurses find themselves in a situation where the patients are making them crazy, when they cannot "deal with" the anticipated issues in their department, when they experience a decreased ability to advocate for certain patients or families, when they are unable to or find it difficult to express empathy or compassion with certain types of personalities, certain disease states, etc; it is frequently more related to the nurse's state of mind, work related stress, or level of compassion fatigue than it is the "things" or situations that the nurse perceives are the root of the problem.

Over the years I have personally experienced compassion fatigue and have dealt with many, many coworkers/peers/employees who have as well. Too often those in the midst of "it" cannot see "it" and are surprised when "it" is suggested as a possibility. I cannot know from a post on allnurses if a person is suffering from this phenomenon. However, when posters make angry statements blaming patients for their discomfort with their jobs, it could well be evidence of a deeper distress. In my experience, chronic pain, frequent flyers, and drug seeking behaviors are some of the most frustrating things we deal with in the ED...as nurses we are often in the middle and powerless (to a large degree) to have a positive impact on the outcomes of the patients.

The cumulative frustrations we experience in our line of work can gather and build and then reveal themselves in all manner of untherapeutic ways. I believe it is important, as health professionals, that we include a healthy amount of honest self reflection into our "self care". This is not always easy and not always comfortable, but it is frequently profitable.

So bottom line...I did not intend my comment to be a personal attack. Rather, I intended it to be a suggestion (as it was identified) that perhaps the patients themselves were not "driving you out" of the ED, maybe it is the cumulative frustration that come with that line of work that are "driving" that bus.

[NYnurseatheart]

Hello OP,

As a nurse for almost 20 years now, and currently working in the ER, I can sympathize with what you went thru in the ER recently. So many doc's are "gun shy" as I see it, because they are afraid of overmedicating, or whatever. Then again, we have other ER docs who will give the patients almost anything they ask for. I have the opposite problem, as I am allergic to most (if not all) narcs. The only narc I can "safely" get is fentanyl (because of it's short half life, it rarely triggers an allergic reaction).

I watched a family member with cancer pain (bone cancer) who was often undermedicated and have had an interest in pain management ever since. I use biofeedback for my own pain (kidney stones are indeed horrible, and in my humble opinion, worse than childbirth which I have experienced 3 times), as well as self hypnosis. I am also on Lyrica, which helps with my neuropathy. I have attended many pain management seminars that are starting to promote a multifaceted approach to pain management.

Besides the oxycontin, what else are you on for pain? Do you take NSAIDS? Are you on Neurontin? Lyrica? I ask because study after study has shown that when patients are on a combination of these meds (not just narcs and NSAIDS) they are able to take less and less of the narcotics and have much more effective pain relief. I have to tell many of my patients that they shouldn't just stop taking their Naproxen or Ibuprofen without talking with their doctor. However I often hear (when I tell them not to stop the NSAIDS) "they don't help me at all so I stopped taking them".

I don't know if there is a happy medium between doc's who overmedicate, and those who are too afraid to give adequate pain relief (or even worse, too jaded to really care), but I do know that you will likely run into this same scenario time and again.

Best of luck to you in weaning yourself from the narcs.