Very Important Pain News

scarta105 · Oct 18, 2006

Bravo to you for being a voice for those patients who suffer with chronic pain. Our society has lived too long with the impression that "suffering is good for the soul." During my clinicals, many experienced and older nurses would complain that "so and so must really love that demerol (or insert any number of pain drugs) because they are always asking for it. While in my mind, I would think, "have you ever thought that the patient may actually be in pain, or maybe, just maybe, he is currently being undertreated for his pain?"

One incident: a 15 year old male admitted for Sickle Cell crisis requested a shot of demerol 50mg for pain...the nurse at the nursing station while drawing up the shot complained constantly that the kid just liked the way the demerol made him feel because he asked for it every 4-5 hours. She was implying that he watched the clock for his shot. His doctor ordered the demerol 50mg q4hrs prn.

Another incident: a 40 year old male admitted with metastatic liver cancer whose doctor ordered morphine 1-3mg q3hrs. I received report from the outgoing nurse who mentioned, "he must have a bad addiction to the morphine because he is always asking for it." When I checked the MAR, the nurse had only been giving him the minimal amount (1mg), and she was making him wait the full 3 hours.

I just don't get it. Both patients were admitted to the hospital in order to manage their unrelenting pain and the doctors had written the orders for pain control, but the nurse takes it apon herself to withhold or minimize the amount because she thinks that the "patient just likes the way it makes them feel?"

Until our society changes it's views about pain and pain management, I'm afraid that things like this will continue. Patients come to us for treatment and support and all we give them back is accusations and name calling. "Drug seeking behaviour" does not necessarily mean that the patient is an addict. It could, and in most instances may mean that the patient is being undertreated for their pain.

I believe that one simple solution that doctors can utilize when dealing with patients who are admitted for pain control could be to write their pain medication orders as scheduled rather than prn so that the nurse must address the pain issue. As always, the nurse assesses the patient before administration of the medication, and if she feels that it is unsafe or if the patient refuses, she just documents that the pain medication was not given.

Groups like the American Pain Foundation and the American Pain Society are a good place to begin to understand the consequences of pain in our country and what we can do to help. We know that the undertreatment of pain is a big issue because states are having to pass laws to force us into addressing this issue. Doctors are being sued because their patients are dying in pain (and then again, doctors are being sued because they are believed to be too liberal in their treatment with narcotic pain meds).

Again, I applaud you for your advocacy for pain management. In my opinion, no one should be allowed to live or die in pain.

rn_imw · Oct 19, 2006

Thanks scarta for your reply. I would also like to encourage you to join me sometime at the Pain Foundation. There are some wonderful boards there like here for posting. They NEED all the support they can get for those who do suffer. I miss my 16 year plus Nursing career.....I was always the, "I have a strong back for my size" one......the one who just *KNEW* I would NEVER be injured....Well, guess what? A year of living with a knife in my back, I now KNOW better. Sadly, this chronic pain is not a joke...For myself, I have much intolerance to opiods.....In fact, when I was young they once tried me on Morphine and stated I was allergic to it because I literally broke out in a rash and got all itchey....at least I didn't get anaphylatic shock! So, I can take very little for this pain...which is another reason I really want to see H.R. 1020 pass so that the Research can be done and more of our Country can be helped. Join us Scarta! Would love to see you add your two "cents" at the boards there. We need YOU and people like you! Thanks for speaking out, Iris

Patient · Oct 25, 2006

Wow! Thanks for the link to the American Pain Foundation. Don't know how I missed it all these years.

EDGRADNURSE · Nov 17, 2006

rn_imw,

Thank you for the information. I'm sorry to hear about your injury and the pain that you are experiencing.

My story--dear husband (36) hurt his back-just a bulging disc (not even herniated). After 2 YEARS of pain and misdiagnosis, he was finally diagnosed with Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome in all 4 limbs.

We were treated like dirt by neurologists and even a PAIN CLINIC. Yes, we were humilated by a doctor at a PAIN CLINIC. All thought that the pain was disproportionate to the injury (WHICH IS THE HALLMARK OF RSD) and my husband was labeled a drug seeker because 5mg Percocet q4 hours didn't knock out the pain and drugs such as neurontin didn't work.

One neurologist wrote a script for prn pain medicine (1-2 tabs). When husband called for refill Dr.said he only wanted husband to take 1 and wouldn't refill , putting my husband into withdrawal (and knowing it). My husband needs pain medicine to FUNCTION AS A NORMAL PERSON and continue working. He had to miss work because of the pain. The neuro exams (EMG, LP, MRIs) were all normal but my husband's feet and legs started to become mottled and swollen. Also, his arms and hands started burning w/pain. "hmm, wonder if it's your thyroid?". We even had consults at 2 large medical centers in Maryland---"are you a diabetic?", "wonder what it could be?" "small fiber neuropathy maybe?". No tests ordered. I mean, come on--RSD is a NEURO disorder. I mentioned autonomic dysfunction and was blown off. I didn't know any better.

One neurologist referred husband to a pain clinic--of course, indicating that my husband seems to need a lot of pain meds. Pain clinic dr didn't even perform a physical assessment (completely ignored my husband's swollen and mottled feet) and told us to get lost as we were looking for pills (huh?)

Finally got the correct dx from another pain clinic that my husband's orthopedic doctor referred him to after being alarmed at the condition of my husband's feet. Even the orthopedic doctor said, "hmm, looks autonomic" and ordered appropriate vascular studies to rule out PAD. The orthopedic dr. is excellent--only originally referred to neurologists to rule out a neuro disorder before considering surgery. He was correct--he certainly did not expect the horrible road we had to travel before going back to him and getting on the right path.

Sorry for my vent. I would love to send you the names of the not so good doctors so that none of them have patients referred to them by the American Pain Foundation.

As an RN, pain management has always been an interest of mine and I ALWAYS assess patients for pain and advocate for them (even before this happened to my husband).

I was so dismayed that the worst treatment we received was at a pain management clinic. Kind of turned me off to the whole concept as it really was a betrayal.

Even though my husband is working w/a respectful pain management doctor, he is afraid to even mention pain as he is afraid that 1) the low does of medicine he is on will be taken away and 2) that he will be labeled a drug seeker. All his trust is gone so he just has to live in pain every day.

Patient · Nov 24, 2006

I was so dismayed that the worst treatment we received was at a pain management clinic. Kind of turned me off to the whole concept as it really was a betrayal.
Even though my husband is working w/a respectful pain management doctor, he is afraid to even mention pain as he is afraid that 1) the low does of medicine he is on will be taken away and 2) that he will be labeled a drug seeker. All his trust is gone so he just has to live in pain every day.

What a horror story! It brings to mind a question I've had for many years, being a chronic pain patient due to abdominal adhesions for so long. If a patient presents with mental problems, he/she is referred for counseling; a patient with cardiac issues gets a referral to a cardiac specialist; a patient with back pain gets referred to an orthopedist. So why is it, that when a patient presents with pain, they are immediately labeled a drug seeker or an out-and-out addict, and are not referred to a pain specialist? I can understand why ED workers tend to throw such patients out when they appear time and time again, but do they never at least try to explain that pain issues should be treated by a pain doctor and at least attempt a referral? Why are such patients just labeled and thrown out the door? I hear ED workers in particular gripe all the time about the frequent flyers and "drug seekers," but do they ever at least try to listen and educate the patient? If one has a good pain doc, trips to the ED for pain crises are about non-existent. At least, that's been my own personal experience, and that of several people I know who have chronic pain. Instead of worrying about giving a junkie a fix, how about educating the patient for a change?

You are so right - your husband was betrayed by his pain doc, and IMHO, is a reportable offense.

OK, end of rant. :-)

EDGRADNURSE · Nov 27, 2006

Thank you so much for your kind reply. Amen to your post. I believe that a lot of patients are undertreated for pain. Perhaps the docs are scared of the DEA and are quick to assume "drug seeking" due to some "red flag" behaviors. These behaviors are also displayed by those suffering from "pseudoaddiction" (undertreated pain). Even if someone does have a drug addiction problem, aren't we as RNs in a perfect position to educate or perhaps obtain help for the patient?

I also don't know of any other affliction other than chronic pain that causes such judgmental attitudes amongst health professionals.

I was thinking of reporting the disrespectul pain doc (the one that did not perform a physical assessment but billed for it) to the state med board. But, I'm afraid that the new pain doc will be dragged into it.

Anyway, the American Pain Foundation website is wonderful. I thank the OP for the info.