Would appreciate some opinions on pain management

Trauma Columnist · Sep 26, 2005

I am sorry that you are being taught to look for signs of a "pain seeker" when assessing pain. Pain is what the patient says it is. It is not the nurse's judgement about whether the patient has pain or not. Please know that this is not the prevailing theory in the nursing world. Continue in school and then see how others handle the issue.

Nikki69 · Sep 26, 2005

I work in a large nursing home and I see this type of thing all the time. In my opinion, it really depends on the patient, and how well the nurses know (or think they know) the patient. In nursing, alot of what we do has to come from our own judgement. Some nurses try to push the patient to get better with a combination of drugs and therapy, not just the drugs. But I think you're right when you say "how can someone measure someone else's pain". It all comes from the heart. If these patients have a chance to get better and go home, why give them a pain med that is going to knock them out and sleep the rest of their lives? On the other hand, why not just give it to them and they'll be quiet and quit pestering you for the drugs? It's really a personal judgement call I think. Pain is what the patient says it is, even if we believe different

asher315 · Sep 26, 2005

I have been a nurse for over 20 yrs and was "taught" about drug seekers but not that much about pain and its management. Early in my career, I made the classic mistakes and decided some pts were "seekers" & not in true pain. With experience and more personal experience, comes enlightenment. I think nurses are afraid they will enable addictions. I worked for 2 yrs in a pain clinic and absolutely loved it (if I ever find another one to work in, I'm there!) and I learned more about pain,medications and pain patients in those 2 yrs than in the 12 before.

Pain is what the patient says it is, regardless of who they are or how they look or act. We never used the term "drug seeker" but "drug abuser" because all of us, when we are in pain, are "seeking" relief by drugs or whatever may work. The "abusers" showed themselves by their actions not related to pain, calling the clinic saying they "lost" their meds, Once, we can believe but calling 3 times in 2 months because you dropped your pain pills down the toilet is a bit much. One girl phoned a pharmacy, pretending to be one of the staff and refilled her pain meds rx. (She got caught). One pt stole rx pads from a dentist office. A couple went dr shopping and 1 pt had a son who was a doctor and gave her whatever she wanted. These are the few that cast a bad light on the rest of the acute and chronic pain sufferers.

Having said all that, don't give up nursing, you can make a difference in the attitudes of your co-workers and others but most importantly, you can make a difference in a pain sufferer's life.

Take care,

sherry t

grannynurse FNP student · Sep 27, 2005

Hi.
First let me say that I don't want this to end up as a debate over real pain or drug seeking. What I am looking for is reasons why there is such a suspicion of pain patients.
I am in nursing school, and am discouraged, disgusted and quite frankly angry at what I am seeing as the judgemental attitudes of some nurses. How dare a nurses try to decide who is in pain, or to what severity they are feeling pain.
Mind you,I am a chronic pain patient myself. You would never know it most of the time because I live with it all the time. This is a personal issue with me and I just don't get it. Heres the clincher, we are actually being taught how to recognize a drug seeker, and guess what...i have all the red flags of a drug seeker. My kidney stone patient also exhibited all the red flags, too...should I deny him pain meds as I am seeing some nurses do? Not actually denying, just being so busy it takes 2-3 hours to get him the meds.
So, could you tell me what constitutes a 'seeker" in some nurses minds/
I am seriously considering leaving the profession because of this. I am seeing this across the board, from the ED to a med surg floor, to PACU, for goodness sakes!
please help me understand this!
Please understand I am NOT trying to start a heated debate, I am just very, very stunned at what I am seeing.
K-

The education of today's potential physicians and nurses is changing. Studies have shown that the average medical school provided just one hour of formal pain management education and nursing schools, three hours. Most of the remainder of education was provided by those all ready licensed individuals, who had been taught by previous generations. Most programs have expended their formal education programs.

Grannynurse :balloons:

Editorial Team / Admin · Sep 27, 2005

Hi.
First let me say that I don't want this to end up as a debate over real pain or drug seeking. What I am looking for is reasons why there is such a suspicion of pain patients.
I am in nursing school, and am discouraged, disgusted and quite frankly angry at what I am seeing as the judgemental attitudes of some nurses. How dare a nurses try to decide who is in pain, or to what severity they are feeling pain.
Mind you,I am a chronic pain patient myself. You would never know it most of the time because I live with it all the time. This is a personal issue with me and I just don't get it. Heres the clincher, we are actually being taught how to recognize a drug seeker, and guess what...i have all the red flags of a drug seeker. My kidney stone patient also exhibited all the red flags, too...should I deny him pain meds as I am seeing some nurses do? Not actually denying, just being so busy it takes 2-3 hours to get him the meds.
So, could you tell me what constitutes a 'seeker" in some nurses minds/
I am seriously considering leaving the profession because of this. I am seeing this across the board, from the ED to a med surg floor, to PACU, for goodness sakes!
please help me understand this!
Please understand I am NOT trying to start a heated debate, I am just very, very stunned at what I am seeing.
K-

Hello, K,

I am not sure what you mean when you say you are being taught to know who is seeking pain meds. Can you elaborate on the methods?

The individual in pain can more often than not, show nonverbally that they are indeed in pain. Facial expressions, sweating, anxiety, combativeness, restlessness, just to name a few. B/P high, pulse tachy, respirations rapid, deep or shallow. Just too many to name here. The patient may say, "I am in pain and rate it on a scale of 1-10 at an 8, but, the observer does not believe the individual. The patient in chronic pain sometimes will not say anything at all and the nurse just does not ask, "Are you in pain?" The patient will get nothing for pain because the individual did not tell the nurse and ask for meds. Or, the individual finally asks for something and the nurse thinks/says, "This patient was fine 5 minutes ago and now that want something for pain. They can't be in pain. They are drug seeking."

I just am somewhat concerned that teaching you (students) "how to recognize and/or tell who is drug seeking" is maybe clouding the students' judgement.

Please elaborate.

kk2000 · Sep 28, 2005

Hello, K,
I am not sure what you mean when you say you are being taught to know who is seeking pain meds. Can you elaborate on the methods?
The individual in pain can more often than not, show nonverbally that they are indeed in pain. Facial expressions, sweating, anxiety, combativeness, restlessness, just to name a few. B/P high, pulse tachy, respirations rapid, deep or shallow. Just too many to name here. The patient may say, "I am in pain and rate it on a scale of 1-10 at an 8, but, the observer does not believe the individual. The patient in chronic pain sometimes will not say anything at all and the nurse just does not ask, "Are you in pain?" The patient will get nothing for pain because the individual did not tell the nurse and ask for meds. Or, the individual finally asks for something and the nurse thinks/says, "This patient was fine 5 minutes ago and now that want something for pain. They can't be in pain. They are drug seeking."
I just am somewhat concerned that teaching you (students) "how to recognize and/or tell who is drug seeking" is maybe clouding the students' judgement.
Please elaborate.

To elaborate a bit: Many discussions about patients that know the time the meds are due, know the name of the meds, or my favorite, "The patient was laughing and smiling when their family came in...they can't be in pain".

Just today in postconference a student was saying that his patient was exhibiting drug seeking behavior, evidenced by the fact that one minute he was laughung and the next minute moaning. I suggested that perhaps it wasn't our job to question this and stereotype this pt. as a drug seeker. i was told that even if he was in pain that he shouldn't have been so dramatic!

Now we are faluting our pateints for being dramatic?????One instructor told a story how of a patient she had in the ED that was in for a pain issue. Patient was also nauseous but instructor said that it was probably due to the pt. be ing an addict and that she was probably having withdrawal so it wasn't real nausea. Every single patient I have had for clinicals in the past 2 weeks has been described to me in report as a drug seeker. Every one! And the dx have been kidney stones, gallbladder problems, cellulitis, fibro and chrohns disease. How can everyone be a drug seeker? In thees instances shouldn't the instructor step in and tell the students NOT to make a snap judgement?

It is VERY obvious to the whole class during lecture that one instructor in particular does not generally believe pain patients. It is like an epidemic and then the whole class has to tell their stories about their drug seeking pateints.

I am so discouraged. We are breeding a group of very judgemental nurses.

Editorial Team / Admin · Sep 28, 2005

To elaborate a bit: Many discussions about patients that know the time the meds are due, know the name of the meds, or my favorite, "The patient was laughing and smiling when their family came in...they can't be in pain".
Just today in postconference a student was saying that his patient was exhibiting drug seeking behavior, evidenced by the fact that one minute he was laughung and the next minute moaning. I suggested that perhaps it wasn't our job to question this and stereotype this pt. as a drug seeker. i was told that even if he was in pain that he shouldn't have been so dramatic!
Now we are faluting our pateints for being dramatic?????One instructor told a story how of a patient she had in the ED that was in for a pain issue. Patient was also nauseous but instructor said that it was probably due to the pt. be ing an addict and that she was probably having withdrawal so it wasn't real nausea. Every single patient I have had for clinicals in the past 2 weeks has been described to me in report as a drug seeker. Every one! And the dx have been kidney stones, gallbladder problems, cellulitis, fibro and chrohns disease. How can everyone be a drug seeker? In thees instances shouldn't the instructor step in and tell the students NOT to make a snap judgement?
It is VERY obvious to the whole class during lecture that one instructor in particular does not generally believe pain patients. It is like an epidemic and then the whole class has to tell their stories about their drug seeking pateints.
I am so discouraged. We are breeding a group of very judgemental nurses.

Hello, kk,:balloons:

That is what I was afraid of.....the patients are getting labeled en masse. Not cool. This is poor instructing.

Please do not fall into that pit of placing a label on all your patients because they don't act like you think they should. And, I am not talking about you, per se. I am talking about how the students are being taught.

The patient is an individual. A human being that deserves to be cared for to the best of your (the nurse) ability. And, just because they are not writhing in pain and have a grimace as opposed to a smile, does not mean they are not in pain. Even in many cultures they will not allow overt displays of emotion such as pain.

I commend you upon looking at your patient with dignity and respect. Good nursing there!!:balloons:

kk2000 · Sep 29, 2005

Hello, kk,:balloons:
That is what I was afraid of.....the patients are getting labeled en masse. Not cool. This is poor instructing.
Please do not fall into that pit of placing a label on all your patients because they don't act like you think they should. And, I am not talking about you, per se. I am talking about how the students are being taught.
The patient is an individual. A human being that deserves to be cared for to the best of your (the nurse) ability. And, just because they are not writhing in pain and have a grimace as opposed to a smile, does not mean they are not in pain. Even in many cultures they will not allow overt displays of emotion such as pain.
I commend you upon looking at your patient with dignity and respect. Good nursing there!!:balloons:

I appreciate your, and everyone's, thoughful replies. I cannot believe what I am seeing and it frustrates me so!

I myself have some pain issues (6 herniated disks), and am fully aware of what it feels like to know you are not believed. Perhaps this sounds a bit strong, but I would rather medicate the "seeker" than take the chance of not or undermedicating the person who truly needs it.

Very, very disturbed, angry and disapponted at the attitudes I am seeing.

Thanks so much,

K-

Trauma Columnist · Sep 29, 2005

The issue of pain management is best not handled during an acute episode of pain. It doesn't matter at that point. However, it can and should be addressed at a primary care provider level.

BabyRN2Be · Sep 29, 2005

KK2000,

From what you are describing, the teaching that's taking place in your school is not in step with current thinking or methods for that matter.

Please don't leave nursing because of it. Once you graduate from school you'll learn the difference between the "ideal" and "real life." I have found that some programs are not in step with real life.

I believe that nursing needs more people like you. People who will take the laments of a patient seriously and not be ready to judge. People exhibit pain in different ways, and not everything goes by the textbook.

Wow, I remember when I went in for a T&A in '74. I was a kid and was not told that it would hurt. They had all these books out for kids "glamorizing" T&A's. That you'd be put out to sleep, but when you woke up you'd get all the ice cream you could ever want!! You'd spend a night or two in the hospital, you'd go home and return to your normal life! WRONG!! Wrong on the "all the ice cream you want" bit and returning to normal life. And they didn't mention the pain. This was at a time in which they didn't have the wong scales and they didn't even ask kids if they were in pain. I was not offered anything the whole stay. I remember laying in bed, thinking I was going to die. I was having very morbid thoughts for a 7yo.

I'm thankful for kids today that this is changing. Some people may say that we are "babying" kids for giving pain meds, because this wasn't done previously. After having gone through what I did at 7, and remember thinking "Where did I want to be buried? What do I want on my grave marker? What will the cemetery look like?" and having thoughts and actually crying because I'd miss mom and dad so much... this at 7 for a T&A! I'm so glad that there are better methods out there now, and I do hope that they continue to address pain issues.

Please don't quit nursing...

sjb2005 · Sep 29, 2005

Education is the key in changing this "drug seeker label" trend. The drug reps for MS Contin as well as many pain clinics will teach a valuable inservice on pain and pain control. Ask your employer to set up an inservice.

Pain is subjective. I believe what the patient tells me. I am not a nurse so I can pass judgement. I find that patients are frequently in pain and it is not being controlled. I do everything in my power to get the patient pain control.

I worked with people suffering from quadraplegia, paraplegia or amputations. Phantom pain is a frequent complaint. "My legs hurt", the pt would say. The nurse would reply, "But you have no legs. How could you have pain in your legs when you don't have any?" Or "How can your have pain in you legs...You can't feel anything from the chest down ?"

In these cases, nurses often do not understand the neuro response to stimuli and interpretation of the stimuli via the neuropathways. Sometimes, people cannot express that they are in pain and act out instead, as in the the pt who suffers from alzheimer's.

I would speculate, from my 14 years experience, that 95% of the patients I have cared for are suffering from uncontrolled pain.

I can only recall 2 patients that may have been drug seekers. They were able to convince their physician to prescribe high doses of morphine and narcotics for their pain. This did not seem to adversely affect them. What ended up adversely affecting them: the poorly diluted cocaine or street drug that they shot up in their PICC lines supplied by a friend or family member. I was the one who found them unconscious, barely breathing and administering High doses of narcan and assisting with intubation to bring them out of it. They survived and denied the situation but their drug tests proved otherwise.