Would appreciate some opinions on pain management

vamedic4, EMT-P · Aug 27, 2006

QUOTE: "Just to offer a little balance. Pain meds are addictive. It is perfectly possible to have real chonic pain and be addicted to pain medication. While by no means does everyone who is put on pain meds become addicted, many do. I work with addicts all the time. Addicts lie. So saying that the patient must be the sole judge of their pain sounds a bit simplistic to me."

Okay waiittt a minute...this is not balance. First off, while we know that pain meds are addicting, anyone must realize that narcotics require a therapeutic level to be reached in the bloodstream in order for them to work effectively. Once that level is reached and maintained (whether short or long term) pain control is achieved.

Hence, people who take narcotics (like they should) are not "addicted" to pain medication, they are "therapeutic" on their meds. And if they don't take it, they suffer withdrawal symptoms.

Now sure, there ARE addicts out there. But are we to mistreat those who are actually in pain because we believe they're "drug seeking"??

Like I tell the nurses I work with...most are just seeking RELIEF FROM THEIR PAIN, however that's achieved. If all it took was to eat Cheerios, spin around three times and sit in a north facing corner for an hour - then that's what people would do. Unfortunately...that doesn't work for everybody. And we owe it to people to adequately assess and manage their pain.

vamedic4

wanting a nap

WillowBrook · Aug 28, 2006

I must admit reading through some of the threads regarding drug seekers and legitimate vs non legitimate pain I am getting a much better understanding (and perhaps some empathy) for how I have been treated upon being admitted to the ED suffering from pain related complaints. I am truly sorry that Doctors and Nurses in the course of doing there job have to be exposed to people who manipulate and fraud the system. I am a former Heroin addict and not once did I ever try and scam a Doctor for drugs, mainly because it was a hell of a lot easier for me to just pick up a phone and call a dealer than it was to spend hours in th ED with some fictitious complaint and not be guaranteed I would even be given anything.

The above being said I would also like to point out that even former heroin addicts do sometimes hurt themselves enough to warrant needing Opiod medications and that is not someone "drug seeking". Case in point: last year I fell through a roof (long story), landed on my backside and fell back cracking my head. I got up and walked around in a daze for a moment before I started experiencing cramping sensations in my back which quickly moved into full blown spasms of the back muscles. At this stage I could still move, albeit in a lot of pain, and I went upstairs to call an ambulance and then came downstairs to wait for them. By the time they arrived I could hardly move and it hurt to even breathe or talk. I got to the ER, was admitted immediately and assessed, by this point I couldn't move my legs at all and was experiencing extreme almost continual spasms. I was ordered to be X-rayed and the Doctor requested that I be given Fentanyl before I was moved. An orderly shows up, moves my down to X-ray and as a Nurse is preparing to move me onto the X-ray table I remember that I am yet to receive Fentanyl and I distinctly remember the Doctor saying I was not to be moved without it. I reported this to the Nurse who ordered me to be taken by to the ED. Upon arriving back the nurse who took over my care could only be described as a bully. I was given Fentanyl and in preparation for the X-ray I also had to have a pregnancy test. She put a bedpan under me, none too carefully I might add, and when I failed to urinate on command loudly announced that if I couldn't do it she would catheterize me and then I would really have something to be in pain about (like falling 8-10 metres through a roof isn't enough). Then she started prodding and poking my legs and giving me the third degree, why couldn't I move my legs, I was moving when I called the ambulance so why couldn't I move properly now, I managed to get downstairs to wait for the ambulance so why did I have this sudden onset of such great pain, all of this repeated over and over again in a very sarcastic "I know you're a liar and I'm gonna make sure you know I know" tone of voice. I didn't know why I could move around 5 minutes after the accident but then suddenly "locked up" the way I did, I suggested that perhaps it was because of the adrenalin or shock of the initial accident; to this she just made an exasperated noise of disgust. Later it was determined by the attending physician that my back muscles had indeed gone into an extended (and very painful) spasm which rendered me effectively unable to move in order to protect my spine from any injury and also that I was suffering from "bruising" due to jarring of the spine. Now the thing is, yes I have a track mark scar on my arm, yes I asked for Fentanyl because that is what I heard I needed to be given before I was moved, yes I have a prior recorded history of Heroin addiction, but I had fallen through a roof and injured myself so regardless of my past behaviours I did not deserve to be treated that way. Let me tell you if I had been trying to get Narcotics, I could have just headed down to the local corner picked up a guy willing to pay for services, hopped on over to the local Methadone clinic and waited for any number of people that I know got connected up with a dealer and scored, all within the space of less than 2 hours. I certainly did not need to fall through a roof and spend a night in pain in the ER :rolleyes:

asnmann · Oct 10, 2006

I, as a nursing student, am also hearing alot of inappropriate subjective babble from several instructors who for some reason have a personal hate for narcotic pain treatment(particularly with the recent rise of the "pain industry")by way of walk-in pain management clinics. There are no doubt crooked things going on in this arena and more than likely always will be. However, I do not see that it is an instructor's place to teach of pain as a physical hardship of life and the treatment of it and substance abuse as a parallel curriculum. I believe suspicion of abuse is a FAR secondary to pain and comfort. It disgusted me to listen to some of the things I heard in the classroom setting and through it all keep my mouth sealed as though I am a lamb of their own feelings. In the end, I will listen to the crap that might get thrown my way, but I will in future practice let my own beliefs and values guide me in my decision making always keeping the patients welfare first. Pain is SUBJECTIVE and MAY be accompanied by objective observations. Regardless of my thoughts or objective findings in assessment, it remains my duty to provide comfort within reason to a patient who may or may not be suffering. I could go on for days, but to cut it short- don't let the gray areas that allow room for personal opinion, mold your own mind to do anything other than what you feel is right. The opinions that some of these professionals have developed are probably based on bad/disturbing scenarios that they have been personally involved in, so like them-let your experience guide you, and hopefully your path will leave you more open-minded.

solumedrol · Oct 10, 2006

hmm.. this is interesting..

augigi, CNS · Oct 10, 2006

To the OP, good on you for questioning this. It's really inexcusable to leave someone in pain "incase" they are "drug seeking". When I am in pain, hell yes I am seeking drugs!

I would not only not listen to this and continue to use your own developing judgement (careful not to project your own pain experiences on to all patients "just in case" they have pain) to offer analgesia AS ORDERED and to advocate for your patients if they are not ordered.

I would also speak with someone at my school as to this attitude. Whether it's requesting pain inservice, or suggesting some other method of further education, I believe it is simply unacceptable to offer this view to students. Is it a clinical instructor, or a school theory? Either way, I'd be debating it - in writing.

subee, MSN, CRNA · Oct 17, 2006

I must admit reading through some of the threads regarding drug seekers and legitimate vs non legitimate pain I am getting a much better understanding (and perhaps some empathy) for how I have been treated upon being admitted to the ED suffering from pain related complaints. I am truly sorry that Doctors and Nurses in the course of doing there job have to be exposed to people who manipulate and fraud the system. I am a former Heroin addict and not once did I ever try and scam a Doctor for drugs, mainly because it was a hell of a lot easier for me to just pick up a phone and call a dealer than it was to spend hours in th ED with some fictitious complaint and not be guaranteed I would even be given anything.
The above being said I would also like to point out that even former heroin addicts do sometimes hurt themselves enough to warrant needing Opiod medications and that is not someone "drug seeking". Case in point: last year I fell through a roof (long story), landed on my backside and fell back cracking my head. I got up and walked around in a daze for a moment before I started experiencing cramping sensations in my back which quickly moved into full blown spasms of the back muscles. At this stage I could still move, albeit in a lot of pain, and I went upstairs to call an ambulance and then came downstairs to wait for them. By the time they arrived I could hardly move and it hurt to even breathe or talk. I got to the ER, was admitted immediately and assessed, by this point I couldn't move my legs at all and was experiencing extreme almost continual spasms. I was ordered to be X-rayed and the Doctor requested that I be given Fentanyl before I was moved. An orderly shows up, moves my down to X-ray and as a Nurse is preparing to move me onto the X-ray table I remember that I am yet to receive Fentanyl and I distinctly remember the Doctor saying I was not to be moved without it. I reported this to the Nurse who ordered me to be taken by to the ED. Upon arriving back the nurse who took over my care could only be described as a bully. I was given Fentanyl and in preparation for the X-ray I also had to have a pregnancy test. She put a bedpan under me, none too carefully I might add, and when I failed to urinate on command loudly announced that if I couldn't do it she would catheterize me and then I would really have something to be in pain about (like falling 8-10 metres through a roof isn't enough). Then she started prodding and poking my legs and giving me the third degree, why couldn't I move my legs, I was moving when I called the ambulance so why couldn't I move properly now, I managed to get downstairs to wait for the ambulance so why did I have this sudden onset of such great pain, all of this repeated over and over again in a very sarcastic "I know you're a liar and I'm gonna make sure you know I know" tone of voice. I didn't know why I could move around 5 minutes after the accident but then suddenly "locked up" the way I did, I suggested that perhaps it was because of the adrenalin or shock of the initial accident; to this she just made an exasperated noise of disgust. Later it was determined by the attending physician that my back muscles had indeed gone into an extended (and very painful) spasm which rendered me effectively unable to move in order to protect my spine from any injury and also that I was suffering from "bruising" due to jarring of the spine. Now the thing is, yes I have a track mark scar on my arm, yes I asked for Fentanyl because that is what I heard I needed to be given before I was moved, yes I have a prior recorded history of Heroin addiction, but I had fallen through a roof and injured myself so regardless of my past behaviours I did not deserve to be treated that way. Let me tell you if I had been trying to get Narcotics, I could have just headed down to the local corner picked up a guy willing to pay for services, hopped on over to the local Methadone clinic and waited for any number of people that I know got connected up with a dealer and scored, all within the space of less than 2 hours. I certainly did not need to fall through a roof and spend a night in pain in the ER

Stories like this lead me to believe that Dachau is still open and training nurses.

solumedrol · Oct 17, 2006

Here's a link to an E-learning module on pain management and assessment.

http://www.rnao.org/Pain_e-learning/index.html

It has a great video that reviews all the key points on pain assessment and also included is an online quiz.

Hope this is helpful.

rn_imw · Oct 18, 2006

Good question! The situation is that there IS a problem out on the Street with Medications being abused. The further situation is that this War to clean up Improper Medication use is being used AGAINST those who suffer from Pain. I am going to put another post under separate heading so that ALL may know of an important Bill that Pain Foundation.com is working very diligently to get passed that will make a HUGH difference. Please don't get discouraged from the entire Nursing Field, Hon. Your HELP is desperately needed. My career has been robbed from me because of the enemy Pain......but I am working every way I can to help others who are suffering from pain. Please know that YOU will be a voice that can make a difference! Blessings to You always, Iris