Your thoughts/reasons patient is in pain or addicted or what...?

Published

Specializes in Med/Surg/Tele/SNF-LTC/Supervisory.

I have a patient who takes Vicodin one tablet every four hours for pain. She is also taking Neurontin and on a Fentanyl patch q72hrs.

My question/concern.. is. She is pretty much on the dot in asking for her Vicodin - often times she asks for it early, after two hours post my giving one to her. Many of the other nurses think she does not need this med, and is simply addicted, and wants it for the "buzz". I sometimes find myself believing this too, but I feel guilty for thinking she is faking the pain because who am I to know what she is feeling.

Sometimes, when she asks for her pill..and I bring it to her after the few minutes or so that it takes for the CNA to tell me she wants it, and for me to finish writing a sentence in my charting, open the lock box, document time etc... only to find her sleeping in her bed or chair, respirations wnl, no grimacing, diaphoresis, guarding or other s/s of pain, and I have to jostle her a few times to wake her to take the pill (she is very hard of hearing, which is why I jostle her). Those are the times when I think she is just addicted and wants a buzz.

The MD won't increase her dose, the daughter has stated that she thinks she doesn't need it, but this patient reports to me that she is in pain and well... I just can't decide how I feel. On one hand.. I do think she may have developed a tolerance to it and is indeed in pain, and on the other hand I think she wants a buzz.

Sometimes if she asks for a pain pill and I bring it in to her, only to find her sleeping, I'll walk back out and she won't call for one for another hour or two.

Can anyone please give me some insight on this.. should I give her the pain pill every time without question? Or should I try to stretch it longer in believing she is just seeking a buzz?

Thank you muchly!!! :confused:

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

She may be looking for a "buzz" as you put it....... but I have a feeling, considering her "age" as it sounds here, that she is looking to block things out and escape. Frankly, if I was in a LTC and unable to do much..... I would like to be to sedated so I wouldn't know just how long and lonely the days really are.....:(.

I am sure she has pain but I would try distraction techniques or get her involved in something that interests her and involves getting her engaged in her surroundings and see if that helps prolonging her requests. I would also investigate a psych consult of med for depression. She sounds almost despondent.....sad. :)

Up Vote Up Vote ×

Give it to her.

Clearly she has chronic pain if she has a Fentanyl patch. And really, who cares if she gets a little "buzz" from her ONE stinkin Vicodin pill? It's not our job to impose our morals on our patients.

Up Vote Up Vote ×
Specializes in PICU, ICU, Hospice, Mgmt, DON.

Also, there was a very recent discussion on this very topic...if you search you can find it and it will probably answer many of your questions!

and just because your patient is "addicted" to opiates does not mean she does not have pain....and frequently those addicted have increase s/s of pain due to the phenomena of hyperalgesia....so, it's really not your call and not for you to judge!

Up Vote Up Vote ×
Specializes in Medical Surgical Orthopedic.

If the patient's vitals are good, and I have an order, I give the requested medication. I honestly don't care why they want it or how much they "really" feel pain.

Up Vote Up Vote ×
Specializes in Med/Surg/Tele/SNF-LTC/Supervisory.

You're right.. I'm giving it to her. The distraction thing may work a little bit, but truly there isn't much to distract her with, yes, she is on antidepressants. I know I'd be one blue gal if I were in LTC too.. would be seeking an escape myself.

Thank you both!

Up Vote Up Vote ×

I dont think its for you to decide if she is "addicted" or not. If she has the vicodin ordered and she asks for it, then give it to her.

Up Vote Up Vote ×
Specializes in Hospice.

There are significant differences between s/s of chronic pain and acute, recent-onset pain. People with chronic pain severe enough to require a fentanyl patch almost never show the behavioral or vital sign changes we associate with severe acute pain.

As for asking "on the dot" for her vicodin ... it's what she's supposed to do. Opioids are far more effective when they are used early, before the pain gets bad, than when they are used to "catch up" with pain that has been allowed to become severe.

Another note: physical dependance on an opioid - tolerance - is not the same as addiction.

Up Vote Up Vote ×
She may be looking for a "buzz" as you put it....... but I have a feeling, considering her "age" as it sounds here, that she is looking to block things out and escape. Frankly, if I was in a LTC and unable to do much..... I would like to be to sedated so I wouldn't know just how long and lonely the days really are.....:(.

I am sure she has pain but I would try distraction techniques or get her involved in something that interests her and involves getting her engaged in her surroundings and see if that helps prolonging her requests. I would also investigate a psych consult of med for depression. She sounds almost despondent.....sad. :)

This! If you ever do hospice you will find this especially in LTC. I made a huge effort to just sit and talk about my day the weather, what's on TV, laugh and joke if there was something to do that about, while doing the HTHs each visit. I put it in my mind to be an old friend. You would be surprised at the improvement in all counts (other than the actual hospice dx). I mean alertness, interaction, eating (if still). I had nonverbal, unresponsive patients catch sight of me coming down the hall with my roller bag and reach a hand out to me to greet me and manage to say "hi" before I even got within range to where I began to look for them, where the staff had no response. I am not blaming the totally overworked staff, I am sure it breaks their hearts. LTC in many places is just an awful place for nurses to work these days. Just the little extra time (that LTC nurses don't have) sometimes is all it takes.

Having said that, give the meds. The pain is real. Dealing with the pain psychologically is something we all wish we had time to do with our patients. Some nurses just cannot. Sad! The one thing we all got into nursing for was to have impact on our patients, actually care for them. The word "nurse" was not intended to just mean medication passer.

Up Vote Up Vote ×
Specializes in Oncology; medical specialty website.
I have a patient who takes Vicodin one tablet every four hours for pain. She is also taking Neurontin and on a Fentanyl patch q72hrs.

My question/concern.. is. She is pretty much on the dot in asking for her Vicodin - often times she asks for it early, after two hours post my giving one to her. Many of the other nurses think she does not need this med, and is simply addicted, and wants it for the "buzz". I sometimes find myself believing this too, but I feel guilty for thinking she is faking the pain because who am I to know what she is feeling.

Sometimes, when she asks for her pill..and I bring it to her after the few minutes or so that it takes for the CNA to tell me she wants it, and for me to finish writing a sentence in my charting, open the lock box, document time etc... only to find her sleeping in her bed or chair, respirations wnl, no grimacing, diaphoresis, guarding or other s/s of pain, and I have to jostle her a few times to wake her to take the pill (she is very hard of hearing, which is why I jostle her). Those are the times when I think she is just addicted and wants a buzz.

The MD won't increase her dose, the daughter has stated that she thinks she doesn't need it, but this patient reports to me that she is in pain and well... I just can't decide how I feel. On one hand.. I do think she may have developed a tolerance to it and is indeed in pain, and on the other hand I think she wants a buzz.

Sometimes if she asks for a pain pill and I bring it in to her, only to find her sleeping, I'll walk back out and she won't call for one for another hour or two.

Can anyone please give me some insight on this.. should I give her the pain pill every time without question? Or should I try to stretch it longer in believing she is just seeking a buzz?

Thank you muchly!!! :confused:

Give it to her when she requests it. If you think she has an addiction problem, speak to her attending about having her evaluated by pain management. It's not your place to "stretch out" her meds to see if she has a problem. More than likely, she has developed a tolerance to her meds.

It would help to know what her dx. is.

Up Vote Up Vote ×
Specializes in ER.

I would give her the med, but I wouldn't wake her. I'd warn her of my plan though, so she stays up if she really needs it. If she's able to finally fall asleep I wouldn't want to take that away from her.

Up Vote Up Vote ×
Specializes in PCU/Hospice/Oncology.

Considering her age.. who cares? Its ONE freaking vicodin every 4 hours. I have patients with the Fent patch, Dilaudid q3 and Benadryl q3 that are young. Shes probably not even getting a "buzz" from the pill because shes actually feeling PAIN. When youre in pain it really just takes the edge off, thats how chronic pain works. The people getting the buzz are getting IV Dilaudid/Morphine5 days after thier acute sickle crisis :p

Shes asking for it before its due because it HURTS and shes scared of the pain coming back. I wouldnt be so quick to call "Drug Seeker." You can usually tell who your drug seekers are going to be because they are frequent fliers on the unit or thier level of pain medication doesnt match the diagnosis or even the favorite, "Heres a list of things I cant take but I can take Dilauded 2mg" Lol?

Up Vote Up Vote ×
+ Join the Discussion