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?
I am not a nurse just researching to get into the medical field. I do have a lot of experience with myself and severe chronic pain condition. For myself I took narcotics for maybe a month and it did not help my condition so then went just on nerve meds like neurontin etc with the urge of my doctors. I guess long term narcotics make your brain process pain more. I also looked into other treatments such as spinal cord stimulators and alternative etc.
I did go to a pain program at Cleveland Clinic with others who had pain much longer and who were addicted to meds. A few things I noticed. Some who were addicted to meds like vicodin were also addicted to non rx meds. Many felt that if they were in the amount of pain which was very high on the current meds they could not imagine how high it would be off. Yet some actually after initial shock and withdrawl were in less pain. I had a friend who was on so many meds in bed full days and in a lot of pain plus drugged. Then she began having other side effects and went off. Her pain actually became better in the long run and she was less drugged. I think narcotic meds or similar have benefits for some though. I know a man who could barely function from peripheral neuropathy and went on fentnyl and now can walk 2 miles a day.
I know it is hard for doctors and nurses to know who is needing meds and who does not for the pain condition. I feel so key in treating patients is how you approach them. I can't tell you how many times I have left an apt crying from feeling unheard or spoken to in a harsh way. I so agree that for a patient to learn to cope and live the best life they can in the condition they have is so key but to make the patient feel like it is in their head the pain or they are an addict if not does not help in any way. Also that a kind hearted nurse or doctor can really brighten and make a patient feel so much better. At my anestesolgists the nursing staff is so amazing. They give me a hug when I come for a procedure and just make me feel at ease. My neurologists staff is so mean I dread just facing them. That helps a person struggling in no way mind or body.
I hope it was ok I replied just some thoughts I had. I know all nurses and people in the medical field have a hard job too and it takes a lot of dedication
Pain is pain and it is whatever the patient says it is - that is something we cannot judge. Yes, I question (in my head) those patients who are allergic to EVERYTHING except for Dilaudid and I question (again, in my head) those patients who say their pain is a 10/10 and they are as calm as can be in bed with a smile on their face, but again, pain is what the patient says it is. You have to put your judgements aside and do what is best for the patient. If the patient has pain medication ordered and their vitals are fine and the patient is due, I go ahead and give it to them.
I only work PT in LTC, but I see a lot of full time nurses get burned out on this issue. We are the ones passing the meds and who know our residents, but getting the docs and family on board with pain control is another issue.
This person either needs an up on the duragesic patch or different long acting meds. What about Mscontin, oxycontin etc?
Maybe the neurotin needs increased too. Sometimes they are on such small doses of neurotin why even bother with it?
When people pull out the "they are addicted" so what I say. We are still controlling the amt given by only giving the meds per order. If they are odered every 3 hrs...I will give it when asked.
we cannot do behavior changes in the short time we interact with patients. Anyway, the pain is THEIRS, not ours, and no matter how we feel about it, it should be treated. Pseudo-addiction is when a patient is being undertreated for chronic pain - and they have drug seeking behaviors. Once the pain is adequately controlled, the behaviors stop. We are caregivers, not prescribers, so our job is to provide relief.
JCG33
7 Posts
I am not a nurse just researching to get into the medical field. I do have a lot of experience with myself and severe chronic pain condition. For myself I took narcotics for maybe a month and it did not help my condition so then went just on nerve meds like neurontin etc with the urge of my doctors. I guess long term narcotics make your brain process pain more. I also looked into other treatments such as spinal cord stimulators and alternative etc.
I did go to a pain program at Cleveland Clinic with others who had pain much longer and who were addicted to meds. A few things I noticed. Some who were addicted to meds like vicodin were also addicted to non rx meds. Many felt that if they were in the amount of pain which was very high on the current meds they could not imagine how high it would be off. Yet some actually after initial shock and withdrawl were in less pain. I had a friend who was on so many meds in bed full days and in a lot of pain plus drugged. Then she began having other side effects and went off. Her pain actually became better in the long run and she was less drugged. I think narcotic meds or similar have benefits for some though. I know a man who could barely function from peripheral neuropathy and went on fentnyl and now can walk 2 miles a day.
I know it is hard for doctors and nurses to know who is needing meds and who does not for the pain condition. I feel so key in treating patients is how you approach them. I can't tell you how many times I have left an apt crying from feeling unheard or spoken to in a harsh way. I so agree that for a patient to learn to cope and live the best life they can in the condition they have is so key but to make the patient feel like it is in their head the pain or they are an addict if not does not help in any way. Also that a kind hearted nurse or doctor can really brighten and make a patient feel so much better. At my anestesolgists the nursing staff is so amazing. They give me a hug when I come for a procedure and just make me feel at ease. My neurologists staff is so mean I dread just facing them. That helps a person struggling in no way mind or body.
I hope it was ok I replied just some thoughts I had. I know all nurses and people in the medical field have a hard job too and it takes a lot of dedication