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Posted 1/19/2011 1:44 AM (GMT 0)
I've been a medical/surgical nurse for a bit over a year now and I have found it difficult to treat patient's who have chronic pain. I used to think that the majority of my patients coming in and speaking of chronic pain would actually be chronic pain sufferers. Now I have a hard time believing the patient is a chronic pain sufferer when they rate their pain as a 10/10 all of the time and their pain medication was given an hour ago (PO meds) or 20 - 30 mins ago( IV meds), there is no guarding, crying, increased HR, or other indication of pain besides this numeric rating. I also have a lot of patients wake up when I walk in the room and, while still drowsy and lethargic, tell me they need their pain medication immediately.
I understand that chronic pain sufferers have their med schedule to handle the pain and that often when admitted to the hospital the MDs and pharm often prescribe pain meds that are not part of the therapy or we screw up the patient's schedule. For these true chronic pain suffers that must be a nightmare I can not imagine. How is it that when a med rec is taken the pain management specialist or MD who follows your progress does not have some sort of document stating that you are diagnosed with chronic pain and this is the therapy you require? Of course the reason you are admitted will also increase your pain- understandable.
My question is, how can I really help chronic pain suffers and how might I be able to distinct btwn those and the drug seekers.
At times I have worried I had misjudged the patient who was on the call light every 2 hours for IV dilaudid, with IV benedryl and IV zofran but it turns out those are our repeat patients who the MDs are unable to diagnose with anything, they come in with street med and alcohol in their system and they are beyond rude to those of us giving the meds.
Please let me reinforce that I do not want to subject my chronic pain patients to the same BS they must get every time they are in the hospital but I don't want and am physically unable to meet the demands of the med seekers.
Any advice on how to differentiate on s/s that are different for chronic pain sufferers?
Posted 1/19/2011 3:42 AM (GMT 0)
How kind you are to actually consider that patients might be legit & at the ER. :)
Questioning
First off, I would say that anyone who is coming in chronically to the ER with alcohol in their system is not taking their treatment seriously & probably needs to have a talk with someone. And anyone coming in with ANY non-prescribed drugs in their system, imho, ought to be treated as an addict. Does their PM know they tested positive? If so, maybe talk to the head nurse about whether the hospital administrator needs to know that information.

That said, these smiley face pain scales just make me completely crazy. What the heck does "worst pain of my life" mean, anyways? My PM uses the Mankowski pain scale -- "10" means you are passed out. It takes out some of the subjectivity. Still, it can make it more difficult to get insurance to cover treatment of someone with an "8" (even though 8 means nausea & dizziness). If your hospital uses the smiley faces, you could try also asking specific behavioral questions.

But if people are taking pain meds, get no pain relief from them, but still want more, they are either dumb as rocks or drug-seekers. On the other hand, if meds are helping a little, you could maybe discuss whether it would be appropriate to counsel the patient to try to wait a bit longer before you administer another dose. Legitimate patients do get fearful of the pain rapidly escalating. The best solution I've seen for that is a PCA. I think they're kinda expensive, but they do free up nurses time and there are lots of studies that show that giving patients control over their pain meds tends to measurably decrease the amount of pain meds they need. So that's an added bonus.
Legit Patients who may not be easily identifiable
Be kind & give the benefit of the doubt. Ultimately, it is up to the doctor to decide whether a patient's condition warrants medicine or not. I can't tell you how irritating it is when my PM has been in to see me and I hear the nurses out in the hallway saying they don't think I need the meds. I live alone, so if I can't get up to get something out of the fridge, I don't eat. If I can't get up to get water or use the washroom, well ... you get the picture. And there usually isn't a good diagnosis with chronic pain (as most here can attest to).
Problems caused by other nurses
The patient could have had a lousy nurse the shift before who made them wait 4 hours for their PRN meds or they were made to lie in their own urine for an hour and now were so afraid it would happen again (i guess i have bad luck). So they ask earlier, but the nurse will only give it to them if their pain is a "10", so they say it is. There are studies about that, too. When a PM tells his patient that he can only get injections when their pain is an 8, that most of his patients come in with pain "at a level 8". The same holds true for meds. It sucks, but sometimes even though we want to be honest, we find that medical professionals place arbitrary limits on treatment. It doesn't make a patient drug-seeking, just desperate for a bit of relief. Treatment should be based on: self care, contribute to society, meaningful relationships. Numbers tend to be more reliable when it is.

I know how overworked nurses are. Still, it really means a lot when a nurse accepts that the doctor really is making sound medical decisions rather than gossiping about it out in the hallway or trying to withhold prescribed treatment b/c she's unilaterally decided the patient must be a drug-seeker.

So if you're gonna get mad at someone, get mad at their lousy doctors. I'm always shocked (and a bit horrified) that there are doctors out there who just give narcs to anyone and everyone, no questions asked. Eventually someone reports them to the OPR, but some of these horrible people kill multiple patients before that happens. But on the flip side, pretty much everything that can be given in a hospital can be given as a prescription so while the shady people shouldn't be sent home with even more hard-core narcs, I don't understand why others wouldn't. I had to be evaluated by a pain psychologist for addiction before they'd do that, but after I passed they were fine with that. No more hospitals for me. :)

Hope that helps! Blessings on you for not just giving in to the mentality that if you can't see it, it must not be real. Keep fighting to maintain that positive attitude! You have no idea what it means to your patients. :)

peace,
frances

Post Edited (Frances_2008) : 1/18/2011 8:54:43 PM (GMT-7)

Posted 1/19/2011 4:23 AM (GMT 0)
  Thats a tough one , everyone's pain is important to them and there are other factors involved as well , like stress , emotional stability and psycological condition too. I guess first looking at the actual condition the patient is in for and checking what the medical literature says the possible pain range is , may be a place to start . But I wouldn't want the job your taking on , its sounds very difficult . But since you are taking it on (good work ! ) talking to the patient and getting as much info as possible sounds logical . I agree patients who say 10 out of 10 all the time make it difficult to discern accuracy of dosage , so of course safety first , then I guess your own judgement as you gather expierence . I don't think I was much help , but I thought your question was important and wanted to try to respond . I wish I could be more help . Good luck , Mikel
Posted 1/19/2011 4:56 AM (GMT 0)
As a longtime RN and a chronic pain patient for over 14 years, it is a difficult situation. I try to always believe that pain is what the patient says it is. Yes, there are many that you doubt, and many abusers. Please bear with me as I relate my hospital stay. I was admitted to have a total knee revision. I was told that my pain would be managed while I was there. I spent over 6 hours in recovery, as I awoke from surgery screaming and cussing in pain .( I was not aware of this as it was told to me by the friend who accompanied me, when my doctor went out to tell her why I was spending so much time in recovery) Everytime I screamed in pain, they gave me more versed, instead of a pain med. I had refused a femoral block, and yet somehow they went ahead and tried it , without my knowledge or consent. I went to surgery at 10 am, and it was 8m when Iwas finally taken to my room. I was told by the anesthiologist that I "had multiple meds ordered for pain, and would not hurt all night."  In my room, I was never given my cpm, or my ice pack, and I had a dilaudid pca, I believe, which I used but it did not control the pain. When I asked for ice I was told:" We do not do that here."  When my nurse came in to do her half a** exam, she kept yelling at me to move my foot. I tried but could not , and she got madder and madder. She told me I was able to do it in right after surgery so "DO IT NOW", but I could not and told her I would if I could. I begged her for meds, and told her I was supposed to have them, ( I had not received any of the methadone I took on a daily basis twice a day) and she told me that the "pca is all , use it, that is all you get and need."  Eventually we found out I could not move my foot because of the femoral block numbed my foot, not my knee, as it was not performed correctly.  I cried most of that night, and dozed off and on, and awoke to see some dr I had never seen and asked about who he was and he told me he was the hospitalist and I would see him everyday, I NEVER SAW HIM AGAIN>   The next morning after shift change, my nurse came in and when I rated my pain at 8-9 she bawled me out for not asking for pain meds before it got to that point. I explained I had begged , litterally begged for meds since the night before, but was told I could not have any. She told me I was a nurse and I knew it was much easier to stay on top of pain, than play catch up. she went and gave me a bolus of dilaudid, and then brought me my methadone, and after an hour or so, it got better. Just for information, I had ice packs ordere around the clock for the first 48 hours, and constant cpm if not up, and received none of that.  When I was sent home the day after, it was a Saturday, my own doc made rounds on Friday, and wrote my scripts, TWO oxycontin, and 30 percocet.  I lived three hundred miles away. I explained that I took two percocet four times a day, they would be gone by Tuesday mrning, and the mail would take much longer for me to call the office on MOnday, and have the script mailed to me (3-4 days) . By the way, I DID NOT GET THE script for over a week, and had to take my pills one two times a day to last. (As I had taken them as prescribed over the weekend)  IT was a hellish experience. AND there was NO NEED for anyone to have gone through that. I wrote to the hospital, and found out so many "LIES" charted in my chart.  This is how chronic pain patients are treated. Most nurses will read that the dr has prescribed their regular pain meds, and if they have had surgery, and have a pca or optional meds prescribed, witll take it upon themselves to not give them the regular meds, as "they do not need it.   This is why patients are so protective of their meds, schedules, etc.  I do not believe that every time you ask somebody that pain is 10 or 10, as that would mean that none of the interventions, meds included are working at all. I have a friend who will answer 15 when asked, andI have tried to explain to her, that is not the best answer, and will most likely make the caregive less likely to bring meds. I hope the worst pain I ever had (10 0f 10) will never be constant, as I work hard to prevent that. I do know that certain meds do not work well for certain people. I , for instance, can take enough morphine to put a normal person out for hours, and it does not affect my pain, it makes me crazy, and itch.  Fentanyl works for me as does methadone, but I went off methadone at the advice of my new dr, as he did not want to prescribe it. I do not like meds like percocet, or the feeling that so many love. I like sustained pain control. Not easy to come by. I think that a savy nurse, can tell by the way somebody moves, guards their painful area, (like an incicion after surgery) etc, how much pain is interfering at the time. Yes, I , too, try to be pleasant when asking for my meds, and do not writhe around, or swear, etc.  If a patient has had the same dose and med for a day or so, and is constantly asking for it early, perhaps that med does not work for them. Often, a little anti nausea med, or toradol IV will potentiate and help, if there are orders for them. A massage, sheets straightened, pillows placed all can help, AS WELL as nurse who responds quickly, and respectfully,with the meds. Anxiety plays an important role in the control of pain,and if thepatient does not feel tey can trust the nurse, pain escalates. I always ask if there is anything else I can do every time I leave a room, I rearrange so they can reach everything on their bedside table, and make sure they have something fresh and cold to drink. It saves time in the longrun.  You can not imagine how trapped anddependet chronic pain patients really are. THEY are dependent on the meds, and on the dr that prescribesthem. They feel powerless. Clock watchers are afraid,and that is why they are asking right before time for the meds. Please be patient and believe them when they say they have pain, but it does not alway require meds.

 Sorry purplereading I hit the edit button on the wrong post I meant to do mine,! nothing is changed! White Beard

Post Edited By Moderator (White Beard) : 1/18/2011 11:02:02 PM (GMT-7)

Posted 1/19/2011 5:56 AM (GMT 0)
NurseKe

I am glad you asked this, because I suffer from chronic pain and have been on Oxycontin for many many years, I am also and RN  and chronic pain from my back ended my nursing career.  Anyway this past November I had a posterior articular joint fusion done at C-3/4. And pain control was a major issue.  The year before I had a C-5/6 ACDF and a few years before that I had my gall bladder removed. And all these surgeries had one thing in common, their pain control sucked!  They do not co-ordinate anything with the patients pain doctor! And that is a mistake! Especially if your having surgery at one hospital and your pain doctor is affiliated with another, this last surgery I had I begged them to call my PM Doc and talk to him about my pain meds and treatment, and they would not! I can not tell you the number of times I heard a nurse say but you are already getting  Bla Bla Bla amount of this pain med! Some of the comments I heard was inexcusable,  you know I worked on an Onco unit for a few years, and we knew how to treat pain and so did the Doctors.  You ask how do you know if a person was in pain, yes you can have a person in pain and not show any of the normal signs, we used to get all the sickle cell patients on our onco unit. Now there are some patients that can have some real pain, but yet often they do not show the typical signs, and if you did not know them you would swear they were not in pain, but if you asked them and they told you their pain was going up to a 8 or 9 you had better believe them, because if you didn't and did not give them something, they would be a mess in no time at all, rolled up in a ball screaming in pain. That was the nature of the disease.  Working in an ER I am sure is different, but I wish more nurses would just quit being so judgemental, and just do what they learned in nursing school, pain is subjective and it is what ever the patient says it is!  PERIOD!!! Then treat it!  After this last surgery I am rather scared to ever have to go back to have another, but yet I know that I will have to have another fusion as time goes on! It was even worse after I left the hospital because since I am alone they  wanted me to go  to nursing rehab facility for a while, I did and it was a NIGHTMARE!!,  I only stayed a few days, because of the pain treatment was so bad! Part of it was the hospitals fault the they discharged me to the nursing facility with no orders for pain control!  You can not immagine what I went through that day and night! Those nurses made me ashamed to know that they shared the same career as I do! I guess I am rambling but this is a very sore subject to me, and I really don't know how it can be fixed, untill we change the attitudes of the Doctors and Nurses, that deal with patients that suffer from chronic pain. We are not drug seekers or addicts, we take pain medications so we can have a somewhat normal life. The pain meds never do completely take away the pain, they just make it tolerable, and most people with CP take their meds just as prescribed, and most would rather not have to take them at all! We just want to live a normal life and not be in pain!  Just because you are not curlled up crying does not mean you do not have pain! 

NurseKE  there are allot of very insightfull post on this forum about how CP affects our lives, back in the early part of 2009 I believe there were several threads about this subject. Most of the  posts were started by fatherjohn, I believe one of them was about do you let CP define your life or something like that. Anyway, you can learn allot about people an how they manage their pain, here at this forum. Infact there are allot of RN's here on this forum, most with back problems.

Oh Yes I just about forgot, Welcome to the Healing Well Chronic Pain Forum!

P.S. purplereadings post was not there when I started writing my post, but I have a very difficult time using my hands and thus I type very slow. purplereading it looks like we have allot in common in our post! and I applaud you, you covered it very very well! Thank-You!

White Beard

Posted 1/19/2011 10:25 AM (GMT 0)
I too, worked health care. I can surely tell you if the patient is in pain, they will indeed show the pain when it is at a 10. For example ever had an iv in wrong in a patient? When I was admitted in the hospital they put my iv in wrong (Yes folks, there is a WRONG way to get it in) and whenever fluids or meds were hooked in it I was crying and screaming, you could tell by my face it was sheer pain. I finally got a nurse after a week to believe me and she put an iv in on my other arm. She sat there flushing it and saying "do you feel that?" I responded "Feel what?" and she looks at me like I gone crazy. And said "Ok you watch me this time I will flush it again." another flush, still no pain. I said "If your talking about the coldness and the icky smell and awful taste, then yes I feel it. If you are talking about the pain, keep trying cuz it doesnt hurt in this iv." She laughed and said "Well I guess you really did have an iv in wrong." Or when I go to the ER over a migraine... I'm trying to hide from light, I'm not as responsive. I'm more like "leave me alone now".
There will be drug seekers in every medical place. But I can certainly tell you, you can always tell the real ones and fake ones apart by the way we act, move, talk, look. Are we grabbing a part of our body in sheer pain? Are we moving real slow? Are we stuttering or seemed kind of distracted while talking? Then we probably are in pain.
Posted 1/19/2011 6:57 PM (GMT 0)
Hello Nurse and Thank you for asking this question.   I had decided to take a break from the board for a while, but your post is so important that I felt compelled to log back in and give you a response.

My personal experiences with hospitals/ERs/Surgeries have not been good.  On my last extended hospital stay two years ago, my RN decided that I did not need the meds I had been ordered after my fusion.  She decided that I was an addict and that I was only wanting to stay high.  She decided to chart meds that I had not been given (specifically IV dilaudid) and I was supposed to be getting that every hour....I know that is alot, but that's what was ordered.  She did not respond for several hours to  my calls, she would ask me what I needed if I buzzed and she would then say someone would be there soon.  This was especially difficult because I was unable to go to the bathroom on my own.  My catheter was in wrong and had to be removed because it was bleeding.  She said it was menstrual blood (I don't menstrate) and left me begging for someone to help me to the bathroom.  Finally a cleaning lady came in and saw what shape I was in and was gracious enough to help me to the bedside commode.  I begged....litterally begged for pain releif because fusion is so bad.  This lady faslely documented my records over and over.  She was off of the floor when I tried to reach her on several occasions.  The charge nurse said she would take care of everything when I finally reported this lady, but she did not answer her phone when I tried to reach her.  Please understand that the other nurses were very good (or at least adequate).  Most (but not all, documented at least some valid information).  None ever measured any of the urine they claimed to measure and only one or two were compassionate to a person in extreme pain.

After I reported the nurse for what she was not giving me, she had a little chat with the Dr on call for the hospital (mind you....not my surgeon and not any Dr I had ever seen) and next thing I know she comes in telling me she is giving me a shot to "help my suffering" and gives me a Haldol (sp?) shot.  Needless to say, it made me feel like I was going insane!!!!  I think this person should be removed from her position and given a shot of a psychotropic drug just for the **** of it like she did to me.  I will never be able to forgive her for what she did.  Her lies are now a part of my record!!!! 

As far as telling the nurses that your pain is a 10 of 10.....I found that the ONLY way to get my meds as scheduled and I really needed them to keep on top of the pain.  They were not honestly a 10 of 10...perhaps an 8, but my 1s cousin (also and RN) was with me during my stay and saw what was going on.  She's the one who told me to say 10 of 10 because that requires action. 

I worked for over 20 years with addicts and criminals.  I understand your reluctance, but if there is ever even a chance that you might believe the person is in real pain...err on the side of helping someone.  Please do not judge us by the way we look when we are in the hospital or by the fact that we are crying.  Life has changed forever for someone undergoing spinal fusion and the pain is unbearable even with the meds.  For me that pain lessens, but never goes away.  I have my nerves burned as often as I can afford it and I take meds for CP every day.  I avoid hospitals if at all possible because of the callous and insensitive people who think you are an addict for simply needing some pain relief.  If the shoe were on the other foot for even a day, there would be a little more understaning in the world for those in pain.

Posted 1/19/2011 8:38 PM (GMT 0)
Great point, WB.

I've gone to counseling now, but before I had a very mild form of dissociation where I blocked all physical & emotional sensations. Couldn't feel pain but couldn't feel pleasure either. My first PM swore I was exaggerating my pain until we did an RF with no sedation & almost no local, and I rated it a 1. From that point on, he took me dead serious when I said my pain was a 6-7. The only "sign" I had of pain was tense muscles in the region I complained about. No crying. And my bp was below average (usually it's 70/40; when I'm in pain it goes up to 90/60 but people make wrong assumptions if they don't know what it usually is). Once my bp actually made it up to 120/80. I told the nurse that was a crisis & she needed to get a hold of my doctor right away. She sat on it. The next day my doctor was mad as #$%^ b/c, with my heart condition, having such a huge jump in blood pressure was incredibly dangerous. He ordered clonidine & doubled my pain meds right away.
Posted 1/20/2011 4:15 PM (GMT 0)
Every time I read about hospitalized patients being denied pain meds I just shake my head and wonder what the heck has happened here. Many moons again when I worked as a nurse in a general hospital, if the doctor ordered a pain med every 4 hours as needed we would give the patient the med if they said it was needed even if we thought that it wasn't due to the patient behavior, diagnosis, vitals, etc. It was not our place to ignore the doctor's orders. In that situation the doctor was the ruler of the universe and it was our job to see that what he wanted was done. Period. (If there was a question about effectiveness, etc the charge nurse would contact the dr).

I do have to say that it wasn't always easy following those orders. We had some chronic pain patients with non-specific back pain, etc who were "frequent flyers" in the hospital. In those days these folks would get admitted for pain control and maybe some physical therapy. I'm sure that there was pain involved but the way some of these folks acted you would have sworn they thought being in the hospital was like being on holiday. We would get several members of the same family in at the same time. You knew if 1 was admitted that it would be family reunion time within a day or two. It was crazy. They would be asking for their pain med injection every 4 hours on the dot. I don't mean to sound callous or mean but we could set our watches to them. I don't think any of the nurses were too excited to engage in dealing with these patients but we ALWAYS did what the doctor ordered. Period. It wasn't our place to play judge on whether or not the drug was to be given. This attitude that nurses can just blow off doctor's orders is totally bogus, unethical and I would imagine illegal and begging for a law suit.

The thing that kills me about all this is that for the past 10(?) years or so at least in the state of MI, there has been a push for better awareness and understanding of pain control measures. We have to take a class every 2 years about pain control just to keep our nursing license. Some medical scholars even talk about pain levels being a vital sign as important as heart rate. So what the heck has happened?

Nurse, I know I didn't really answer your question but wanted to share some of my experience on that subject. I guess what I would suggest to you is to give the meds as ordered. If you have a problem with the order or have suspicions about the patient, take it up with your charge nurse, supervisor, or the patient's doctor. Unless things have changed a lot over the years, I just don't think that as a nurse that it is your place to judge who does or doesn't get the ordered pain meds.

I wish you the best of luck with your nursing career. Lee
Posted 1/20/2011 6:14 PM (GMT 0)
This is a great topic and I am very glad to see someone in the medical profession come here and ask questions. I think many of us are just plain jaded on going to a hospital especially to ER and I know how bad I will let things get before letting the dr admit me. Many of us have had this idea at some point that by going to the hospital we are going to get help and pretty much most of the time this does not happen.

Drs and nurses tend to try and lump us all into one category when it comes to pain. Pain is such an individual type thing, no two are alike. Don't compare me to the guy or gal in room 2 that is there also in pain. If I don't require a huge dose of a pain killer to get my pain level down, that does not mean I am not in much pain, it could be I am very sensitive to that drug. If I need a shot big enough to a kill a horse, don't doubt that I could possibly be in that much pain.

There needs to be a better way of documenting a person's pain when they come in for help. The little smiley face thing is as worthless as it can be. My PM dr does not use this as her guide on what the patient's pain level is. Instead she has a sheet the nurse hands you to read and on it is listed how you are able to handle doing every day activities and it also includes the use of how much pain medication you use a day, what your day is like with and without pain meds. Mainly its is being able to take care of yourself with or without help. If you are a 7 in her office then you are hospital bound.

I guess the bottom line is as a nurse all you can do is use your best judgment but not be judgmental at the same time. It is a real two edge sword for both of us.
Posted 1/21/2011 5:36 AM (GMT 0)
I guess we forgot to add the "physical symptoms" such as increased BP, Heart rate, and Breathing that are to signify increased pain. But then again, this is not always so. The patient in extreme pain who is using breathing techiniques, like slow deep breaths, and lying perfectly still, may not exhibit any of these. By the responses, it is evident, how inadequately and cruely. There are no excuses for this. At one point, the hospital where I worked implemented a pain response , intervention, and result table for every prn med given. We were to chart the time and type of med given, and then in 30 minutes were to chart the result: whether pain had been relieved, or further intervention was necessary. BUT many times the nurse never charted whether or not the med relieved the pain. If you have given birth, or witnessed many labor patients, you will notice that some need pain relief from the very first irregular contraction, are writhing and screaming in pain, and others go through the whole process, never making a sound, requiring no medication at all. I have had 5 children with no pain relief, no epidurals, etc. Did I hurt? Sure, but it was a managable pain, that came and went, and had breaks in between. I also KNEW that there would BE AN END TO THE PAIN> With chronic, constant pain, there is no end in sight. Please remember to treat all patients with respect and in the manner you would want to have yourself or your family treated.
Posted 1/21/2011 4:19 PM (GMT 0)
This is a good question for chronic pain patients. I'll limit my reply to ER visits because that's where I've had this situation come up the most. First of all, I am always polite to the nurses and staff. Even when I am in severe pain, I make sure to pay attention to this & if I am curt I apologize & remind the nurse that my pain level is very high. Since I was made to walk several times with a broken vertebra, I reserve a "10" for nightmares like that one. I tell the nurse that I am only allowed certain amount of pain medication each day by my pain management doctor & if that has not been cutting it for 24-36 hours (and interrupting my sleep, of course), it was necessary to make this trip to the ER. I alert my PM when I go to the ER & give the nurse & Dr. his number. I tell them what meds I'm on & how often I take them. I also try to remember to bring the prescriptions (I 'm still a bit leery about bringing my pills & patches in -- once 15 Norcos vanished from my bottle when a staffer "delivered" the bottles to the Dr.). I offer the name & number of the pharmacy, too -- well, it is on the bottle but whatever. Then I curl up & read until the Dr. gets there. When I see the doctor, I make sure he or she knows they can contact not only my PM but my orthopedist and my GP as well. I never demand a particular drug except for Torradol. If asked what works for me, I state my preference but make it clear that it's the Dr.'s that decides how to treat me. Yes, this sounds rather servile, but considering the way chronic pain patients are usually perceived and treated in the ER, I find this the most effective tactic. 50% of the time the nurses & Dr.'s treat me great. The other half of the time they insinuate I'm a typical, slimy drug seeker wasting their time & polluting the earth. Last time I had to go to the ER, the doc accused me of stealing a script bearing my own name and address out of a garbage can. He said he didn't have the time to contact my doctors', claiming that I could have just grabbed the names from a phone book. This happened while he had an intern observing the visit. I don't think I'm paranoid, but she smirked through the entire "exam" & said to the Dr.(before they both had even left the room ) "Did you see her tear up? You really got her number!" Man, this recent story is small potatoes compared to what others on the forum have suffered & I've had bigger, more abusive jerks as well. But -- this is mean & petty particularly when one's tried to be as cooperative as possible. It makes your soul hurt as much as your body.
Posted 1/22/2011 10:54 AM (GMT 0)

crankypoet said...
This is a good question for chronic pain patients. I'll limit my reply to ER visits because that's where I've had this situation come up the most. First of all, I am always polite to the nurses and staff. Even when I am in severe pain, I make sure to pay attention to this & if I am curt I apologize & remind the nurse that my pain level is very high. Since I was made to walk several times with a broken vertebra, I reserve a "10" for nightmares like that one. I tell the nurse that I am only allowed certain amount of pain medication each day by my pain management doctor & if that has not been cutting it for 24-36 hours (and interrupting my sleep, of course), it was necessary to make this trip to the ER. I alert my PM when I go to the ER & give the nurse & Dr. his number. I tell them what meds I'm on & how often I take them. I also try to remember to bring the prescriptions (I 'm still a bit leery about bringing my pills & patches in -- once 15 Norcos vanished from my bottle when a staffer "delivered" the bottles to the Dr.). I offer the name & number of the pharmacy, too -- well, it is on the bottle but whatever. Then I curl up & read until the Dr. gets there. When I see the doctor, I make sure he or she knows they can contact not only my PM but my orthopedist and my GP as well. I never demand a particular drug except for Torradol. If asked what works for me, I state my preference but make it clear that it's the Dr.'s that decides how to treat me. Yes, this sounds rather servile, but considering the way chronic pain patients are usually perceived and treated in the ER, I find this the most effective tactic. 50% of the time the nurses & Dr.'s treat me great. The other half of the time they insinuate I'm a typical, slimy drug seeker wasting their time & polluting the earth. Last time I had to go to the ER, the doc accused me of stealing a script bearing my own name and address out of a garbage can. He said he didn't have the time to contact my doctors', claiming that I could have just grabbed the names from a phone book. This happened while he had an intern observing the visit. I don't think I'm paranoid, but she smirked through the entire "exam" & said to the Dr.(before they both had even left the room ) "Did you see her tear up? You really got her number!" Man, this recent story is small potatoes compared to what others on the forum have suffered & I've had bigger, more abusive jerks as well. But -- this is mean & petty particularly when one's tried to be as cooperative as possible. It makes your soul hurt as much as your body.

I remember the second trip in 2 days I had gone to the er due to a 12 foot fall onto a concrete floor, landing on my tailbone.. i had been prescribed percocet 7.5/325 and they were not doing it. I was waiting in tears in the waiting room for two hours, not taking my pain medicine for fear of OD should they give me something else while I was there, andd the nurse seeing me referred to me to the charge doctor as "the pain freak" I said, excuse me, how dare you? look at this bottle of medicine (I had 120+ pills in it) "If i was trying to get high, why the hell would I be here?" I begged and begged for them to admit me, and they refused to do that or run an MRI...the next day I was taken by ambulance to a diff hospital because I could no longer walk or feel my feet (I have regained the use of that in a limited capacity) But it truly is horrendous how doctors treat patients when there is medical proof of their injuries. INS companies as well.

 

Now I'm being denied by my sadist INS adjustor for my pain meds because "He broke his hand two years ago and was prescribed pain meds so there is no causal relation for him to be on them for his back injury" Not a chance it will hold up in court, but it is making my life hell now because instead of opana IR 20 mg 4x daily, (was a miracle drug for me would often bring my pain down to a 5 or lower) I am on oxycodone 30 mg IR instead (brings me down to a 7 , 6.5 at the most, and when the spasms hit (nothing works but valium, been on every muscle relaxant under the sun too!) nothing, and i mean nothing will take it away. Not even IV morphine or dilaudid at the ER.

Posted 1/23/2011 1:52 AM (GMT 0)
After my stomach surgery I was supposed to push the button on the pca which the nurse shoved into my right hand. I told her I could not hold it, promptly dropped it, and she stuck it in my hand again and said she would not give me anything, and I had to do it myself. I couldn't make her understand that I'd had an arterial line in that wrist and couldn't feel my hand or make it work right. (I suspect nerve damage because it continues to be a problem. There were 3 holes in the wrist where they missed and a hematoma to my elbow.) I continued to ask for help but the nurses on the floor just kept saying I had to do it myself, so I kept losing the button and kept suffering. Pca is a terrible thing for paitents who cannot react to help themselves.

I'm extremely sensitive to some meds. The 5mg dilaudid they gave me right after surgery stopped my breathing for the next couple of hours. Sometime after I started breathing in recovery they asked me if I needed to go to a monitored floor, to which I said, "of course, since I keep stopping breathing." Then I went back to sleep. Even on the floor I kept on stopping breathing until the monitor alarm started up. The first time that happened a nurse came in, but not all the times it happened after that. Fortunately I came to enough because of the noise to take some deep breaths. I don't know how much dilaudid or whatever was in the machine I was being given, but it was too much at a time and not often enough. I know that usually 1 mg is enough to stop pain I had from an accident, but I needed 2 mg a couple of days when I had diverticulitis with an abscess.

After breast cancer surgery I was not allowed to have any pain meds while in recovery. This after I had woken up during the suturing and nobody noticed! Maybe I shouldn't have tried so hard to hold still. When I was moved to the waiting to go home area I was given 1 vicodin. After an hour I was lying there crying and a nurse got an order to give me iv med.

But doctors are no better. My endoscopy was delayed, so I was 3 hours late taking my tramadol for fibro and a pretzel back. I kept asking for either meds of to get my own. The doc came in, put his hands on his hips and announced, "I don't prescribe pain medicines!" Finally I got through to a nurse who let me get my own.

I can't ever get it across to anesthesiologists that I have fibro and post-polio. It's recommended, for both conditions, to give a pain med and a muscle relaxant like diazepam a half hour before surgery. Without it we end up in fibro flares and muscle spasms.

Of course I've had good experiences, but I'm afraid of any more surgeries and have started taking my own pre-op meds before any procedures.
Posted 1/23/2011 2:38 AM (GMT 0)
More and more I see people entering the medical field without a single care for the patients, solely for profit margins. I know junkies will always be there. But having no heart for people that come in in obvious agony is in violation of the first part of their oath. Do no harm my ass.
Posted 1/23/2011 2:43 AM (GMT 0)
Nurseke, it depends o the source of their pain. If the pain is actualyncaused by a spasming Muscle, no amount of narcotic will take the pain away until the spasm is managed. When I lost use of my legs, it took two shots of morphine before I could even begin to he "normal and lucid" yet the pain was still there, and very intensely so because the spasm was untreated by narcotics. I've been on eeryhif antispasmodic under the sun and Valium is the only one tha seems to treat it. Lucky me.
Posted 1/23/2011 2:54 AM (GMT 0)
Retiredmok I hope you hired a lawyer and got her license revoked. That's not just negligence. That's intent to do harm.
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