Opioids Pain Rating system and persons with addictions

[Coraline]

They need the pain scale to have a way to document the pain. Away to justify pain medication.

It's the staff that could use some compassion training. Most are burnt out professionals who just don't care anymore. They are under staffed and over worked. They need a paid vacation.

But it's still no excuse to ignore the patients crying out for help.

 

[BeachBum4u]

Its not to say the pain is all in one's head.

It's really funny you said this because the fact is, it is all in one's head!! All I can say is if "I" say I am at a pain level of 9 due to a damn hangnail, then that's the fucking deal; end of discussion. No one in the entire world can judge what the hell my pain level is, period! I've personally never gone to that level of absurdity with my doctors but for crying out loud, what I feel as pain is unique to me and only me. You or no one else on this planet can honestly "judge" what my pain level is for ANY injury or ailment. Sorry for the rant but you can probably tell, I am passionate on the topic.

 

[livetheopiatedream]

I second that^

 

[Coraline]

milagro that sounds horrible, I'm so sorry you had to go through that.

my best friends GF was in a head on collision and went through the windshield and when I brought her to the ER it took them over an hour to bring her Toradol, Toradol!!

It was incredibly disrespectful and neglectful, and when I complained to the doctors about toradol being insufficient and inappropriate for someone in her condition, they made me leave because I was "enabling" her.

I have been there done that. I was thrown out a of pick up truck bed going 60 mph. I had could see my bone on my leg in two spots from a beer bottle or a bob wire fence. I got up pulled my sister out of the cab of the truck. I was totally blind at that point. I finally started to see a gain and saw a fire by the motor and the transformer next to the truck. I pulled her out. Then I walked in circles idk how much time passed but I collapsed in some people's arms.

They gave me nothing. Not even to take home. I had an appt and a week later when I could move again to get something. I pissed the bed and everything because I could not move. I had to wear that neck brace because my neck/ head flopped like a new born baby. That pain well beyond a 10 in my book. I still have neck problems from that accident. You touch my head the wrong was, oh say like your playing with me and you want my head in a certain place, I get pissed because it hurts and feels weird.

I then had to go to the ER many times for post traumatic stress and get shot up with idk what ever that gave me all the time. I'm a little better now but I still freak out when someone else is driving a little fast or anything.

 

[laschenova]

I am a Nurse and Chronic Pain Patient. Just because a person is sleeping, playing on a phone (distraction from pain), watching tv, or another activity, doesn't not mean a person isn't expierencing real 6-10 pain.

Source my own expierences and evaluation of patients.

Pain is subjective and is what ever the patient say it is and hurts where ever the patient says it hurts.

Someones 2 may feel like a 5 to someone else and so on.

Source medical school.

Some people may want stronger pain medications for various reasons, but you have to treat it.

DO NOT start thinking that some one isn't hurting and they may be an addict and just want drugs.

If you are that type of person get out of the medical field. We don't need more people like this.

I would rather treat 100 drug seeker for pain to make sure the 1 person who was in direr need got the meds they deserved.

It is not for us to decide if they are hurting and influencing MD's that they are drug seekers benifits nobody really. Even drug seekers have level 10 pain.

Sorry if I seem angry and offensive but I deal with a lot of non caring people who are suppose to care for patients with out judgement.

Oh, wow. I just got a PM from someone who wanted to know why I hadn't been back to this thread. I had assumed that I still only had one reply! Boy was I wrong!

Zoey, I do think you entirely misunderstood me. The purpose of my thread was to get some insight, and I never have and never would ever assume that someone is drug seeking and withhold pain medication. I always err on the side of caution. I started this thread to get a little insight but mostly in hopes of starting an interesting discussion. I have always enjoyed a good debate. I would rather give 20 addicts a dose of dilaudid and a script for vicodin than have one patient suffer on my watch.

I started thinking of it reading a thread about pain management, and remembering how I used to perceive pain before I had my son. I was in induced, unmedicated labor with a 9 and a half pound baby for 52 hours before I had an emergency c-section. The epidural never worked, and they induced me with cytotec, cervadil, and pitocin. It turns out I am extremely sensitive to pitocin. I had off the chart back to back contractions with almost no break in between. I had no idea that a human could be in so much pain. I was horrified that the surgical techs and the nurses in the OR were rolling their eyes at me as I screamed, bawled, writhed and vomited in pain. I actually was begging the OB to hurry up and cut me open. When someone who is terrified of surgery is screaming "just hurry up put me under and cut him out of me!", you know they are in pain, lol.

I do not work in pain management, and would not want to. It seems like it would be emotionally draining and depressing. I am a pain patient myself, and I have been on both sides.

I do agree that some professionals are entirely unsuited for the profession. , and the pain medication aspect is merely the tip of the iceburg. I worked with a doctor who was an absolute nightmare. She was/is a family practitioner and treated every patient likethey were drug seekers, idiots, and a nutjobs. She reduced quite a few patients to tears for various reasons (teasing and demeaning them for gaining as little as 3 pounds, telling them they were imagining their depression/anxiety/OCD, abruptly discontinuing meds that were started by other doctors with no taper like xanax or percocet) I heard these stories because a lot of her patients started seeing me for appointments after seeing her a few times.

She is seriously an evil person IMO, and though I feel badly that I didn't stay to help out the patients (for the ones on Tricare and Medicaid we were the only primary care that took their insurance), it was too much for me having to work with her.

I work in Pediatric Gastroenterology right now, which I enjoy immensely. Since the majority of my patients are failure to thrive and are being seen for reflux, celiac disease, crohn's, ulcers etc I only give pain meds now for post op and in some cases as breakthrough meds for older children with severe abdominal pain that has been resistant to other therapies.

 

[brutus]

I may be wrong here, but I was under the impression that chronic use of opiates lead to lower pain tolerances.

 

[BeachBum4u]

I may be wrong here, but I was under the impression that chronic use of opiates lead to lower pain tolerances.

In theory taking opiates for pain "should" reduce ones pain level, in that instance at least. Yes, if the meds are working right, then you should feel a reduction in your pain levels but here's where the earlier discussions got into the whole "in your head" stuff. The reality is that folks who take opiates long-term (multiple years, 30+ for me) can experience a higher level of pain recognition. This is what's going on in your brain, it's just that one's body becomes so accustom to having a medicine in them reducing pain levels that without any medicine in the system that same person can become hypersensitive in perceiving pain. I'm sure in the technical sense, it has something to do with narcotic receptors, pain receptors and maybe even serotonin levels. Pretty complicated stuff, all in all. I hope some of the posts have been some help to the OP. Take Care!

 

[6apbhmm]

In theory taking opiates for pain "should" reduce ones pain level, in that instance at least. Yes, if the meds are working right, then you should feel a reduction in your pain levels but here's where the earlier discussions got into the whole "in your head" stuff. The reality is that folks who take opiates long-term (multiple years, 30+ for me) can experience a higher level of pain recognition. This is what's going on in your brain, it's just that one's body becomes so accustom to having a medicine in them reducing pain levels that without any medicine in the system that same person can become hypersensitive in perceiving pain. I'm sure in the technical sense, it has something to do with narcotic receptors, pain receptors and maybe even serotonin levels. Pretty complicated stuff, all in all. I hope some of the posts have been some help to the OP. Take Care!

I think that's exactly what wiggi meant.
You feel chronic pain -> use opiates, it gets better -> so you stop using them -> then when sober you feel worse pain than you felt before doing opiates because you are over sensitived.

 

[Coraline]

If you stop using opiates you may have some hypersensitivity to pain for a short while but it goes away. You don't have it for the rest of your life. Hypersensitivity can occur when your nerves are not use to being free and not blocked and they don't know what to do. Then they calm down and work normal.

I take opiates and have never expierenced hypersensitivity outside of having the flu.

 

[Swimmingdancer]

^I think it varies depending on the person and their unique brain and body, how long they take opioids and in what doses. I have an extremely heightened sensitivity to pain from being on methadone for over 10 years.

 

[Fire&Water]

I have been there done that. I was thrown out a of pick up truck bed going 60 mph. I had could see my bone on my leg in two spots from a beer bottle or a bob wire fence. I got up pulled my sister out of the cab of the truck. I was totally blind at that point. I finally started to see a gain and saw a fire by the motor and the transformer next to the truck. I pulled her out. Then I walked in circles idk how much time passed but I collapsed in some people's arms.

They gave me nothing. Not even to take home. I had an appt and a week later when I could move again to get something. I pissed the bed and everything because I could not move. I had to wear that neck brace because my neck/ head flopped like a new born baby. That pain well beyond a 10 in my book. I still have neck problems from that accident. You touch my head the wrong was, oh say like your playing with me and you want my head in a certain place, I get pissed because it hurts and feels weird.

I then had to go to the ER many times for post traumatic stress and get shot up with idk what ever that gave me all the time. I'm a little better now but I still freak out when someone else is driving a little fast or anything.

There are lawyers for this...you could possibly get your ER bill erased if you can prove (witnesses) they left you in pain over a period of time.

 

[NeighborhoodThreat]

I've been told by people in the U.S. Emergency Medicine community that they were told in school to treat pain first and ask questions later...but in practice, they do the opposite.

 

[Coraline]

That's the way it is suppose to be.

Then you have your old "seasoned" nurses and drs. who think they know everything. You can not tell them anything about anything.

When I got my first job as a nurse (I don't use new nurse because I'm still new and have a life time to learn new things), one of my pt was a Hospic pt suffering from COPD. I bonded with her and her family.

She became worst and worst. One night she was different. She was sleeping too much and I knew her time had come. It was 10:45pm when I decided to call people and notify them of her change in condition.

This was actually right before shift change. The on coming nurse was beyond furious. He yelled at me and told me she would be fine and that he had to clean up the mess I made. I felt 2 inches tall. I could not sleep that night from sheer embarrassment.

I came on the next day apologizing. He pulled me into the office and said. "I am so sorry. You were right. She passed 2 hrs after you left." He apologized.

My point is more expierenced people think they know everything. They do know a lot. But every situation is different. No two zebras have the same stripes. I humble my self and take a pt words for face value, for the most part, at least when it comes to pain. I know what it's like to be told your not hurting. This comes from the one who sees me suffering the most.

 

[Fire&Water]

Many, many "god' complexes...

 

[laschenova]

There are quite a few doctors, NPs, PAs, RNs, LPNs, CNAs etc who have God complexes and are more concerned about covering their asses than actually helping the patients. But I think there are many, many good and compassionate ones out there, but we hear about them less often. The bad ones make more sensational stories IMO.

It also depends on where they work. I have heard plenty of negative stories about hospice, mental health facilities or nursing home CNA's LPNs (licensed practical nurses) treating their patients horribly. Of course there are many who are wonderful and compassionate, but you only seem to hear about the bad ones. You have to keep in mind that most LPN's have been slowly phased out of every healthcare setting except for nursing homes, assisted living and hospice settings. A few doctor's office will hire them still, but not many. They all seem to want CNA's, who can do a good deal of the bedside duties that an LPN's can, and are paid far less. So many of t he older LPNs are finding themselves being forced out and are naturally very upset by the change. To top it off while the older LPNs used to work in hospitals or in offices, now they are typically stuck with working in what can be (in my opinion) the most depressing and emotionally challenging setting in healthcare.

Also other professionals might be stuck working at an understaffed hospital or in a dangerous setting like a state mental institution get quickly burned out.

 

[laschenova]

That's the way it is suppose to be.

Then you have your old "seasoned" nurses and drs. who think they know everything. You can not tell them anything about anything.

When I got my first job as a nurse (I don't use new nurse because I'm still new and have a life time to learn new things), one of my pt was a Hospic pt suffering from COPD. I bonded with her and her family.

She became worst and worst. One night she was different. She was sleeping too much and I knew her time had come. It was 10:45pm when I decided to call people and notify them of her change in condition.

This was actually right before shift change. The on coming nurse was beyond furious. He yelled at me and told me she would be fine and that he had to clean up the mess I made. I felt 2 inches tall. I could not sleep that night from sheer embarrassment.

I came on the next day apologizing. He pulled me into the office and said. "I am so sorry. You were right. She passed 2 hrs after you left." He apologized.

My point is more expierenced people think they know everything. They do know a lot. But every situation is different. No two zebras have the same stripes. I humble my self and take a pt words for face value, for the most part, at least when it comes to pain. I know what it's like to be told your not hurting. This comes from the one who sees me suffering the most.

That is awful. Sorry he was so horrible to you. Were you trying to tell him that her family needed to be contacted before she passed, or that she needed help to make her more comfortable in her last hours? I am confused as to why he would react so nastily to you simply telling him you thought she wouldn't make it through the night. He sounds unbelievably lazy, and it just makes me so angry to hear things like that.

 

[Coraline]

I did all the work. I called and followed protocol. He would have to talk to the Hospic people when they arrived. He didn't want that.

I was a brand new nurse 3 months under my belt so I knew nothing. He had the "God" complex.

He only worked the night shift and didn't get along with anyone. Cna's hated him. He talked in a condoncending(sp?) voice.

Don't feel bad about the pt. she had quality care. I cared for her 60 hrs a week. Of course there were other pt too but I give more attention to those who are in need. She was happy and pain controlled.

 

[tricomb]

Condescending* Hospice*

 

[laschenova]

I have no words, I really have to be careful when I talk about my experiences with doctors, it is such a highly emotionally painful subject that I have to be very careful not to relive my memories.

There have been more than one occasion when I left the doctors office crying, then got on the freeway driving home and drove as fast as I could down the 405 and closed my eyes and took my hands off the steering wheel, literally hopeless. It's just really really really fucked up to think that I'm not the only person who has considered killing themselves and thinking "Maybe THEN they'd realize that how they treated me was not okay".

But who am I kidding? I bet none of them would have any trouble sleeping at night.

Obviously, I'm extremely biased, but it's still. not. okay. That's all I can say on this subject for now.

God, I am so sorry to hear that. I have felt the same way unfortunately. It is a horrible, horrible feeling, feeling like you are trapped in an unbearable situation and that no one can help you, least of all the person who is supposed to be the one looking out for your physical and emotional wellbeing.

That is pretty much the main reason I went back to school and got into healthcare. I wanted to get rid of that helpless feeling I had. I try to help out and right the wrongs in what little way I can.

Hugs.

 

[tricomb]

Thanks! Yeah it's really awesome to hear about people having great experiences with healthcare and people who compassionate and are in the position to help others and take advantage of that for the good.

Glad to hear there are people like you and Zoey in the medical field, I personally suffer from GI issues it's definitely not fun. Must be a very interesting field to work in though.