Pain Will Not Kill You

[Seshat]

I live with chronic pain, so when I hear people say "pain won't kill you" it makes me want to kill them. They just don't get it. Sometimes you *want* to die, just to make the pain stop

And as we here all know, to our sorrow, self-euthanasia does happen.

When I saw the title of this thread, my initial reaction was that rising anger - but I took a glance at the author, and went 'wait - tpm DOES get it'.

And yeah .. in the circumstances TPM described, and with the limitations of non-opiods/opiates that Panacea explained to us; 'pain won't kill you but the first line pain meds for your current situation will' ... okay. Makes sense.

[kpzra]

I've lived in pain since I was 3, my nerve endings didn't grow back right after my burns. I have no tolerance for junkies who are "in pain" to get a fix when for 28 years nothing has helped me and I just SU,DO.

[Metody]

I like the ones who're allergic to tylenol, but not to norco, or who always get sick when they take that hydromorphone stuff, but they want some dilaudid now because that works.

Oh, what a long, long shift it was.

[kpzra]

I'm just happy most drug seekers don't realize what an ambulance carries.

[Sapphire Silk]

I live with chronic pain, so when I hear people say "pain won't kill you" it makes me want to kill them. They just don't get it. Sometimes you *want* to die, just to make the pain stop (fortunately my days that are like that are very very rare). Panacea can verify that I am the BIGGEST pansy in the world when it comes to needles, but when I get a major flare-up on, I will BEG for anything, even if it has to be delivered with a needle the size of a ten-penny nail.

On the other hand, the drug-seekers only make it harder for legitimate patients to get the meds they need. Douches like the patient in the OP are so totally off-base that I support the nurse's response to him.

I do hereby certify that Evil Empryss is the BIGGEST pansy in the world when it comes to needles. Last time she got sick she had to get Ativan sublingual (my suggestion IIRC) before she could let the nurse start the IV and draw labs . . . and I still had to hold her hand.

And that's OK. No one in their right mind likes needs, and she's always stood up for me when I've been sick and had to get stuck (though she does look away with a shudder, she doesn't run screaming from the room).

I wish we had an answer to the drug seekers. It's a complicated problem; sometimes they actually do have legitimate pain that is not adequately addressed.

We had a patient in clinic this week who has a long history of chronic pain (back pain mostly) and was on several medications at home: neurontin, ultram, percocet, and flexeril (a muscle relaxer). She was admitted for a very painful bowel condition that was a new diagnosis for her. The doctor ordered dilaudid for that, which was appropriate, but a low dose (only 1 mg IV every four hours). He continued her home meds, but everything but the neurontin was ordered PRN or "as needed." So if the patient didn't ask for them, she didn't get them even though she took them on a regular basis at home.

She was complaining about 10/10 pain and according to the nurses demanding pain meds hourly (yet not even getting the dilaudid every four).

I explained to my students that the reason for her behavior was not drug seeking behavior, as the staff were accusing her of. It was that she was undermedicated. Just because she was in the hospital for the bowel pain didn't mean that her chronic pain somehow went away. I asked the student who had her, "where does she say her pain is?" The student replied, "her back and her belly." Yet when we looked at the chart, the staff nurses were only assessing the abdominal pain, not her chronic pain.

I told me students this lady should have been offered her home pain meds on a regular basis in addition to the dilaudid, because she's likely developed tolerance to narcotics. She can handle the additional doses. She's not a drug seeker. She's in real pain.

If you don't address that pain, then you force the patient to invent reasons to get what they need, which just makes the problem of is it a chronic pain not adequately treated vs addiction that much more murky. This happened with this patient; she invented a history of seizures because she thought it would get her her meds.

I'm just happy most drug seekers don't realize what an ambulance carries.

It wouldn't do them much good. The paramedics work on algorithms. If your complaint does not fit, they do not give meds, period. They take you to the hospital and let the docs figure it all out.

Paramedics only carry morphine, and only give it to severe trauma victims or heart attack victims.

Of course, if the addict wanted to rob the medics, that would be a different story. It happens every once in blue moon.

A local gang of kids broke into my car once because they knew he was a paramedic and I was an ER nurse, and they thought I'd have drugs in my car. As a nurse, I'm not authorized to carry narcotics in my vehicle. My roommate was a state employee and required to carry them by law because he had to stop at any accident scene and render assistance; he had a full kit of equipment he had to carry with him everywhere he went. Fortunately, he wasn't home when that happened, or they would have gotten his stuff. All I had was first aid stuff: gloves, bandages, a stethoscope, splints.

I like the ones who're allergic to tylenol, but not to norco, or who always get sick when they take that hydromorphone stuff, but they want some dilaudid now because that works.

Oh, what a long, long shift it was.

I'll bet Been there, bought that T shirt.

I usually could spot the drug seekers when they'd claim to be allergic to Tylenol, aspirin, and ibuprofen, and all nsaids.

While allergies to Tylenol can happen, they are very rare. Ditto for ibuprofen (aspirin is uncommon but well known).

Then the suspicion would be confirmed when the doc offered a drug they didn't want, like Ultram (not an nsaid, not an opiate).

[crazylegs]

It wouldn't do them much good. The paramedics work on algorithms. If your complaint does not fit, they do not give meds, period. They take you to the hospital and let the docs figure it all out.

Not in the UK - they're independent practitioners & can decide what pain meds to give & when, there just has to be pain present (so for example abdo pain suggestive of appendicitis could get morphine).

Of course this isn't massively relevant to the story but I thought you might find it interesting

[Sapphire Silk]

Not in the UK - they're independent practitioners & can decide what pain meds to give & when, there just has to be pain present (so for example abdo pain suggestive of appendicitis could get morphine).

Of course this isn't massively relevant to the story but I thought you might find it interesting

I do. I keep forgetting about half of our members are not from the US

[crazylegs]

I do. I keep forgetting about half of our members are not from the US

It's certainly interesting for me as well - shows how different places work, sometimes give helpful hints too!

[kpzra]

*snip*
It wouldn't do them much good. The paramedics work on algorithms. If your complaint does not fit, they do not give meds, period. They take you to the hospital and let the docs figure it all out.

Paramedics only carry morphine, and only give it to severe trauma victims or heart attack victims.

Of course, if the addict wanted to rob the medics, that would be a different story. It happens every once in blue moon. *snip*

I was talking about robbing them. I know full well what they carry, I was one for years and am getting back into it once my daughter is older.

[Seshat]

Great. If they do start robbing ambulances, ambulances will have to stop carrying the pain meds.

Safety of the paramedics comes first. Pain management for the patients is highly desirable, sure, but if it's too dangerous to be a paramedic there just won't BE any ambulances for the patients - pain management or not.


Panacea:
I'm sitting here shuddering about that poor woman who was being pain-treated ONLY for the reason she was in hospital, not for her chronic pain. Thank you for intervening!

[crazylegs]

Great. If they do start robbing ambulances, ambulances will have to stop carrying the pain meds.

Don't you believe it.

[Large] Ambulance Service in the UK has had a number of breaks into their ambulances - even though CDs are in a safe. [Large] Ambulance Service had the bright idea of putting the CDs into a pouch on the Paramedics belt to prevent damage to the vehicles (put causing damage to the Paramedics instead). Not the bast idea in the world ever.

[Seshat]

Excuse me while I have a 'what moron came up with that idea' moment.

[crazylegs]

Excuse me while I have a 'what moron came up with that idea' moment.

Someone who doesn't have to deal with the consequences of said policy...

[Sapphire Silk]

Panacea:
I'm sitting here shuddering about that poor woman who was being pain-treated ONLY for the reason she was in hospital, not for her chronic pain. Thank you for intervening!

Both physicians and nurses are not trained very well on how to deal with chronic pain. The scammers and addicts we deal with can make us cynical, especially when confronted with manipulative behaviors.

I wish physicians would make home pain meds round the clock rather than prn. Too many nurses will refuse to even offer them, giving them only if the patient asks. The delays in getting pain meds when asked for makes patients anxious, so they ask more often and often early in the hopes of getting meds on time . . . which gets them slapped with the "drug seeker" label. It's a pervasive problem, sadly

[AnaKhouri]

There's someone named Robinette Broadhead on the phone for you...

...I love you.