Chronic Pain Patients, comment

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            For those drug seekers with chronic diseases, it is fairly easy to obtain what they want.  A couple of trips to the hospital and they learn how the system works.  The article above reminded me of my observation of particular patients in the past who have tried to take advantage of their hospital stay.  This may sound insensitive, but this pertains to only a small number of those people who make pain an excuse and start coping with it in an unhealthy way.  What surprised me the most was after having a third, young, Diabetic Ketoacidosis (DKA) patient over the period of six months were the abusers.  These youngsters in their teens and twenties, with type I diabetes seem to have been talking amongst each other.  First DKA brings them to the hospital.  What caused DKA is sometimes suspicious.  A spider bite, a wound on the leg, or sometimes a simple flu normally increases their blood glucose levels which do not seem to be controlled with usual amount of insulin they get each day. 

            Once in the ICU for insulin drip, they know exactly what to ask for.  They are admitted with stated allergies to Vicodin and Morphine and complain of pain on that leg 10/10.  That leaves the practitioners with the choice of Hydromorphon (Dilaudid) to order.  Dilaudid is a fairly strong and harmful narcotic that is prescribed only when the patient is observed closely.  For some reason they already know how often this medicine is prescribed and therefore their pain starts exactly when the next dose is due.  Many times as they ask for pain medicine, they also complain of itching.  Therefore, for the first few times the RN would ask the doctor for some Benedryl IV.  Dilaudid and Benedryl IV given within a few minutes apart, I heard it creates a good “high”.  Some sure know how to manipulate the system. 

You would think that there has to be an underlying issue here.  Type I diabetes, a chronic condition, will put the affected youth at a greater risk for depression.  Are these individuals depressed and unfortunately have adapted to poor coping mechanisms.  Yes, I would say they are and they all need a psychiatric evaluation.  It is true that they might be suffering from diabetic neuropathy and the pain is real.  But, when you see three different young patients from the same town being admitted to ICU for DKA and all have the same allergies and want the same medications at the same time.  It should raise some curiosity to re-evaluate our care and get more people involved.

Original Post:
June 16, 2009
Title; Chronic Pain Patients
I find dealing with chronic pain patients a pain in the neck. It is not that I don’t medicate them as ordered or report their responses as is appropriate. I call their doctors with their requests for more pain medication, more sedative hypnotics, more Benadryl, more sedating anti-emetics. Of course, not all patients suffering from chronic pain behave this way. But many do. I try to be professional and keep my opinions to myself, but I have no empathy for them. I believe they have pain. I don’t believe it is as severe as they claim. And so many of their behaviors are med seeking. It is very hard to separate. I have stated that our one to ten pain scale works for them, except that their pain is one OR ten. They are either in pain or not, which most often means they are sedated and sleeping. It often seems to me that they would be happiest on a Diprivan drip and vented…..I know. That is not nice. One of the things that make it hard to cope with, is that working a surgery floor, you see so many people that have had HUGE surgeries and ought to be writhing in pain, such as the lap chole with chronic pain is flapping around, writhing, crying out and acting out like a child. The elderly gent that has had a diverting colostomy because of a huge abscess on his backside is quietly asking for pain meds ever four hours. The vaginal hysterectomy with chronic pain is yelling and all over the bed. I KNOW that their pain is what they say it is, I get it. But it makes me feel so judgemental and non-sympathetic towards chronic pain patients. I probably need more education to help alleviate this feeling. It would not change my treatment, but it could change my attitude.

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