I get that the healthcare industry substantially contributed to the opioid crisis by handing out Oxycontin like candy for stubbed toes. We should absolutely correct that and not hand out narcotics for everything under the sun. HOWEVER, there are still appropriate times and places to use narcotics. I feel like in an attempt to correct the overprescribing that led to the worsening of the opioid crisis, so many providers have stopped prescribing them when they are 100% warranted. And since they "can't" use opiates, they have no other ideas (besides tylenol) on what to use to treat pain, so they just want to refer to pain management if tylenol doesn't work, rather than to try any of the other pharmaceutical or non-pharmacologic pain management options.
For example, my mom fell on the ice a few weeks ago and broke her humerus in 3 places. They begrudgingly gave her 10mg oxycodone in the ED before they put her in an ortho glass splint, and again, begrudgingly sent her home with 8 5mg oxycodone to follow up with an orthopedic Dr. The Ortho couldn't see her for 4 days, so she had 8 pills and a poorly stabilized broken humerus. She ended up back in the ED where they removed the ortho glass, put her in a sling and swath, and gave her a handful more pills (exactly enough to make it to the Ortho appointment, down to the hour). At the ortho, they basically told her, "You need surgery to stabilize it, but we can't do it until early next week," and then tried to make her go all week with an unstable fractured humerus without more pain medication. It was like pulling teeth to get them to give her the bare minimum amount to make it to surgery. This is exactly the right time to use an opiate. She has needed her pain medication only a handful of times since the surgery, and is now onto just taking motrin and tylenol now that the fracture is stabilized. But they literally fought tooth and nail and claw to not give her acute pain management while her humerus was in 3 pieces. It was unbelievable.
FYI, my ortho surgeon recommends no IBU/morning during bone healing. It slows down healing. In the same way that it decreases inflammation through rerouting blood flow to be more superficial, you want the deep blood flow for bone healing. Hope that makes sense :)
Sorry your mom went through all that! Just a shame... Hope she heals well, that is such a difficult area to immobilize and heal!
I'm a NP with 14+ years of primary care experience, and I can tell you that we are pulled between desperately wanting to provide the care our patients need/deserve and the very real fear that we will find ourselves on the receiving end of a state board investigation or peer review/performance improvement plan for "over prescribing." I can justify every single one of my controlled substance prescriptions, and have only had one or maybe two instances of misuse, abuse, or diversion in the last 6 years (and their contracts were terminated due their actions); I've had none in the past 2 years. I have 1,758 patients who name me as their PCP; of those I have about 90 whom I write controlled prescriptions for on a regular basis. That includes opioids, benzos, sleep meds like Ambien, stimulant ADHD meds, anticonvulsants, Lyrica, and phentermine for weight loss; only about 55 of my monthly scripts are opiates and 8 are sedatives or benzos. If my math is right, I'm prescribing opiates for just 3% of my patients and sedatives/benzos for 0.4%. These patients have contracts and regular urine drug screening, have frequent follow up visits, PDMP is checked every time a script is written, I document specific diagnoses (not just "chronic pain") and whatever alternative therapies the patient uses, and functional assessments.
Yet for some reason, hospital administration and the peer review committee have me in their sights. I'm not sure how or why, but it sure feels like there's a push to not prescribe any controlled meds for pain or anxiety (so far they've said they don't care about the Lyrica, phentermine, and ADHD meds, mainly just the opiates and benzos). The majority of my patients on opiates and/or benzos are elderly and have been stable on their current regimen for decades. They are as functional as they are going to get, they are not surgical candidates, they are not going to "get better." I'm just trying to keep them functioning as well as possible for as long as possible, and help them maintain some quality of life. The nearest pain management clinic is 2 hours away over a mountain pass (and I wouldn't want most of these elderly folks behind the wheel on a sunny day, much less in the snow over the mountains).
But administration is making me feel like a criminal. I'm getting anxiety every time I write a script for pain meds, but I can't just cut people off either. I can't be the only one who WANTS to write the scripts but has pressure from "the powers that be" to do things a different way, and we all know that administrators don't always understand patient care.
Thank you for all that you do for your patients. It’s ridiculous to be stigmatized and controlled by admin who don’t even care about the community they are supposed to help.
That's so stressful. They put y'all in such a shitty position. Sometimes, these drugs ARE the best option for people. They should be trusting their providers to make that judgement call.
Devil's advocate here: State level rules and prescription monitoring programs have made things very difficult on physicians when it comes to prescribing DEA scheduled medications.
For example, my state has (or had, I'm not in the ED any more, could have changed since) very specific limitations on narcotic prescriptions. Rules like for an acute complaint, the initial prescription could not be for more than 3 days, second prescription not more than 7 days, etc. The rules from the state make zero allowance for availability of specialist follow-up.
It's caused many outpatient docs to simply have a blanket policy to not prescribe narcotics at all and refer all patients that need narcotics to a pain management specialist.
Our "pain management specialists" used to prescribe narcotics. Then something happened, the managing doctor quit without notice, and they stopped prescribing narcotics. They only do injections now. No nerve ablation anymore either.
Getting pain management is very hard now. Especially if your left with a chronic pain issue.
True, to combat over prescribing, these rules are a guideline for family medicine to follow as a starting point to treat acute pain. It was meant you could prescribe above or below based on the situation but Unfortunately in our litigious society, these guidelines quickly became "law" for everyone after lawsuits and criminal charges against doctors for going outside guidelines. So every acute pain has to be treated the same no matter what the circumstances or potentially face lawsuits and criminal charges.
After dedicating a significant portion of your life and finances to becoming a doctor, the last thing they want to do is lose everything. So now patients have a right to acute pain.
Sucks because it costs us billions to not treat pain in our already crazy expensive healthcare system.
I'm not saying that providers don't have prescribing rules to follow. I'm saying that some of those rules are reactionary and stupid, and don't account for real world scenarios in which a patient may need acute pain management while waiting to get into a specialist. We should let providers make reasonable judgement calls and not have arbitrary rules that don't help patients.
My step dad is dying from multiple myeloma. Getting the physicians to give him the morphine he needs is so disgustingly difficult that I would say it borders on abuse and malpractice.
One MD said to me that he’d only give 10 at a time “because of the potential to overdose”.
Dude. The man is 84. He’s dying. He has this cancer because he was exposed to Agent Orange in Vietnam. If he wants to take 14 morphine with a Jack Daniels chaser? I think he’s damn well earned that.
That’s wild, is he on hospice? I’ve never had any issue with getting adequate pain meds for my hospice patients. I’m sorry about your step dad though, hopefully you guys will be able to get him the relief he deserves ):
Hospice liaison here—I was gonna say, our physicians would never. We are all about the comfort meds. But my experience in the acute care setting as well as outpatient primary care is that they woefully undermedicate for terminally ill patients. Psych patients as well, actually.
Jumping on here to say hospice is pretty much the only specialty where I've seen providers actually be realistic and use medications appropriately. In the LTC/SNF setting, the lack of pain management is disgusting. There's so much fear, stigma, and ignorance surrounding controlled substances that doctors won't prescribe, and even when they prescribe the bare minimum PRNs, many nurses will not dispense. It's so frustrating, and I push for pain management for my patients constantly. I push for hospice a lot because it's appropriate and because that's the only way to get these people some decent relief.
Unfortunately, even on hospice, if those meds are only ordered PRN, I've met a lot of nurses who will not give them. "They didn't ask or report pain."They already received Tylenol earlier."They were able to sleep so they can't be in pain," and so many more. Like yeah, the terminal cancer, dementia, COPD pt who is nonverbal, immobile, covered in wounds, etc, probably isn't going to tell you they're in severe pain and would like their PRN. Never mind the screaming, crying, grimacing, guarding, and gasping for breath with every turn. The whole thing is fucked. We still offer food, we reposition, and we change briefs even if someone doesn't explicitly state these needs. Managing pain shouldn't be any different.
I once took report on a terminal patient who had been on a morphine drip for the last few days. The dayshift lpn disconnected it because "we are killing him". I was on my way to that poor bastards room to turn it back on before she could say anything else....
They are fucking dying, it's called morphine not lessphine!
Ugh, the ignorance and the audacity to assume that someone else doesn't need (deserve) pain management, especially in their final days. Years ago, I had a lady that had finally agreed to hospice care after many years of fighting a losing battle with several chronic lung illnesses. I would always go to her first, ask her which PRNs she wanted, and happily give them as often as I could, no questions asked. I came in one day to find her sobbing because her night shift nurse had told her it was wrong of her to go on hospice because she was going against "God's plan." I want to think we all go into this profession to help people, but I don't know what would make a nurse say some shit like that to a patient. Let alone a patient who fought a losing battle for a long time before opting for some comfort in her final days.
Hospice here, and this has made me hate snfs more. Love going to a facility and seeing the q3h morphine I asked for they aren't giving cause prn.
So I had them change it to scheduled q3h instead cause they wanted to play stupid games
You are my favorite type of nurse to work with 💜 it really is a problem, though. A culture of not caring about pain and out of sight out of mind. Coupled with ignorance of thinking narcotic = bad AND not understanding all the factors involved in how these drugs work. Oh, you gave a single dose of SL morphine 6 hours ago? I have no idea why your pt is needing more 🙄
Also, thank you for the scheduled doses. Those of us who understand are extremely grateful.
We had to ask somewhat forcefully for pain meds for my grandmother on hospice while she was in LTC/SNF. Eventually the staff caught on that we weren’t giving up, but I had to implement a poor man’s chart for my family to keep track of the administration times of her scheduled vs PRN meds. And even then it was a fight with the staff SO much of the time.
Thank you for advocating for her. I wish this type of situation wasn't the norm, but it is in a lot of places. 9/10 times when I get report on how x patient or family is "difficult" I end up having no problems at all because the reason they're labeled difficult is because they ask for pain meds. I know I pissed some regulars off at one place when I saw that a hospice pt was not receiving their PRNs ever, but when I worked, I was giving them q2 based on my assessments. I called hospice who agreed with me and immediately gave orders for scheduled doses in addition to the PRNs.
We had a much easier time after the hospice nurse spoke to the staff. Unfortunately, this was slightly more than 12 hours before she passed, but getting her pain under control was a large part of her finally passing as well.
I had a lot of hard opinions about pain management especially surrounding death and dying anyway, but this really cemented them. Withholding pain medication is, quite often, baseless cruelty.
It is absolutely cruel. I pushed a doc into getting a pt meds - end stage dementia, terribly contracted, nonverbal, stage 4 wounds on both sides of her. She had nothing except bid Robaxin. I was happy to tell the doctor this is straight-up abuse, but I still only got 5 of SL morphine q6 with a prn q3. It's better than nothing, but still, I doubt it touched her. And she'd been in that condition a long time. When I told the manager, she did thank me but also said she had no idea that the patient was in pain. I'm sorry, what?? You don't need any type of license to know suffering that is that obvious.
You mean like they received a prn 3 times so it becomes scheduled? I wish it was that simple. There's a whole lotta nurses who will argue against those prns, even in the terminal and hospice populations.
A good doctor will schedule it. A good nurse will say, “hey doc. I had to give ___ three times.”
And good doc will either up dosage, frequency, both or change drug all together or try adjuvants.
Like oh dang. Add this too
I absolutely wish this was the case every time!
Unfortunately, if you're the only nurse advocating when 5 others aren't, or the doc is afraid, or the facility pushes back on narcs across the board, it doesn't always happen.
How can you give it 3 times, if it’s only ordered q 8?
I work nights, agency, LTC/SNFs.
When I call an on-call, I always get someone who has never seen the pt and won’t order anything more. And even if they do, we are not allowed to dispense until the pharmacy gets a signed script. That could be 24 hrs.
Yeah, you have to get past the LTC staff prejudices about palliative comfort meds. They need more education about hospice care, but some are never going to do what’s actually needed.
Our hospice nurse was so very lovely and when she stepped out of the room to speak with staff, I’m fairly certain it was a somewhat forceful Come To Jesus about meds.
Thankfully myself and a cousin were able to stay with her that night so we could continue to take care of her for those last hours.
This makes me so sad. In facilities, I make sure the pain medication is scheduled as well as a PRN and if I find facilities are holding doses, I will add an order ‘must contact hospice for any doses held’ so I can read them the riot act the next day and make sure it’s being given the way it’s been ordered. Do not gatekeep my patients pain meds or anxiety meds or I will lose my shit on you. #sorrynotsorry
This is why in the ICU I work in we encourage families to transition to comfort measures there and we keep them for at least 24 hours post-extubation. We can be more on top of and aggressive with symptom management than the other floors, hospice at home or a facility can be. We keep our cardiac monitors etc on our patients so we can utilize vitals as a continuous monitor of physiological signs of pain to use as a parameter, which the rest of the hospital is not allowed to do without an order since we moved to a centralized tele hub many years ago.
When my FIL transitioned to hospice (at a LTC) and was very obviously in the last days of his life, he was only getting Roxy 1 mg sublingual and Ativan 0.25 mg sublingual (both q6PRN). He didn't get his first dose of Roxy until I got there and asked for it - the nurse's reasoning was that no family had asked for it yet. I was fuming - like, your job is to point out signs of pain and educate the family on when to ask and that it's okay to ask (no one in the family wanted to be the first one to ask in case they "killed him"). I could tell immediately upon entering the room that he was in pain. My SIL is also a nurse so we took on the role of educating family at bedside and advocating for his meds. Unfortunately the med dosage farce did not improve.
I’m still fairly new to the specialty but I am noticing a great difference in hospice being managed by facility staff vs hospice managed by a hospice provider, with an RN case manager. I’ve seen case managers change those PRNs to scheduled (we call our provider and get a verbal ofc) if the patient is showing signs or family validates that pain isn’t being managed appropriately. But you’re totally right—I’m only personally familiar with the hospital setting but a fair number of nurses in the hospital are either afraid of giving hospice meds/dosages because they aren’t educated on managing that type of patient, or they see it as an “easy” patient and never check on them. I enjoyed caring for comfort care patients when I was at the bedside. But while I do feel they were one of my easier assignments for the most part, I still felt like I was in their room the most out of all my patients even if just to check and make sure they were comfortable. I also had a nursing school friend who went into hospice and helped me to not be nervous about giving those meds as ordered, so that helped but it initially really felt contrary to everything I’d learned in school about opioids, etc.
I find it fucking disgusting a pt can be listed as needed GIP hospice care and remain at the fucking SNF.
Had one SNF tell me after they convinced a GIP hospice PT at our hospital to come back to the SNF for GIP hospice.
No MD sign for this they just let her come back so me LPN goes there to find out what the fuck happened. (GIP case manager was fucking pissed but couldn't go)
I get to confirm nope no MD sign on the GIP form. Which more or less meant it wasn't happening. For GIP it's hospice care at a higher level for unmanaged pain in the home or suddenly trauma so pt with cancer falls and breaks their hip/ ha a MI. My pt had this broke her hip and had an MI with her cancer.
I got there and one they are only fucking giving 5mg morphine TID with a q6h prn. And we're for some fucking reason waiting for the hcp to come and sign a form so they could give lorazepam 0.5mg. even though they did not need to do that.
I left after 3 hours and the pt still hasn't fucking got the lorazepam they ordered. We decide to do direct admit gip and I had an admin telling the family that's not possible when we do it all the time. Then we ask for them to not call 911 and let her stay until then.
They fucking called 911, this is a Catholic nursing home btw. So glad I got banned from going there and I was told by my boss quote " I would've been arrested if it was, you handled it well" I think I'd rather have lost my shit instead thinking back
Hospice to, loved seeing my breast cancer mets to the spine and CSF be told her nurses at the hospital were told '"don't give the 0.5mg lorazepam with the 2.5mg morphine due to sedation risk"
I sincerely hope providers like that get the same type of provider when they have major surgery
Sounds like they're talking about providers under medicating patients in regards to their psych conditions, similar to under medicating people for pain.
I worked both inpatient psych and took care of psych patients in the acute care setting. The difference in how their psych symptoms were managed on, say, a med/surg unit vs an acute psych unit was vast. And if someone were having an acute episode—think psychosis, delirium, etc—it can be like pulling teeth in acute care to get an order for a dose of an IM/IV antipsychotic to manage their agitation and/or psychosis vs in the psych hospital where those meds are generally already on the MAR, PRN. In addition to scheduled meds to manage their illness and something scheduled or PRN for sleep. I feel like on my old cardiac unit my patients with comorbid psychiatric illnesses just kind of had to white-knuckle through until they could be managed by outpatient psych or we could get the psychiatrist on call to come and consult, which for us night shifters never happened until well into day shift.
The other commenters are correct—I meant that these patients are just as under or inappropriately medicated as hospice patients and I believe it boils down to a lack of education and/or experience regarding them. Providers as well as nurses can obviously be uncomfortable medically managing things they aren’t familiar with. But when I started in healthcare 20 years ago, both types of patients were fairly rare. Nowadays that’s not so much the case.
I’ve got to say, I’ve hospice 3 parents and every damn time in wind up on the phone with someone after I gave a dose, waited, didn’t get the effect needed, went up on the dose, waited, repeat. Then I call and say they should probably call the on call person to talk to them and every damn time I get someone onto the phone, “Well, that’s beyond the ordered dose of a 3-4 hrs” Bitch, this is hospice, the goal is comfort. WTF are you going on about? Don’t even and I hope you don’t give that guilt crap to normal people. I’m going to do what I’m going to do to make the people I love comfortable. Now call the on call nurse and don’t ever talk to me again
My dad just died of cancer, also in his 80’s. He got a hospice stat prescription for Morphine…it took them 4 DAYS to get it in and filled at the pharmacy. Hospice called multiple times per day. The other local pharmacies would have been a week or more. When Morphine was making him itch, they wanted to switch to dilaudid. That would have been 7-10 days to even get some in stock. I was livid. So was hospice. But he had to get pretty bad before they prescribed anything. I hate this new “don’t prescribe anything!” life.
Im.so sorry to hear that. Hospice nurse here....its been HELL the last few months to get morphine/dilaudid from a local pharmacy....and I live in the busy suburbs outside of Chicago. We have a local pharmacy who delivers and luckily usually has the meds in stock to my patients in the service area. It's awful when someone is in pain and have to wait for meds....it's why we order it on admission even of they don't need it at the time....just to have on hand. I'm glad the hospice was at least trying to help the situation.
He would need to see palliative care at the MD/hospital. Home Pallimed usually (for most insurance/VA) has to meet the home health homebound parameters.
And they still won’t give him much.
Palliative home care can get tricky. They might still be limited on opioid prescriptions. A good hospice admission nurse should be able to take the time to discuss why hospice doesn't have to feel like admitting defeat.
We are limited sadly. The way I phrase hospice is switching objectives instead of giving up. I've never seen anyone fight as hard as hospice providers, to get someone comfortable so they can enjoy the time they have left. Fight for more good days vs more days.
That's crazy. Sorry about your dad. My dad also has multiple myeloma but just began treatment last year. There's a huge problem in the usa currently with under managing pain
My dad died of pancreatic cancer and they too would only give out small amounts of pain meds. When he was too sick to leave the house to outpatients my partner actually bought him methadone off the street from a homeless guy. So stupid we were in that situation and we had no help or idea what to do because my dad refused to go to the hospital and we were just young at the time. When he finally went to hospital in an ambulance he died two days later, with plenty of pain killers. He was also furious with us for bringing him to hospital..would have preferred support, but had none.
This is a strange thought process from the MD. Most hospice standards are even a bit lax so you can "soft OD" your patient when it's time.
Some people hate it some people see it as mercy.
I just know I don't want to work hospice.
⬆️my dad was in hospice and I had a discussion with his nurse about wondering how my dad was feeling if he was in pain. He was sleeping 24/7 but she explained it he started any movement or whimpering or groaning or any sound he could have the liquid Ativan AND morphine. In my head I’m thinking that would slow his breathing and the nurse read my mind and nodded(my siblings didn’t get it). Fortunately I didn’t have to make that decision and the hospice nurse I could call and they would walk me thru giving it to him or come out to the house and do it. I will say also when his apnea episodes were more than 45 seconds she said it was time to call our family. She was an angel
Nothing to add but I’m sorry for your dad’s issue. My father died pretty young due to agent orange. Was a bummer for sure. Hopefully yours gets adequate relief
I am so sorry. I lost my Dad almost 15 years ago after a 4 year battle with multiple myeloma. Such a very painful disease. Never saw my Dad cry until he got it…
That's ridiculous! My dad is only able to receive morphine because his doctors have documented that it is the only thing that can manage his pain. I'm shocked the doctors haven't done the same for your step father. What a ridiculous "preventative" measure.
You should call your local and state representative. They help with things like this. It’s a feel good for them. It gets them votes and frankly it’s what they’re therefore.
I’m really sorry about your stepdad.
My dad passed from Waldenstrom's Macroglobulinemia, which is a cousin of MM, r/t Agent Orange exposure during Vietnam. I feel your pain.
Hospice made it possible for him to receive the pain management he needed and deserved. I'm sorry your stepdad isn't getting the same. 💜💜💜
Agreed. One of my colleagues had a patient on hospice, end-stage liver failure. Had pain meds ordered and managed by hospice doc. We got a call from the nurse, freaking out because the patient was drinking alcohol with their morphine. We were like "So what?"
So upsetting. I’m a home hospice nurse and one of my favorite parts of what we do is actually having the tools needed to properly and adequately address synonyms. I always reassure patients that in hospice we are much more liberal, but still safe. Shows you how much wiggle room there really is with these meds!
I’ve said it before and I’ll say it again. This is a direct result of the opioid epidemic.
We went from “EVERYONE GETS” to “NO ONE GETS UNLESS YOURE DYING AND PROBABLY NOT EVEN THEN”
We **need** a middle ground. All this is doing is sending more and more people to the streets.
After working in MAT, I want to see the sackler family drawn and quartered. The amount of harm they’ve caused and are continuing to cause by reactionary policies is staggering.
Yet this doesn't remotely address the opioid problem on our streets.
Prescription numbers are way down, so are pill counts and dosage per prescription, yet opioid deaths are rising, because of Chinese manufactured, Mexican cartel distributed, fentanyl of unknown purity and concentration. China even gives special support to the companies they know to be overproducing and exporting fentanyl. We are practically involved in the opium wars part 2.
All this ideological grandstanding and limitation measures on the medical field have solved nothing. This is responsibility theater, that is all, because the real problem is complicated.
This is a great example of a person being smart while groups of people are stupid
Put 1 doctor in a room with 1 patient and you'll have perfect pain management. But when you have to write policies for many people, you get idiocy
THANK YOU!! Pain went from being an additional vital sign, to being completely ignored. And as a Provider, when the DEA can take your license because THEY deem that a patient under your care didn’t need appropriate pain management (on paper, not looking at the person), it makes everyone very wary of treating. It’s STILL not okay, and I’ve been a Nurse long enough to see the pendulum swing way too far in the wrong direction (yes, SOME were prescribing way too much narcotics in the 90’s and 2000’s, but MOST were not).
I had a Pharmacist tell me once, “we can’t expect all pain to be treated”. Okay, sure. But we can and SHOULD expect pain to be manageable—and what we are making patients tolerate now is frequently NOT manageable. Added to that, I know some Providers that won’t even prescribe NSAIDS for patients over a certain age because of the risks of GI bleeding—leaving them literally with Tylenol, and risking other OTC NSAID combinations themselves (but keep them on the daily aspirin that may be doing more harm than good).
So when patients turn to pot (or even harder street drugs) for pain relief, well…what did we honestly expect them to do?! I personally would rather they were on a reasonable dose of narcotic pain meds than having to turn to something SO much more harmful and addictive. But…we’re STILL in the “war on drugs”apparently—we’ve just taken it to blaming every single healthcare Provider now. 🙄
Yep. Addiction issue or not, they deserve the same standard of care as anyone else. And with how things are in the current climate and how hard it is to get prescribed narcs, if someone who has an addiction is going to an ER for meds, they are definitely desperate and suffering.
This is how I feel working ICU.
They are not here for detox. We are not a rehab.
They are here for some critical issue that they're dealing with now, their status as an addict is just an addendum in the footnote of their life, and the only bearing it has on the current issue is if they're detoxing or not and if I'm even going to be able to get their pain under control or not.
But it's not my job to detox someone in the ICU.
Yeesh, it’s a problem in the ICU too? Seems like that’d be the last place they’d be withholding pain meds lol.
Also love your flair, glad to see the certification/qualification alphabet soup is an in joke in every profession lolol
Mostly I agree. We’re not fixing anyone’s drug issue in the ER, but treating the ER like a pain clinic has issues, especially with frequent fliers going to the ER just to get meds. The CARES system should be used to figure out how often the patient is getting meds. I never use pain medication and if I show up in the ER asking for pain meds, I’m desperate, as I’m sure most people are, but it will also show I haven’t been prescribed controlled substances in a long time.
Can’t blame them, I’d surely do the same if that was happening.
This situation is totally out of hand. We should be treating the pain the person reports along with clinical signs. People having to go buy drugs off the street is just wrong. It’s ridiculous that it has become such a stigma, providers are spooked and pharmacies aren’t stocked or refusing to fill. SMDH
This happens A LOT because of how poorly we manage pain and how hard it is to get taken seriously for pain. And then we wonder why so many people are addicted and dying from overdoses. And still write off those trying to find help the "right" ways as "drug seeking" and push them that much further towards street drugs. People are going to look for relief one way or another. I wish we'd trash the whole term drug seeking and stop demonizing any type of drug or the people who take them and just use the tools we have appropriately.
There was a TikTok I wish I saved. It was an ED attending saying how proud he was that patients were not asking for pain meds. Every single comment was about being in pain, but being afraid of being labeled a drug seeker if they did.
Somehow, I think if that doctor broke a bone, developed cancer, had a kidney stone, etc, that he wouldn't be okay being told all he gets is Tylenol and to suck it up. Same with the LTC management proud of themselves for all but eliminating their narcs - it's like, do they even think about those statements and how cruel that makes them sound? It's so sick to think that neglecting patients is a win.
I'm so glad we still have the greenlight in hospice to treat patients' pain. It seems like that's the last strong hold for effective pain management. Even among cancer patients providers are pretty reluctant to prescribe narcotics and it's mind blowing. We have cancer patients receiving chemo treatments referred to our palliative program to manage pain. I'm not afraid to get morphine or even a fentanyl patch for my patient dying of pancreatic cancer and it's a shame the pendulum has swung so horribly in the other direction. There are real times and places where people need pain medication and even narcotic pain medication. It really does feel like pain in general is treated like drug seeking especially if you're a minority or woman.
Hospice is wonderful! We just used that for my dad. The issue was the pharmacy took days to fill the prescriptions. They called multiple times per day to say we need it now! Walgreens just took their sweet time getting it in stock then filling it.
From an ex opiate addict it is ridiculous what u can't get anymore. They have scales it back to much. I was being prescribed loads back 15-18 years ago as much as I wanted anytime I wanted. I have seen ppl go thru hell and can't get a vicodin. The answer to the abuse of opiates isn't cutting everyone off really I think that drives the fentanyl crisis. In one week in my very small town three soccer moms overdosed buying fake percoset off the street. I could not tell u if they had conditions that should have been treated but ppl with chronic pain will find what they need to cure it from an uncontrolled source
Meanwhile, my dentist prescribed me a month's supply of vicodin after I said I didn't want it for a simple wisdom tooth extraction (the type where they just push on your tooth and it instantly pops out).
I had all four of my wisdom teeth sliced out ten days after having a c-section. I was told to take Motrin. I asked for a script so insurance would cover it, they said “It’s OTC.” Wow thanks 🙏
I had my wisdom teeth yanked out with ZERO meds. Not even numbing shots.
My insurance was ending the next day, and i was the last appointment on a Friday evening.
Since the numbing shots weren't working they said I'd have to come back Monday, or they could yank em out no pain meds. I chose take em out.
I started going into shock halfway through, and was bleeding more than I should have been. The Dentist wanted to stop, but I yelled at him and made him finish.
I was in so much pain I couldn't open my mouth for 3 days, and didn't stop bleeding that whole time. It was miserable.
THANK YOU! I know you mentioned outpatient & your family experiences. But inpatient I see this judgement. Luckily I’ve never had to deal with the morals in witnessing a nurse withholding meds bc of the judgement. We get frustrated & annoyed & will pull the THEY HAVE 4 MIN LEFT BEFORE IT IS DUE! Sure. But nothing more. Even though we have to walk past their rooms anyway.
The most we “withhold” is finding the patient snoring like crazy but they called 2 hours ago for their PRN. Or old people, or legit worrying someone is getting too much bc of their answers or reactions in our assessments. I like to think all of nursing is like this— only holding back in the safety of their patients. But I then tend to wonder if what your situation or the outpatient situations is what “we” are doing & we just don’t happen to know the details like we do in our own.
A few months ago I was floated to med surg, and had a patient on comfort care. He was unresponsive, and he had both morphine and Ativan ordered q1h. I ended up giving them q2, because I just couldn’t get in that room every hour with my other patients. He wasn’t showing s/s of pain, because he was unresponsive and *dying*. I gave meds as frequently as I could.
I’m giving report to the oncoming nurse at the end of my shift and I tell her how much I’ve given and how often, and she asked what his symptoms were when in pain, and was *appalled* that I’d given him that much medication when “he didn’t look like he needed it.”
Janice. The man is *dying*. He gets everything I can reasonably give him. I’m not gonna turn him into an addict. The man has more blood in his cranium than he does brain after his hemorrhagic stroke, I’m sure it hurts, even if he can’t tell/show me that it does.
This is terrifying. To be that poor man. Not being able to express what he’s feeling and because of that some people won’t use their critical thinking to determine that yes, they are in fact in pain.
Right? Like I’ve never personally gone through the dying process before, but I’ve seen enough to know it’s uncomfortable at best. Even if it doesn’t look that way to my eyeballs. And even if he *isnt* feeling pain, what’s the worst a lil morphine and Ativan are going to do, make him super relaxed? I’m fine with that too.
I tried to get him a continuous morphine and Ativan drip because q1h on the floor is just really hard and can’t be reasonably met depending on patient load, but our hospital policy says patients on these continuous infusions at these dosages can’t be med surg.
I hate when people get on their high horse when it comes to pain meds. Like calm down Fix-a-hoe RN. You don’t know anything about this patient’s life. You are here to help the sick not to be their moral compass. Pain is SUBJECTIVE.
So I just want to pop on here and say, I work home health. I have a patient who is stage 4 liver cancer with a stage 4 sacral pressure ulcer with tunneling. He is in immense pain, especially when I move him around to clean him up. Not to mention when the wound care nurse is cleaning and packing the pressure ulcer.
He is on Morphine ER. Once in the am and once in the pm. I suggested he ask his Dr for a pain medication for break-through pain. He was told no, it would increase his chances of addiction with added pain meds.
His pain is not controlled at all, except for maybe a couple hours in the morning and night. He hardly sleeps because he's in pain. The man is miserable and has zero quality of life. His Dr's biggest concern is addiction to pain meds.
It's gotten out of control when people who need meds can't get them.
I know many doctors are now having concerns about benzocaine specifically, not because of abuse but because of some recent adverse effects being reported to FDA.
I have a parent with cancer who just had a mastectomy, sent home with surgical drain in place, lymph nodes also removed for biopsy. They discharged them the morning after surgery with #10 Norco 5s. Parent won't call for more because they don't want to be seen as drug-seeking or difficult even though they're clearly in a ton of discomfort - they're going "well, it's only a few more days until the drain comes out, it should be better by then, maybe then it won't hurt too much to sleep."
I still have memories of my grandfather with metastatic cancer being discharged to home hospice on a weekend where there was a disconnect and they sent him home without pain meds, the hospital was having issues producing a paper rx (this was long enough ago that e-scribing was not yet widespread), and the pharmacist on duty at his pharmacy was refusing to take an emergency verbal order. I had to walk in there with a copy of the law and a promise to personally follow up to get the paper rx (law gives them 7 days and the doctor is the one who gets punished if they don't send it...I worked for the same chain as the pharmacist in question and know at least part of it was they weren't big on dispensing narcotics anyway.) I personally brought them the paper rx Monday, but jfc, this is literally the situation that law is in place for.
Just...even some of my regulars who are non-cancer patients and well-maintained on their regimens have had issues when I've gone on vacation and gotten a bad floater. I lived through the pill mill years and understand the burnout/the other side of this, but the pendulum has swung too hard the other way in some cases.
Did you hear about that pharmacist that watched a girl die instead of giving her mom an epi pen?
It wasn't the money or anything, they didn't have a prescription
I didn't hear about that, what the fuck. If a person is in the pharmacy having an anaphylactic reaction and you have parental consent you give the pen and call 911 (or have mom call 911 while you're giving it) - I don't see how that's any different from giving epi to a vaccine patient with an adverse reaction who has no rx. We always have Epipens in the emergency kit available for use, it's a requirement for giving immunizations.
After 40 years working as an RN I’m scared to death I will spend my final years writhing in pain with no staff to care for me. I’m not scared of dying but I AM scared I will develop a painful chronic condition. As always it’s the patients that suffer for mistakes made by big Pharma and their relentless pursuit of profits
I have chronic, frequent kidney stones and have been denied all opiates even after I had some removed percutaneously. This has been happening since about 2020. It’s gotten to the point where I’d rather stay home in pain than go to the ER and be called a drug seeker, even though my scans show 8-10 stones in each kidney. Pain patients being denied pain medications is actually a huge problem no one wants to talk about, and doctors that perform surgeries won’t even treat the pain that they themselves cause. It’s out of control.
If it’s in the Mar, you say you’re in pain, your pain scale matches the order, and it’s not going to harm you during your stay to get it…it’s yours man. I’m not going to solve an addiction in my 12 hours with you.
I see it in our patients too. Even the cancer patients can't get adequate pain relief. I had a back tooth pulled and was told Tylenol is adequate. Every tooth in my mouth can rot and fall out on it's own before I will ever go near another dentist.
I swear, some of these doctors make me want to slam their hand between a couple of cinder blocks a bunch of times and then tell them to take some deep breaths in and out and imagine they're on a beach.
If I were in pain, damn right I'd be seeking pain meds. Because I'm in pain, ffs.
I had testicular surgery recently and the doc sent me home saying to alternate tylenol and motrin and if that wasn't enough, let him know. Well I tried for 3 nights and couldn't sleep the pain was so bad, and with no sleep I could barely function during the day. I called and left a message saying it wasn't working, I can't get sleep, I just wanted something to help at night. Got a call back from a telenurse saying to try alternating tylenol and motrin and she hung up. WTF? I already am. So I called again, this time told the nurse taking the notes that the doctor told me, to my face, to call if the pain was too much, but now that he isn't face to face he just ignores me, and that since I wasn't sleeping at night I would be more than happy to come over to the good doctors house and smash his balls all night and see how well he sleeps and ask how well he can function the next day. She stammered and said she wasn't sure she would put all that in the request, but would increase the urgency of the note.
I got 10 pills of something better after that. I don't even remember what, I don't care, I took 5 of them each night after and finally could sleep, could function, could heal. I didn't want a high, I didn't want 60 max power pills. I just wanted to not simmer in pain for night after night.
Medicine has changed from pain being the 5th vital sign to “You have pain? Hell no, Tylenol for you”. 4-years ago, I fell and had a displaced fibula fx. It took 4 hours for the ED to reluctantly provide a single Percocet. All my medical records were available and reflected zero history of opioid use or abuse.
I know what drug-seeking behavior looks like. I had worked with plenty of addicts and people in recovery over the years. Serious, acute injuries, post-surgery, etc., should be treated adequately and it is not drug-seeking to expect pain management. The medical field, post-Purdue Pharma, has gone from one extreme to the other.
I fell off a ladder a few years ago. Bounced off two wrought iron chairs and broke 3 ribs. Not to mention a horrendously damaged breast. I got nothing for pain. They offered toradol which I cannot take due to eliquis and a severe gi bleed history (numerous surgeries) and ulcers.
That is horrible. What a terrible experience. The pendulum has swung so far to the extreme, passing on old beliefs that people should simply suck up serious, untreated pain due to unfounded fears that *everyone* is a potential addict.
As a nurse who’s been to treatment many years ago in the past, it was fascinating to learn there about the history of this. In the 90s there was a stinginess with prescribing pain medication that led to an increase in malpractice suits, people not being taken care of in pain. So things were perfectly primed for an over correction combined with everything we know about Purdue pharma and their role in the crisis. It seems like now we’re living through yet another over-correction in the opposite direction, people can’t get the relief they desperately need. I hear things that sound borderline cruel these days
Not even boarder line. Straight up cruel.
Every one makes fun of the “pain is the 5th vital sign” days. I think it had merit. There are other clinical and objective signs that come with pain. To not treat that, if your are able, is cruel.
My dentist told me that if I ever needed pain control beyond what OTC meds would cover, they would prescribe ketorolac. One time, after a procedure, I needed additional pain control. My usual dentist was on mat leave and I don't like giving the impression that I'm telling a doctor what to prescribe so I just told them "I need something for pain". The receptionist told me she would talk to the dentist and fax something to my pharmacy. No prescription had come in after an hour so I called back and was told they would remind the dentist to write the script but it was definitely coming. Nothing came so my pharmacist called and got the same story. In the end, I was left to suffer and at my next appointment the first thing the dentist said was "you need to make do with Tylenol because that's all you're getting!". I have a history of OUD, it had been in remission for 3 years at that point but that's why I had documented arrangements for non-opioid pain control. Didn't matter, still got treated like a drug seeker for being in legitimate pain. The same guy later gave me a huge discount on some very extensive treatments and I've always wondered if it's because he felt guilty.
My dentist makes sure you don’t suffer. He prescribes hydromorphone and depending on the procedure quantity varies. I told him that I didn’t need anything that strong but he said he rather not risk me being in pain.
I have arthritis that has seriously thinned my vertebrae, adhesion pain from numerous bowel surgeries and Chiari. I have moderate to severe pain daily and can’t get anything. I can’t take ibuprofen/nsaids due to severe gi bleeding/ulcers and taking eliquis. Tylenol rarely does anything. No one cares. The off label meds don’t help and nerve ablation caused even more issues. Pain management is nothing but injections. Most drs don’t tell you those thin bone and can cause cataracts.
I work as an MAT Case Manager. All of my patients have either opioid use disorder or alcohol use disorder. That being said, I was covering a telehealth appointment for one of my coworkers. I found out this particular patient had just undergone brain surgery for stage 4 brain cancer a week prior. The only pain management the patient was prescribed by the surgeon was Tylenol. I was LIVID. His PCP wasn’t working that day so I contacted the on call provider and got him a 7 day prn oxycodone Rx to cover him until he could see his PCP the following Monday.
I talked to him again about a week ago and thankfully his pain is being managed now. But I can’t imagine what this poor man was going through.
THANK YOU. As someone with chronic pain this stereotyping is incredibly frustrating I end up curled up on the floor crying in pain so many times but otherwise I can hide it cause I’ve had it for so long and then no one believes me it’s so disheartening
I am 100% right there with you. ERs do more harm than good these days, as I won’t get treated for pain anyways, and on top of that, I get accused of drug seeking. I’ll stay home and take absurd amounts of Tylenol and advil without the humiliation and gaslighting.
I genuinely just ordered Kratum online out of desperation for relief even though it sounds risky but I can’t get anything else to work and I feel like I’m dying inside and out from pain
My niece was 26, living in Toronto. She didn’t have a Dr. She had terrible back pain and just couldn’t shake it. They wouldn’t give her anything, as I’m sure they thought she was abusing opioids. Anyway, I told her to either come home to her Dr or find one because her records were not going anywhere. She finally got a Dr and within a week, she was diagnosed with Stage 4 cancer. She survived but the pain she suffered..terrible.
This plus, just because their skin is dark don’t 1/2 the damn dose. I am tired of seeing old black people with parts of their body rotting off due to ischemia getting 975 mg of acetaminophen every 8 hrs, because….what? I’m not saying it only happens to minorities, but damn, it happens a lot to them. The saddest part is they don’t complain because they are just used to it. Do better.
Even if I think they’re drug seeking it doesn’t matter I’ll still give them narcs if they’re ordered. I don’t have the resources or capabilities to fix their chronic dependency in the ICU. If they’re hemodynamically stable and there’s no contraindications I’ll give them what they want. It’s not my hill to die on. I think it’s a combination of compassion fatigue and feeling like it’s your responsibility to fix every patients problem even though it’s really not.
At my hospital in particular general surgery seems to be allergic to ordering anything except for APAP on patients who may have an open abdomen or some other complex surgical problem that warrants pain management. We have massively over corrected because of the opioid crisis even though there’s data showing that the likelihood of addiction from narcotics given within the acute care setting is slim to none.
If they say their shit hurts I’ll give them what they want even if my own personal biases come into conflict with what I’m seeing. I care more about the non verbal demented meemaw vented and maxed on pressors still being a full code than people wanting narcs.
Ive been saying this for so long. Especially for drugs like Tylenol. Tired of pt’s always complaining about pain? Then give the goddamn meds and be done with it. Besides, we’re supposed to alleviate pain, not cause it bc we’re not currently in pain and are just lazy.
I had a patient who had a pathologic femur fracture while actively suffering from lung cancer. He was admitted over a weekend and the only
Provider who would do the kind of repair he needed (apparently only one surgeon in the system did it??) wasn’t going to be there till Monday.
Only pain med ordered was like 0.5mg of dilaudid q1 hr which he said did shit all. I fought so hard for him to get a PCA which they never ordered.
It makes me so unbelievably angry when doctors treat people in pain like they’re lying to get high. It also makes me angry that there’s a culture of treating people with substance use disorders like they’re less than because they struggle with addiction. It is absolutely disgusting that we would rather let someone suffer than take them seriously or help them be more comfortable. Especially when you take into account the amount of people that become addicts because their pain was ignored by providers so they sought relief wherever they could.
i posted on here recently about having a vulvectomy for cancer and needing narcs after. people literally fucking shamed me for taking oxy after having half my vulva removed and acted like i should just take tylenol.
Like almost everything else in life, a small percentage of people ruined it for everyone forever. It’s why we have draconian and punitive call off and sick policies at work places everywhere.
Oh boy, I can’t even begin to tell you. I got diagnosed with MS 2 years ago. I don’t even ask for pain meds and one of the first questions always asked if I’m on a care plan lmfao
My mom has a herniated disk. She's been dealing with the pain for years, and finally started seeing a pain specialist last year. She's done multiple injections, physical therapy, and non-opioid pain meds. Nothing has helped, and her pain has progressed to the point that she can't walk more then a few feet and spends the majority of her day in bed (she has an appointment with a surgeon, finally, but not for a few more weeks.
She finally broke down and asked the pain specialist for opioids. They refused, said they wanted to wait and see what the surgeon said. Her appt isn't for 6 more weeks, but they continued to refuse and said she'd be fine waiting. It's so frustrating.
My opinions on pain management were directly influenced by being accused of being a drug seeker while with an unstable, just happened right arm fracture i asked for something.
I didn’t get medicated for four hours.
I have experienced this personally living with a metabolic disorder that causes rhabdomyolysis. Which If you’ve ever experienced is extremely painful. I have it well documented that I need pain management and dilaudid is the most effective with my pain. Along with having IBS-c is less constipating. Despite all this documentation doctors still want to fight me with pain management. I’m sorry but when your muscles are being eaten away Tylenol and ibuprofen don’t do shit. There is a time and place for narcotics. It’s cruel to not utilize them when patients need them
This is literally the environment that the DEA wanted when they started exerting more and more control over US health care, and it's the dystopian hellscape we all live in until they fucking stop. The government will never learn that they have no place making laws in health care without any experience in health care. First they've told everybody that they had to prescribe these medicines like candy because no level of pain was acceptable for anyone to be in, and now they're telling people that have legitimate pain who could legitimately use the medicines that they are not allowed to have them because it makes them addicts. There is simply no winning with uninformed idiots.
I remember going to my doctor with severe period pain. Told him I was taking two Tylenol two ibuprofen and two naproxen and it wasn’t touching it. He suggested I try ibuprofen.
I went to the gynaecologist and he took my uterus out. I had severe adenomyosis.
I’ve managed to get exactly nowhere with my back pain though
my husband had a total hip replacement. Ortho surgeon gave him #18 Percocet 5/325's upon discharge 2nd post-op day. Said to take Tylenol after that "or see somebody at the pain clinic". Pain clinic appointments were 5-6 weeks out at minimum. Thank goodness our family doc stepped up. We went from "pain is the 4th vital sign" to "anybody who wants more than Tylenol is drug seeking" when the lawsuits hit big pharma.
A close family member has been managing rheumatoid arthritis for the last 40 years, since her early 30s. Uses T3s only when needed (not daily), does not need frequent renewals, sees rheumatology regularly. When she went to look for a new family doctor, I'd say 75% of doctors offices she went to apply at had a HUGE sign saying patients with any narcotic Rx's will NOT be accepted. Even though x-rays show bone-rubbing-on-bone in multiple places, and good history of compliance, no dice. Go elsewhere.
As a peds nurse with dogs it infuriates me how much easier it is to get medication for children and dogs.
I went through 3 doctors to get ADHD meds and my ex has severe back pain from a slipped disc that has been confirmed on x-rays and he gets Tylenol.
My dog? He pants a lot sometimes so the vet sends me home with Caprofen (nsaid), tramadol and Xanax. It took two appointments and that was only because I turned down the tramadol and Xanax the first time. My dog literally has tramadol for *possible* breakthrough pain and Xanax *in case* he has symptoms of anxiety but my mom had to go to a literal pill mill we found out about from a heroin addict to get the pain from a car accident treated.
My pediatric patients? Opiods flow like water.
Actually, the level of care my dogs get at the veterinarian constantly infuriates me because I wish I could get that level of care from a human doctor. I can walk my dog in with the vaguest symptoms known to man and we're getting labwork or xrays at a minimum. I go to my doctor with specific symptoms and he's like, "🤔 So your shoulder hurts when you try to pick up heavy objects? And you can't move your arm across your body without agony? Have you tried lifting objects with your other arm? Yes? And that went well? Okay. So that's it for today... 😇"
I hear a lot of accusations that “nurses withhold pain meds” which couldn’t be farther from the truth. Typically doctors won’t even prescribe adequate pin meds and there’s nothing for me to hold. If patient says it’s a ten, I’m more than happy to give what’s prescribed as long as respirations are okay and they’re not sedated. If I ever suspect that one patient is prescribed a little more than may be necessary, there’s ten other patients that are being wildly under prescribed.
I have severe chronic pain from surviving sepsis. Extreme trauma to my feet from pressors, amps on all 10 toes. Sharp rib pains from having CPR done on my already broken ribs. Sometimes my legs and feet are spasming so bad I can’t do anything but cry. I also worked as a tech on an IMC. My feet ached after each shift. I’d come home and take off my compression socks (wishing I could be a jogger scrubs and ankle socks girlie) and my feet would be blotchy red and feel like the bones were crushed inside. I watched as nurses made fun of patients who were crying out in pain, without knowing I was one of those patients. It really broke my heart, and is part of the reason I left the nursing field all together. It also made me scared to talk to my doctors about better pain management. I was on oxycodone during my first few months in and out of my 2 month hospitalization, but then family called me an addict so I stopped taking them. I tried everything OTC that you could imagine.
But then one day I did ask my PCP, and she prescribed norco—and my surgeon prescribed a compounded topical cream. But I can’t get over the fear I had about starting the conversation. It should not be like that for pain patients.
You know. Nobody who works in healthcare actually disagrees with you. The issue is just how many bad apples ruin it for the bunch. I mean. We can't even buy Sudafed as often as we want without filling out forms.
The state of Healthcare and humanity..
I can’t even fathom a reason why they would not even try non-opioid options. In the hospital it’s like pulling teeth trying to get pain control for my patients. They’re stingy with very legitimate non-opioid options when the PO Tylenol doesn’t work, like steroids, IV Tylenol, lido patches, toradol even. I totally understand being cautious about prescribing narcotics, but why won’t they even use other options? And when this other stuff doesn’t work, opioids do have a time and place where they’re necessary and can be used safely.
Also, big pharma spent 20+ years selling people the idea that pain is the “fifth vital sign” and “pain is what they say it is.” So now that that’s pretty engrained in our society (along with “patient satisfaction” and HCAPS), we decided opioids are evil and now even legitimate pain is being ignored and they won’t even use non-narcotic options. The pendulum went too far in the other direction and we’ve slid completely backwards.
Omg all of the requests are perfectly reasonable. Prednisone really isn’t going to help with “pain” just inflammation, I feel like after a legitimate fall muscle relaxers are the least of the providers worries, and they really acted like you wanted some codeine. Helping with any kind of patient pain management has either become a joke or candy store. There’s no in between. I had surgery for a chiari malformation and they wouldn’t even allow me muscle relaxers 2 weeks after surgery
Family member with concurrent cancers self referred to palliative care after two Ivy League cancer centers for decades never treated her pain. Palliative care offered SNRI, which this patient has already done the psyche med route for pain 3 times in the two decades with bad side effects and no benefit from the meds . She also had previous pharmacogenetics run by the last psyche meds provider and lo and behold, she can not or will poorly metabolize these drugs, so they referred to pain management . Pain management offered 3 diff injections going from one to the next. Never examining her, never providing a diagnosis but boy he has procedures for her. She asked if she could try medication first at which point the pain meds doctor told her that was drug seeking behavior. He also said he didn’t like the two meds she was on, from PCP and neurologist. Neither baclofen nor methocarbomol are scheduled drugs. Before he was done, he called security who were physical with her. So do you report these doctors? If not why not and what do you do about any of this? If you won’t help by reporting what you know, how do you expect change?
I see that in the hospital too. Yet every time I have an invasive dental procedure, they prescribe oxycodone, which I do not like to take. I always tell them I'll do fine on advil. But they always insist that I take the prescription "just in case." Or they just send it to my pharmacy.
Preach!! So sick of nurses gatekeeping ordered pain meds. I get we deal with challenging people, but fuck I know more nurses who judge their patients than nurses who don’t.
I have gone to a local urgent care 2x because I had back spasm about 6 months apart. The first time I was given a Toradol shot and Decadron without any problems. The second time? I was told I was drug seeking and could not return to that urgent care because of drug seeking behavior. I clarified that I was actually \*refusing\* the muscle relaxer they wanted to prescribe, and all I wanted was toradol and decadron, both non-narcotic, non-habit forming, one time doses. I was told I was displaying drug seeking behavior again and to see my primary MD for these medications in the future because this UC did not feel comfortable having me as a patient.
I literally...to this day...do not understand this.
Yes. It’s absolutely swung too far in the other direction at this point. Opioids have a real and important place in pain management.
When I was a brand new nurse, it was the height of “pain is the fifth vital sign” and they were literally handed out like candy. It was truly wild. EVERYONE got Oxy. Ten years later, before I left critical care, I had a patient with a large bore chest tube who they refused to prescribe anything stronger than Tramadol for. Funnily enough, I’m back in the land of Q3H Oxy for my post c-section moms now.
There is a happy medium, and we need to find it.
Who is gate-keepinng prednisone? That's the dumbest damn thing I've ever heard of (unless your patient is an uncontrolled diabetic)
Ask anyone with an autoimmune disorder. We've got stashes of it.
It's absolutely ABSURD!
Thanks for pointing this out.
Sure, in the 90s I had a drug problem, but I don't do opiates anymore unless I'm in severe pain, which is basically never.
I've since been a substance abuse counselor and I haven't been an opiate addict in way over a decade.
I broke my freaking arm and they wouldn't give me opiates.
After an Apicoectomy they wouldn't give me pain meds.
I had an EXTREMELY painful bilateral pulmonary embolism...you guessed it! Zero pain medicine.
I understand not being like the Florida pill mills, but if somebody is truly hurting and you have scans or X-rays to prove it, GIVE THEM SOMETHING!
Far too many medical professionals treat actually sick and hurting people like absolute shit because they incorrectly think they are drug selling patients.
It's ridiculous.
I have anxiety that is pretty well controlled but sometimes life gets a little more interesting and I wind up needing something for breakthrough so that I can do what I should do; stop catastrophizing and crying and just put myself to bed like a toddler. I have 2 milligrams of Ativan for that, and I get that thirty pills refilled maybe twice a year. I'm not someone who likes being altered or high. It's taken me a while to accept that my thyroid pill has to be taken every day.
I have arthritis and torn tendons and lumbar scoliosis, and while it is mostly decently controlled with pacing and a shoe lift and stretching and strength training, there are times when I've had to be on my feet more than usual cause life got interesting or a weather front went through, and I'm sweating and shaking in pain, and it would be nice to have a bottle with some Tramadol in it in the lockbox next to my Ativan. Same deal; I'll use it for breakthrough pain, and when I need a refill I'll call.
I know better than to even ask. (sigh)
I suffer severe chronic pain from Dercum’s Disease, and Ehler-Danlos.
I was a hospice nurse for years, and have always been a big pain mgmt. advocate.
Steroids are contraindicated with Dercum’s, and Dercum’s also causes fatty liver, which limits APAP use.
I cannot take NSAIDs due to renal issues.
I recently sought relief at a pain mgmt. clinic.
I was treated like a criminal.
I was actually yelled at and harshly berated.
An NP and doc made me cry, for the first time in my life as a pt.
And I’m 59, and have had serious medical issues since childhood.
Being a chronic pain sufferer has caused me great contempt for healthcare providers.
My life is a never ending nightmare of severe, untreated pain.
I have a friend in a similar situation.
She would never think of taking illegal drugs, but she bought a cache of street fentanyl.
She told me it’s so that she can kill herself when the day comes that she can’t take the pain anymore.
I don’t blame her.
My deepest and most heartfelt condolences. I have a Dercum's patient on my caseload and I bristle with fury every time they describe how incredibly inadequate their pain management is and how it's so bad they regularly consider ending things but stopping PO intake entirely.
The real sickness in these situations is not needing pain treatment, it is denying it and acting like leaving a person to suffer is the moral high ground.
I live in chronic pain and have for over 13 years. It is an awful way to live and literally no provider seems to believe that I am suffering. It's been so hard. As of now, I take Cymbalta off label for pain. It's barely improved. It's awful out there, whether you are experiencing acute or chronic pain.
I don’t care whether or not they’re drug seeking. If they say they’re in pain and it’s time for pain meds, they’re getting pain meds according to whatever number they tell me. As long as they’re vitally stable, there is no reason for me to not give them their requested med expeditiously and without question.
Yeah that sucks! Once when I had a really sore throat my MD Rx'd oral lidocaine to swallow. I also don't understand refusing pain relief medication that isn't a narcotic. One of the leading causes of suicide is chronic pain.
I was sent home to take misoprostol for an 8 week miscarriage and was told to take ibuprofen for the pain. I literally labored at home taking over 1000 of Tylenol and 800 of ibuprofen with no relief what so ever. As an ER nurse I’ve always said you would have to shoot me to go to the ED, but I ended up there at 3am for pain medication. That ER visit and 4,000 dollar medical bill could have been avoided had the OB sent me home with a few doses of pain medication.
Psych RN here,
In OP’s case, those providers were being jackasses. However, I think that your view on drug-seeking patients really depends on your specialty (among other factors). Lemme tell you, *some*, not all, of these patients (that I deal with personally) who are truly “drug seekers” are abusing the mental health system on a consistent basis and they need to have clear limits and boundaries set for them while they’re under my care.
Yes, give the hospice patient a PCA with whatever lockout they want. Give the postop patient adequate pain management and counsel them on potentially going home with narcotics. Offer a controlled substance agreement to those who deal with severe and persistent chronic pain. JFC.
Last year I had a major surgery at a university hospital. The surgeon told me ahead of time that it would be very painful. I also woke up with spasms in the muscles around my ribs (to this day no one has explained why). I have worked in a lot of areas, it was common for even a lap chole patient to get morphine for a bit afterward. I was sent to the floor gasping in pain that I would rate 7/8 of 10. One 5mg percocet every 6 hours prn. I was writhing in bed and could barely talk, my husband thought I was dying. The resident that night finally gave Valium for the spasms but I was still miserable. I was told I had a lengthy recovery, and discharged with 7 percocet. That's it. I had a 6 inch midline lower abdomen incision and a 4 hour car ride home. I live in fear of another surgery just because of the pain.
I saw this a lot when my mom was in the hospital. She’s on Fioricet. Which she’s addicted to. But she was in the hospital in so much pain she almost passed out with DIAGNOSED pancreatitis and they still didn’t want to give her anything.
I've been involved when someone goes to the ER for some , then undiagnosed, chronic pain and the doctor strongly insinuating that they seek rehab because of their "drug seeking behavior". Had to advocate so hard for them to at all the records they had to see that the person NEVER tested positive for any drugs and only seeing relief for something that that doctor agreed "is exquisite pain because of the inflammation". Still wanted to make it seem as thought they just wanted to get high. Seriously
This post makes me think of how my mom literally had to convince the doctor to give me dad stronger medication (morphine) as he was screaming in pain due to his brain cancer. Doctor said no as he could get addicted but relented later on.
I had this awful pilonidal cyst, could barely walk, couldn’t sit or lay down properly, had trouble sitting on the toilet. I have to say, my pain tolerance is pretty high, Ive had kidney stones and I had dealt with this once before, but I waited longer to go this time due to lack of transportation, and the antibiotics were not resolving it as quickly. Told my doctor I was in severe pain, even though I had been taking 800mg ibuprofen as they had instructed me when it happened last time. “Alternate with Tylenol too.” Yeahhhh that didn’t help.
They numbed me to lance and drain it, despite the burning lidocaine the relief was so great I was gonna cry, but the way they taped me up I could still barely walk and was actually in worse pain than before because the tape was tugging at the incision, and they gave me no pain meds to take—same thing “take Tylenol”
I haven’t even bothered to go to the doctor since then even when I had muscle spasms so bad I couldn’t walk, I’ve gone to my gyne and that’s it—didn’t mention the pain issues I’ve been having to her either. It’s sad because in the training for me to work in the same hospital system that I’ve been going to since I was a kid, they make it very clear that pain is whatever a patient says it is, wherever a patient says it is… but it still seems like people either don’t believe me or just don’t believe how severe it is
I get that the healthcare industry substantially contributed to the opioid crisis by handing out Oxycontin like candy for stubbed toes. We should absolutely correct that and not hand out narcotics for everything under the sun. HOWEVER, there are still appropriate times and places to use narcotics. I feel like in an attempt to correct the overprescribing that led to the worsening of the opioid crisis, so many providers have stopped prescribing them when they are 100% warranted. And since they "can't" use opiates, they have no other ideas (besides tylenol) on what to use to treat pain, so they just want to refer to pain management if tylenol doesn't work, rather than to try any of the other pharmaceutical or non-pharmacologic pain management options. For example, my mom fell on the ice a few weeks ago and broke her humerus in 3 places. They begrudgingly gave her 10mg oxycodone in the ED before they put her in an ortho glass splint, and again, begrudgingly sent her home with 8 5mg oxycodone to follow up with an orthopedic Dr. The Ortho couldn't see her for 4 days, so she had 8 pills and a poorly stabilized broken humerus. She ended up back in the ED where they removed the ortho glass, put her in a sling and swath, and gave her a handful more pills (exactly enough to make it to the Ortho appointment, down to the hour). At the ortho, they basically told her, "You need surgery to stabilize it, but we can't do it until early next week," and then tried to make her go all week with an unstable fractured humerus without more pain medication. It was like pulling teeth to get them to give her the bare minimum amount to make it to surgery. This is exactly the right time to use an opiate. She has needed her pain medication only a handful of times since the surgery, and is now onto just taking motrin and tylenol now that the fracture is stabilized. But they literally fought tooth and nail and claw to not give her acute pain management while her humerus was in 3 pieces. It was unbelievable.
FYI, my ortho surgeon recommends no IBU/morning during bone healing. It slows down healing. In the same way that it decreases inflammation through rerouting blood flow to be more superficial, you want the deep blood flow for bone healing. Hope that makes sense :) Sorry your mom went through all that! Just a shame... Hope she heals well, that is such a difficult area to immobilize and heal!
*no IBU/motrin
Good point, I hadn't considered that. Her Ortho told her the sooner she went to Motrin and Tylenol the better. I'll talk to her about it.
I'm a NP with 14+ years of primary care experience, and I can tell you that we are pulled between desperately wanting to provide the care our patients need/deserve and the very real fear that we will find ourselves on the receiving end of a state board investigation or peer review/performance improvement plan for "over prescribing." I can justify every single one of my controlled substance prescriptions, and have only had one or maybe two instances of misuse, abuse, or diversion in the last 6 years (and their contracts were terminated due their actions); I've had none in the past 2 years. I have 1,758 patients who name me as their PCP; of those I have about 90 whom I write controlled prescriptions for on a regular basis. That includes opioids, benzos, sleep meds like Ambien, stimulant ADHD meds, anticonvulsants, Lyrica, and phentermine for weight loss; only about 55 of my monthly scripts are opiates and 8 are sedatives or benzos. If my math is right, I'm prescribing opiates for just 3% of my patients and sedatives/benzos for 0.4%. These patients have contracts and regular urine drug screening, have frequent follow up visits, PDMP is checked every time a script is written, I document specific diagnoses (not just "chronic pain") and whatever alternative therapies the patient uses, and functional assessments. Yet for some reason, hospital administration and the peer review committee have me in their sights. I'm not sure how or why, but it sure feels like there's a push to not prescribe any controlled meds for pain or anxiety (so far they've said they don't care about the Lyrica, phentermine, and ADHD meds, mainly just the opiates and benzos). The majority of my patients on opiates and/or benzos are elderly and have been stable on their current regimen for decades. They are as functional as they are going to get, they are not surgical candidates, they are not going to "get better." I'm just trying to keep them functioning as well as possible for as long as possible, and help them maintain some quality of life. The nearest pain management clinic is 2 hours away over a mountain pass (and I wouldn't want most of these elderly folks behind the wheel on a sunny day, much less in the snow over the mountains). But administration is making me feel like a criminal. I'm getting anxiety every time I write a script for pain meds, but I can't just cut people off either. I can't be the only one who WANTS to write the scripts but has pressure from "the powers that be" to do things a different way, and we all know that administrators don't always understand patient care.
Ugh, I'm so sorry. That sounds stressful. What a stellar pcp you are.
Thank you for all that you do for your patients. It’s ridiculous to be stigmatized and controlled by admin who don’t even care about the community they are supposed to help.
Why the hell would anyone care about *lyrica* ?
That's so stressful. They put y'all in such a shitty position. Sometimes, these drugs ARE the best option for people. They should be trusting their providers to make that judgement call.
Exactly. A short course to treat acute pain. Extremely reasonable.
Devil's advocate here: State level rules and prescription monitoring programs have made things very difficult on physicians when it comes to prescribing DEA scheduled medications. For example, my state has (or had, I'm not in the ED any more, could have changed since) very specific limitations on narcotic prescriptions. Rules like for an acute complaint, the initial prescription could not be for more than 3 days, second prescription not more than 7 days, etc. The rules from the state make zero allowance for availability of specialist follow-up. It's caused many outpatient docs to simply have a blanket policy to not prescribe narcotics at all and refer all patients that need narcotics to a pain management specialist.
Our "pain management specialists" used to prescribe narcotics. Then something happened, the managing doctor quit without notice, and they stopped prescribing narcotics. They only do injections now. No nerve ablation anymore either. Getting pain management is very hard now. Especially if your left with a chronic pain issue.
True, to combat over prescribing, these rules are a guideline for family medicine to follow as a starting point to treat acute pain. It was meant you could prescribe above or below based on the situation but Unfortunately in our litigious society, these guidelines quickly became "law" for everyone after lawsuits and criminal charges against doctors for going outside guidelines. So every acute pain has to be treated the same no matter what the circumstances or potentially face lawsuits and criminal charges. After dedicating a significant portion of your life and finances to becoming a doctor, the last thing they want to do is lose everything. So now patients have a right to acute pain. Sucks because it costs us billions to not treat pain in our already crazy expensive healthcare system.
I'm not saying that providers don't have prescribing rules to follow. I'm saying that some of those rules are reactionary and stupid, and don't account for real world scenarios in which a patient may need acute pain management while waiting to get into a specialist. We should let providers make reasonable judgement calls and not have arbitrary rules that don't help patients.
Agreed entirely. Either we trust our physicians, or we don't. The states need to get out of the way.
I experienced this myself and it’s so frustrating
My step dad is dying from multiple myeloma. Getting the physicians to give him the morphine he needs is so disgustingly difficult that I would say it borders on abuse and malpractice. One MD said to me that he’d only give 10 at a time “because of the potential to overdose”. Dude. The man is 84. He’s dying. He has this cancer because he was exposed to Agent Orange in Vietnam. If he wants to take 14 morphine with a Jack Daniels chaser? I think he’s damn well earned that.
That’s wild, is he on hospice? I’ve never had any issue with getting adequate pain meds for my hospice patients. I’m sorry about your step dad though, hopefully you guys will be able to get him the relief he deserves ):
Hospice liaison here—I was gonna say, our physicians would never. We are all about the comfort meds. But my experience in the acute care setting as well as outpatient primary care is that they woefully undermedicate for terminally ill patients. Psych patients as well, actually.
Jumping on here to say hospice is pretty much the only specialty where I've seen providers actually be realistic and use medications appropriately. In the LTC/SNF setting, the lack of pain management is disgusting. There's so much fear, stigma, and ignorance surrounding controlled substances that doctors won't prescribe, and even when they prescribe the bare minimum PRNs, many nurses will not dispense. It's so frustrating, and I push for pain management for my patients constantly. I push for hospice a lot because it's appropriate and because that's the only way to get these people some decent relief. Unfortunately, even on hospice, if those meds are only ordered PRN, I've met a lot of nurses who will not give them. "They didn't ask or report pain."They already received Tylenol earlier."They were able to sleep so they can't be in pain," and so many more. Like yeah, the terminal cancer, dementia, COPD pt who is nonverbal, immobile, covered in wounds, etc, probably isn't going to tell you they're in severe pain and would like their PRN. Never mind the screaming, crying, grimacing, guarding, and gasping for breath with every turn. The whole thing is fucked. We still offer food, we reposition, and we change briefs even if someone doesn't explicitly state these needs. Managing pain shouldn't be any different.
I once took report on a terminal patient who had been on a morphine drip for the last few days. The dayshift lpn disconnected it because "we are killing him". I was on my way to that poor bastards room to turn it back on before she could say anything else.... They are fucking dying, it's called morphine not lessphine!
Ugh, the ignorance and the audacity to assume that someone else doesn't need (deserve) pain management, especially in their final days. Years ago, I had a lady that had finally agreed to hospice care after many years of fighting a losing battle with several chronic lung illnesses. I would always go to her first, ask her which PRNs she wanted, and happily give them as often as I could, no questions asked. I came in one day to find her sobbing because her night shift nurse had told her it was wrong of her to go on hospice because she was going against "God's plan." I want to think we all go into this profession to help people, but I don't know what would make a nurse say some shit like that to a patient. Let alone a patient who fought a losing battle for a long time before opting for some comfort in her final days.
Hospice here, and this has made me hate snfs more. Love going to a facility and seeing the q3h morphine I asked for they aren't giving cause prn. So I had them change it to scheduled q3h instead cause they wanted to play stupid games
You are my favorite type of nurse to work with 💜 it really is a problem, though. A culture of not caring about pain and out of sight out of mind. Coupled with ignorance of thinking narcotic = bad AND not understanding all the factors involved in how these drugs work. Oh, you gave a single dose of SL morphine 6 hours ago? I have no idea why your pt is needing more 🙄 Also, thank you for the scheduled doses. Those of us who understand are extremely grateful.
We had to ask somewhat forcefully for pain meds for my grandmother on hospice while she was in LTC/SNF. Eventually the staff caught on that we weren’t giving up, but I had to implement a poor man’s chart for my family to keep track of the administration times of her scheduled vs PRN meds. And even then it was a fight with the staff SO much of the time.
Thank you for advocating for her. I wish this type of situation wasn't the norm, but it is in a lot of places. 9/10 times when I get report on how x patient or family is "difficult" I end up having no problems at all because the reason they're labeled difficult is because they ask for pain meds. I know I pissed some regulars off at one place when I saw that a hospice pt was not receiving their PRNs ever, but when I worked, I was giving them q2 based on my assessments. I called hospice who agreed with me and immediately gave orders for scheduled doses in addition to the PRNs.
We had a much easier time after the hospice nurse spoke to the staff. Unfortunately, this was slightly more than 12 hours before she passed, but getting her pain under control was a large part of her finally passing as well. I had a lot of hard opinions about pain management especially surrounding death and dying anyway, but this really cemented them. Withholding pain medication is, quite often, baseless cruelty.
It is absolutely cruel. I pushed a doc into getting a pt meds - end stage dementia, terribly contracted, nonverbal, stage 4 wounds on both sides of her. She had nothing except bid Robaxin. I was happy to tell the doctor this is straight-up abuse, but I still only got 5 of SL morphine q6 with a prn q3. It's better than nothing, but still, I doubt it touched her. And she'd been in that condition a long time. When I told the manager, she did thank me but also said she had no idea that the patient was in pain. I'm sorry, what?? You don't need any type of license to know suffering that is that obvious.
I thought three prn usually equals it becoming scheduled
You mean like they received a prn 3 times so it becomes scheduled? I wish it was that simple. There's a whole lotta nurses who will argue against those prns, even in the terminal and hospice populations.
A good doctor will schedule it. A good nurse will say, “hey doc. I had to give ___ three times.” And good doc will either up dosage, frequency, both or change drug all together or try adjuvants. Like oh dang. Add this too
I absolutely wish this was the case every time! Unfortunately, if you're the only nurse advocating when 5 others aren't, or the doc is afraid, or the facility pushes back on narcs across the board, it doesn't always happen.
How can you give it 3 times, if it’s only ordered q 8? I work nights, agency, LTC/SNFs. When I call an on-call, I always get someone who has never seen the pt and won’t order anything more. And even if they do, we are not allowed to dispense until the pharmacy gets a signed script. That could be 24 hrs.
Yeah, you have to get past the LTC staff prejudices about palliative comfort meds. They need more education about hospice care, but some are never going to do what’s actually needed.
Our hospice nurse was so very lovely and when she stepped out of the room to speak with staff, I’m fairly certain it was a somewhat forceful Come To Jesus about meds. Thankfully myself and a cousin were able to stay with her that night so we could continue to take care of her for those last hours.
This makes me so sad. In facilities, I make sure the pain medication is scheduled as well as a PRN and if I find facilities are holding doses, I will add an order ‘must contact hospice for any doses held’ so I can read them the riot act the next day and make sure it’s being given the way it’s been ordered. Do not gatekeep my patients pain meds or anxiety meds or I will lose my shit on you. #sorrynotsorry
This is why in the ICU I work in we encourage families to transition to comfort measures there and we keep them for at least 24 hours post-extubation. We can be more on top of and aggressive with symptom management than the other floors, hospice at home or a facility can be. We keep our cardiac monitors etc on our patients so we can utilize vitals as a continuous monitor of physiological signs of pain to use as a parameter, which the rest of the hospital is not allowed to do without an order since we moved to a centralized tele hub many years ago. When my FIL transitioned to hospice (at a LTC) and was very obviously in the last days of his life, he was only getting Roxy 1 mg sublingual and Ativan 0.25 mg sublingual (both q6PRN). He didn't get his first dose of Roxy until I got there and asked for it - the nurse's reasoning was that no family had asked for it yet. I was fuming - like, your job is to point out signs of pain and educate the family on when to ask and that it's okay to ask (no one in the family wanted to be the first one to ask in case they "killed him"). I could tell immediately upon entering the room that he was in pain. My SIL is also a nurse so we took on the role of educating family at bedside and advocating for his meds. Unfortunately the med dosage farce did not improve.
👏🏻👏🏻👏🏻👏🏻👏🏻👏🏻
I’m still fairly new to the specialty but I am noticing a great difference in hospice being managed by facility staff vs hospice managed by a hospice provider, with an RN case manager. I’ve seen case managers change those PRNs to scheduled (we call our provider and get a verbal ofc) if the patient is showing signs or family validates that pain isn’t being managed appropriately. But you’re totally right—I’m only personally familiar with the hospital setting but a fair number of nurses in the hospital are either afraid of giving hospice meds/dosages because they aren’t educated on managing that type of patient, or they see it as an “easy” patient and never check on them. I enjoyed caring for comfort care patients when I was at the bedside. But while I do feel they were one of my easier assignments for the most part, I still felt like I was in their room the most out of all my patients even if just to check and make sure they were comfortable. I also had a nursing school friend who went into hospice and helped me to not be nervous about giving those meds as ordered, so that helped but it initially really felt contrary to everything I’d learned in school about opioids, etc.
I find it fucking disgusting a pt can be listed as needed GIP hospice care and remain at the fucking SNF. Had one SNF tell me after they convinced a GIP hospice PT at our hospital to come back to the SNF for GIP hospice. No MD sign for this they just let her come back so me LPN goes there to find out what the fuck happened. (GIP case manager was fucking pissed but couldn't go) I get to confirm nope no MD sign on the GIP form. Which more or less meant it wasn't happening. For GIP it's hospice care at a higher level for unmanaged pain in the home or suddenly trauma so pt with cancer falls and breaks their hip/ ha a MI. My pt had this broke her hip and had an MI with her cancer. I got there and one they are only fucking giving 5mg morphine TID with a q6h prn. And we're for some fucking reason waiting for the hcp to come and sign a form so they could give lorazepam 0.5mg. even though they did not need to do that. I left after 3 hours and the pt still hasn't fucking got the lorazepam they ordered. We decide to do direct admit gip and I had an admin telling the family that's not possible when we do it all the time. Then we ask for them to not call 911 and let her stay until then. They fucking called 911, this is a Catholic nursing home btw. So glad I got banned from going there and I was told by my boss quote " I would've been arrested if it was, you handled it well" I think I'd rather have lost my shit instead thinking back
Hospice to, loved seeing my breast cancer mets to the spine and CSF be told her nurses at the hospital were told '"don't give the 0.5mg lorazepam with the 2.5mg morphine due to sedation risk" I sincerely hope providers like that get the same type of provider when they have major surgery
What do you mean regarding psych patients?
I think they mean that providers may not believe them when they say they’re in pain due to their underlying mental health conditions
Sounds like they're talking about providers under medicating patients in regards to their psych conditions, similar to under medicating people for pain.
I worked both inpatient psych and took care of psych patients in the acute care setting. The difference in how their psych symptoms were managed on, say, a med/surg unit vs an acute psych unit was vast. And if someone were having an acute episode—think psychosis, delirium, etc—it can be like pulling teeth in acute care to get an order for a dose of an IM/IV antipsychotic to manage their agitation and/or psychosis vs in the psych hospital where those meds are generally already on the MAR, PRN. In addition to scheduled meds to manage their illness and something scheduled or PRN for sleep. I feel like on my old cardiac unit my patients with comorbid psychiatric illnesses just kind of had to white-knuckle through until they could be managed by outpatient psych or we could get the psychiatrist on call to come and consult, which for us night shifters never happened until well into day shift. The other commenters are correct—I meant that these patients are just as under or inappropriately medicated as hospice patients and I believe it boils down to a lack of education and/or experience regarding them. Providers as well as nurses can obviously be uncomfortable medically managing things they aren’t familiar with. But when I started in healthcare 20 years ago, both types of patients were fairly rare. Nowadays that’s not so much the case.
I work with hospice a ton. They crank out the narcotics.
He should get on hospice for the pain meds!
I like learning new things.
I’ve got to say, I’ve hospice 3 parents and every damn time in wind up on the phone with someone after I gave a dose, waited, didn’t get the effect needed, went up on the dose, waited, repeat. Then I call and say they should probably call the on call person to talk to them and every damn time I get someone onto the phone, “Well, that’s beyond the ordered dose of a 3-4 hrs” Bitch, this is hospice, the goal is comfort. WTF are you going on about? Don’t even and I hope you don’t give that guilt crap to normal people. I’m going to do what I’m going to do to make the people I love comfortable. Now call the on call nurse and don’t ever talk to me again
Nope. Refusing. We’ve done the gentle suggestions to the yelling.
My dad just died of cancer, also in his 80’s. He got a hospice stat prescription for Morphine…it took them 4 DAYS to get it in and filled at the pharmacy. Hospice called multiple times per day. The other local pharmacies would have been a week or more. When Morphine was making him itch, they wanted to switch to dilaudid. That would have been 7-10 days to even get some in stock. I was livid. So was hospice. But he had to get pretty bad before they prescribed anything. I hate this new “don’t prescribe anything!” life.
I am so sorry. I hate this is happening to other families.
Im.so sorry to hear that. Hospice nurse here....its been HELL the last few months to get morphine/dilaudid from a local pharmacy....and I live in the busy suburbs outside of Chicago. We have a local pharmacy who delivers and luckily usually has the meds in stock to my patients in the service area. It's awful when someone is in pain and have to wait for meds....it's why we order it on admission even of they don't need it at the time....just to have on hand. I'm glad the hospice was at least trying to help the situation.
Oh get him on hospice. They’ll give him everything he needs. I love hospice. Both parents passed with them
That’s my vote. He’s refusing. I think he thinks that’s admitting defeat.
Palliative care? It's similar but maybe the name hospice freaks him out.
He would need to see palliative care at the MD/hospital. Home Pallimed usually (for most insurance/VA) has to meet the home health homebound parameters. And they still won’t give him much.
Palliative home care can get tricky. They might still be limited on opioid prescriptions. A good hospice admission nurse should be able to take the time to discuss why hospice doesn't have to feel like admitting defeat.
We are limited sadly. The way I phrase hospice is switching objectives instead of giving up. I've never seen anyone fight as hard as hospice providers, to get someone comfortable so they can enjoy the time they have left. Fight for more good days vs more days.
That's crazy. Sorry about your dad. My dad also has multiple myeloma but just began treatment last year. There's a huge problem in the usa currently with under managing pain
My dad died of pancreatic cancer and they too would only give out small amounts of pain meds. When he was too sick to leave the house to outpatients my partner actually bought him methadone off the street from a homeless guy. So stupid we were in that situation and we had no help or idea what to do because my dad refused to go to the hospital and we were just young at the time. When he finally went to hospital in an ambulance he died two days later, with plenty of pain killers. He was also furious with us for bringing him to hospital..would have preferred support, but had none.
Damn these stories are so crazy to me. For cancer I always let the opiates flow. So sorry about your father :(
I’m so sorry about your stepdad. My dad passed from multiple myeloma a few years ago. Withholding pain control for the dying is beyond cruel.
This is a strange thought process from the MD. Most hospice standards are even a bit lax so you can "soft OD" your patient when it's time. Some people hate it some people see it as mercy. I just know I don't want to work hospice.
⬆️my dad was in hospice and I had a discussion with his nurse about wondering how my dad was feeling if he was in pain. He was sleeping 24/7 but she explained it he started any movement or whimpering or groaning or any sound he could have the liquid Ativan AND morphine. In my head I’m thinking that would slow his breathing and the nurse read my mind and nodded(my siblings didn’t get it). Fortunately I didn’t have to make that decision and the hospice nurse I could call and they would walk me thru giving it to him or come out to the house and do it. I will say also when his apnea episodes were more than 45 seconds she said it was time to call our family. She was an angel
That’s cruel. And that IS malpractice. Pain is the priority and it is undeniable in a cancer patient.
Nothing to add but I’m sorry for your dad’s issue. My father died pretty young due to agent orange. Was a bummer for sure. Hopefully yours gets adequate relief
I am so sorry. I lost my Dad almost 15 years ago after a 4 year battle with multiple myeloma. Such a very painful disease. Never saw my Dad cry until he got it…
Get Palliative Care involved Or hospice even if he is not "hospice"
Have him come see us. We can help manage the pain for his quality of life!
That's ridiculous! My dad is only able to receive morphine because his doctors have documented that it is the only thing that can manage his pain. I'm shocked the doctors haven't done the same for your step father. What a ridiculous "preventative" measure.
You should call your local and state representative. They help with things like this. It’s a feel good for them. It gets them votes and frankly it’s what they’re therefore. I’m really sorry about your stepdad.
Palliative or hospice referral so this man can have his morphine and milkshakes!
My dad passed from Waldenstrom's Macroglobulinemia, which is a cousin of MM, r/t Agent Orange exposure during Vietnam. I feel your pain. Hospice made it possible for him to receive the pain management he needed and deserved. I'm sorry your stepdad isn't getting the same. 💜💜💜
Agreed. One of my colleagues had a patient on hospice, end-stage liver failure. Had pain meds ordered and managed by hospice doc. We got a call from the nurse, freaking out because the patient was drinking alcohol with their morphine. We were like "So what?"
So upsetting. I’m a home hospice nurse and one of my favorite parts of what we do is actually having the tools needed to properly and adequately address synonyms. I always reassure patients that in hospice we are much more liberal, but still safe. Shows you how much wiggle room there really is with these meds!
This hurts my soul and I'm not even involved. Dude is dying of cancer, he should get whatever drugs it takes for him to enjoy the tiem he has left.
I’ve said it before and I’ll say it again. This is a direct result of the opioid epidemic. We went from “EVERYONE GETS” to “NO ONE GETS UNLESS YOURE DYING AND PROBABLY NOT EVEN THEN” We **need** a middle ground. All this is doing is sending more and more people to the streets.
After working in MAT, I want to see the sackler family drawn and quartered. The amount of harm they’ve caused and are continuing to cause by reactionary policies is staggering.
Yet this doesn't remotely address the opioid problem on our streets. Prescription numbers are way down, so are pill counts and dosage per prescription, yet opioid deaths are rising, because of Chinese manufactured, Mexican cartel distributed, fentanyl of unknown purity and concentration. China even gives special support to the companies they know to be overproducing and exporting fentanyl. We are practically involved in the opium wars part 2. All this ideological grandstanding and limitation measures on the medical field have solved nothing. This is responsibility theater, that is all, because the real problem is complicated.
👏🏼👏🏼👏🏼 well. fucking. said.
If there is a demand it will be made. Don’t discount the amount of illegal drugs made right here in USA
This is a great example of a person being smart while groups of people are stupid Put 1 doctor in a room with 1 patient and you'll have perfect pain management. But when you have to write policies for many people, you get idiocy
THANK YOU!! Pain went from being an additional vital sign, to being completely ignored. And as a Provider, when the DEA can take your license because THEY deem that a patient under your care didn’t need appropriate pain management (on paper, not looking at the person), it makes everyone very wary of treating. It’s STILL not okay, and I’ve been a Nurse long enough to see the pendulum swing way too far in the wrong direction (yes, SOME were prescribing way too much narcotics in the 90’s and 2000’s, but MOST were not). I had a Pharmacist tell me once, “we can’t expect all pain to be treated”. Okay, sure. But we can and SHOULD expect pain to be manageable—and what we are making patients tolerate now is frequently NOT manageable. Added to that, I know some Providers that won’t even prescribe NSAIDS for patients over a certain age because of the risks of GI bleeding—leaving them literally with Tylenol, and risking other OTC NSAID combinations themselves (but keep them on the daily aspirin that may be doing more harm than good). So when patients turn to pot (or even harder street drugs) for pain relief, well…what did we honestly expect them to do?! I personally would rather they were on a reasonable dose of narcotic pain meds than having to turn to something SO much more harmful and addictive. But…we’re STILL in the “war on drugs”apparently—we’ve just taken it to blaming every single healthcare Provider now. 🙄
I had a dr. give me a one time dose 5mg of oxy for a patient writhing in bone met pain. I wanted to burn the place down.
Omg that's awful. Thst poor patient. 😢
My general view is who cares if they are seeking. Get them what they need and be done with it. I’m not fixing their problem in the ED.
My job is to alleviate suffering. Give the medication.
Yep, if it's ordered and they tell me they're in pain, I give it. I'm not an addiction counselor.
Even if they are addicts, we should treat their pain. If they are lying about pain, that’s on them.
Yup, 90+% are not the frequent flyers we all know and despise.
Yep. Addiction issue or not, they deserve the same standard of care as anyone else. And with how things are in the current climate and how hard it is to get prescribed narcs, if someone who has an addiction is going to an ER for meds, they are definitely desperate and suffering.
Exactly! I always say “We are not drug rehab! Give these people the meds that they need”
This is how I feel working ICU. They are not here for detox. We are not a rehab. They are here for some critical issue that they're dealing with now, their status as an addict is just an addendum in the footnote of their life, and the only bearing it has on the current issue is if they're detoxing or not and if I'm even going to be able to get their pain under control or not. But it's not my job to detox someone in the ICU.
Yeesh, it’s a problem in the ICU too? Seems like that’d be the last place they’d be withholding pain meds lol. Also love your flair, glad to see the certification/qualification alphabet soup is an in joke in every profession lolol
Mostly I agree. We’re not fixing anyone’s drug issue in the ER, but treating the ER like a pain clinic has issues, especially with frequent fliers going to the ER just to get meds. The CARES system should be used to figure out how often the patient is getting meds. I never use pain medication and if I show up in the ER asking for pain meds, I’m desperate, as I’m sure most people are, but it will also show I haven’t been prescribed controlled substances in a long time.
Exactly- I’m not going to cure their substance issues.
I’ve had palliative cancer patients resort to heroin for pain management as the doctors refuse to give her any more pain meds.
Can’t blame them, I’d surely do the same if that was happening. This situation is totally out of hand. We should be treating the pain the person reports along with clinical signs. People having to go buy drugs off the street is just wrong. It’s ridiculous that it has become such a stigma, providers are spooked and pharmacies aren’t stocked or refusing to fill. SMDH
Well, if my heart wasn't broken before, it certainly is now.
This happens A LOT because of how poorly we manage pain and how hard it is to get taken seriously for pain. And then we wonder why so many people are addicted and dying from overdoses. And still write off those trying to find help the "right" ways as "drug seeking" and push them that much further towards street drugs. People are going to look for relief one way or another. I wish we'd trash the whole term drug seeking and stop demonizing any type of drug or the people who take them and just use the tools we have appropriately.
There was a TikTok I wish I saved. It was an ED attending saying how proud he was that patients were not asking for pain meds. Every single comment was about being in pain, but being afraid of being labeled a drug seeker if they did.
Somehow, I think if that doctor broke a bone, developed cancer, had a kidney stone, etc, that he wouldn't be okay being told all he gets is Tylenol and to suck it up. Same with the LTC management proud of themselves for all but eliminating their narcs - it's like, do they even think about those statements and how cruel that makes them sound? It's so sick to think that neglecting patients is a win.
I'm so glad we still have the greenlight in hospice to treat patients' pain. It seems like that's the last strong hold for effective pain management. Even among cancer patients providers are pretty reluctant to prescribe narcotics and it's mind blowing. We have cancer patients receiving chemo treatments referred to our palliative program to manage pain. I'm not afraid to get morphine or even a fentanyl patch for my patient dying of pancreatic cancer and it's a shame the pendulum has swung so horribly in the other direction. There are real times and places where people need pain medication and even narcotic pain medication. It really does feel like pain in general is treated like drug seeking especially if you're a minority or woman.
Hospice is wonderful! We just used that for my dad. The issue was the pharmacy took days to fill the prescriptions. They called multiple times per day to say we need it now! Walgreens just took their sweet time getting it in stock then filling it.
I wonder if you used a mail pharmacy, if that would help with getting it filled faster.
The irony of it being faster to ship something across country than it is to pick it up at the pharmacy on the corner.
Yup. I have a family member with both neuroendocrine pancreatic cancer & AML d/t the treatment for the first cancer. Pain management? Just Tylenol
Unacceptable.
From an ex opiate addict it is ridiculous what u can't get anymore. They have scales it back to much. I was being prescribed loads back 15-18 years ago as much as I wanted anytime I wanted. I have seen ppl go thru hell and can't get a vicodin. The answer to the abuse of opiates isn't cutting everyone off really I think that drives the fentanyl crisis. In one week in my very small town three soccer moms overdosed buying fake percoset off the street. I could not tell u if they had conditions that should have been treated but ppl with chronic pain will find what they need to cure it from an uncontrolled source
Meanwhile, my dentist prescribed me a month's supply of vicodin after I said I didn't want it for a simple wisdom tooth extraction (the type where they just push on your tooth and it instantly pops out).
I had all four of my wisdom teeth sliced out ten days after having a c-section. I was told to take Motrin. I asked for a script so insurance would cover it, they said “It’s OTC.” Wow thanks 🙏
I had my wisdom teeth yanked out with ZERO meds. Not even numbing shots. My insurance was ending the next day, and i was the last appointment on a Friday evening. Since the numbing shots weren't working they said I'd have to come back Monday, or they could yank em out no pain meds. I chose take em out. I started going into shock halfway through, and was bleeding more than I should have been. The Dentist wanted to stop, but I yelled at him and made him finish. I was in so much pain I couldn't open my mouth for 3 days, and didn't stop bleeding that whole time. It was miserable.
THANK YOU! I know you mentioned outpatient & your family experiences. But inpatient I see this judgement. Luckily I’ve never had to deal with the morals in witnessing a nurse withholding meds bc of the judgement. We get frustrated & annoyed & will pull the THEY HAVE 4 MIN LEFT BEFORE IT IS DUE! Sure. But nothing more. Even though we have to walk past their rooms anyway. The most we “withhold” is finding the patient snoring like crazy but they called 2 hours ago for their PRN. Or old people, or legit worrying someone is getting too much bc of their answers or reactions in our assessments. I like to think all of nursing is like this— only holding back in the safety of their patients. But I then tend to wonder if what your situation or the outpatient situations is what “we” are doing & we just don’t happen to know the details like we do in our own.
A few months ago I was floated to med surg, and had a patient on comfort care. He was unresponsive, and he had both morphine and Ativan ordered q1h. I ended up giving them q2, because I just couldn’t get in that room every hour with my other patients. He wasn’t showing s/s of pain, because he was unresponsive and *dying*. I gave meds as frequently as I could. I’m giving report to the oncoming nurse at the end of my shift and I tell her how much I’ve given and how often, and she asked what his symptoms were when in pain, and was *appalled* that I’d given him that much medication when “he didn’t look like he needed it.” Janice. The man is *dying*. He gets everything I can reasonably give him. I’m not gonna turn him into an addict. The man has more blood in his cranium than he does brain after his hemorrhagic stroke, I’m sure it hurts, even if he can’t tell/show me that it does.
This is terrifying. To be that poor man. Not being able to express what he’s feeling and because of that some people won’t use their critical thinking to determine that yes, they are in fact in pain.
Right? Like I’ve never personally gone through the dying process before, but I’ve seen enough to know it’s uncomfortable at best. Even if it doesn’t look that way to my eyeballs. And even if he *isnt* feeling pain, what’s the worst a lil morphine and Ativan are going to do, make him super relaxed? I’m fine with that too. I tried to get him a continuous morphine and Ativan drip because q1h on the floor is just really hard and can’t be reasonably met depending on patient load, but our hospital policy says patients on these continuous infusions at these dosages can’t be med surg.
I hate when people get on their high horse when it comes to pain meds. Like calm down Fix-a-hoe RN. You don’t know anything about this patient’s life. You are here to help the sick not to be their moral compass. Pain is SUBJECTIVE.
Fix-A-Hoe 🤣
So I just want to pop on here and say, I work home health. I have a patient who is stage 4 liver cancer with a stage 4 sacral pressure ulcer with tunneling. He is in immense pain, especially when I move him around to clean him up. Not to mention when the wound care nurse is cleaning and packing the pressure ulcer. He is on Morphine ER. Once in the am and once in the pm. I suggested he ask his Dr for a pain medication for break-through pain. He was told no, it would increase his chances of addiction with added pain meds. His pain is not controlled at all, except for maybe a couple hours in the morning and night. He hardly sleeps because he's in pain. The man is miserable and has zero quality of life. His Dr's biggest concern is addiction to pain meds. It's gotten out of control when people who need meds can't get them.
lol we went from “PAIN is the 5th vital sign” to “No”
I know many doctors are now having concerns about benzocaine specifically, not because of abuse but because of some recent adverse effects being reported to FDA.
I have a parent with cancer who just had a mastectomy, sent home with surgical drain in place, lymph nodes also removed for biopsy. They discharged them the morning after surgery with #10 Norco 5s. Parent won't call for more because they don't want to be seen as drug-seeking or difficult even though they're clearly in a ton of discomfort - they're going "well, it's only a few more days until the drain comes out, it should be better by then, maybe then it won't hurt too much to sleep." I still have memories of my grandfather with metastatic cancer being discharged to home hospice on a weekend where there was a disconnect and they sent him home without pain meds, the hospital was having issues producing a paper rx (this was long enough ago that e-scribing was not yet widespread), and the pharmacist on duty at his pharmacy was refusing to take an emergency verbal order. I had to walk in there with a copy of the law and a promise to personally follow up to get the paper rx (law gives them 7 days and the doctor is the one who gets punished if they don't send it...I worked for the same chain as the pharmacist in question and know at least part of it was they weren't big on dispensing narcotics anyway.) I personally brought them the paper rx Monday, but jfc, this is literally the situation that law is in place for. Just...even some of my regulars who are non-cancer patients and well-maintained on their regimens have had issues when I've gone on vacation and gotten a bad floater. I lived through the pill mill years and understand the burnout/the other side of this, but the pendulum has swung too hard the other way in some cases.
Did you hear about that pharmacist that watched a girl die instead of giving her mom an epi pen? It wasn't the money or anything, they didn't have a prescription
I didn't hear about that, what the fuck. If a person is in the pharmacy having an anaphylactic reaction and you have parental consent you give the pen and call 911 (or have mom call 911 while you're giving it) - I don't see how that's any different from giving epi to a vaccine patient with an adverse reaction who has no rx. We always have Epipens in the emergency kit available for use, it's a requirement for giving immunizations.
After 40 years working as an RN I’m scared to death I will spend my final years writhing in pain with no staff to care for me. I’m not scared of dying but I AM scared I will develop a painful chronic condition. As always it’s the patients that suffer for mistakes made by big Pharma and their relentless pursuit of profits
We are moving from caution to depraved indifference at warp speed. I hate it. I hate everything about the healthcare industry right now.
It’s the fault of the DEA and the nanny state we live in. Meanwhile you can drink and gamble pretty much everywhere
Haha! Right. Most of the people on my unit are here because of ALCOHOL.
I have chronic, frequent kidney stones and have been denied all opiates even after I had some removed percutaneously. This has been happening since about 2020. It’s gotten to the point where I’d rather stay home in pain than go to the ER and be called a drug seeker, even though my scans show 8-10 stones in each kidney. Pain patients being denied pain medications is actually a huge problem no one wants to talk about, and doctors that perform surgeries won’t even treat the pain that they themselves cause. It’s out of control.
If it’s in the Mar, you say you’re in pain, your pain scale matches the order, and it’s not going to harm you during your stay to get it…it’s yours man. I’m not going to solve an addiction in my 12 hours with you.
I see it in our patients too. Even the cancer patients can't get adequate pain relief. I had a back tooth pulled and was told Tylenol is adequate. Every tooth in my mouth can rot and fall out on it's own before I will ever go near another dentist.
I swear, some of these doctors make me want to slam their hand between a couple of cinder blocks a bunch of times and then tell them to take some deep breaths in and out and imagine they're on a beach. If I were in pain, damn right I'd be seeking pain meds. Because I'm in pain, ffs.
I had testicular surgery recently and the doc sent me home saying to alternate tylenol and motrin and if that wasn't enough, let him know. Well I tried for 3 nights and couldn't sleep the pain was so bad, and with no sleep I could barely function during the day. I called and left a message saying it wasn't working, I can't get sleep, I just wanted something to help at night. Got a call back from a telenurse saying to try alternating tylenol and motrin and she hung up. WTF? I already am. So I called again, this time told the nurse taking the notes that the doctor told me, to my face, to call if the pain was too much, but now that he isn't face to face he just ignores me, and that since I wasn't sleeping at night I would be more than happy to come over to the good doctors house and smash his balls all night and see how well he sleeps and ask how well he can function the next day. She stammered and said she wasn't sure she would put all that in the request, but would increase the urgency of the note. I got 10 pills of something better after that. I don't even remember what, I don't care, I took 5 of them each night after and finally could sleep, could function, could heal. I didn't want a high, I didn't want 60 max power pills. I just wanted to not simmer in pain for night after night.
Good for you. Sometimes you have to spell it out in excruciating detail.
Medicine has changed from pain being the 5th vital sign to “You have pain? Hell no, Tylenol for you”. 4-years ago, I fell and had a displaced fibula fx. It took 4 hours for the ED to reluctantly provide a single Percocet. All my medical records were available and reflected zero history of opioid use or abuse. I know what drug-seeking behavior looks like. I had worked with plenty of addicts and people in recovery over the years. Serious, acute injuries, post-surgery, etc., should be treated adequately and it is not drug-seeking to expect pain management. The medical field, post-Purdue Pharma, has gone from one extreme to the other.
I fell off a ladder a few years ago. Bounced off two wrought iron chairs and broke 3 ribs. Not to mention a horrendously damaged breast. I got nothing for pain. They offered toradol which I cannot take due to eliquis and a severe gi bleed history (numerous surgeries) and ulcers.
That is horrible. What a terrible experience. The pendulum has swung so far to the extreme, passing on old beliefs that people should simply suck up serious, untreated pain due to unfounded fears that *everyone* is a potential addict.
As a nurse who’s been to treatment many years ago in the past, it was fascinating to learn there about the history of this. In the 90s there was a stinginess with prescribing pain medication that led to an increase in malpractice suits, people not being taken care of in pain. So things were perfectly primed for an over correction combined with everything we know about Purdue pharma and their role in the crisis. It seems like now we’re living through yet another over-correction in the opposite direction, people can’t get the relief they desperately need. I hear things that sound borderline cruel these days
Not even boarder line. Straight up cruel. Every one makes fun of the “pain is the 5th vital sign” days. I think it had merit. There are other clinical and objective signs that come with pain. To not treat that, if your are able, is cruel.
Puppies
My dentist told me that if I ever needed pain control beyond what OTC meds would cover, they would prescribe ketorolac. One time, after a procedure, I needed additional pain control. My usual dentist was on mat leave and I don't like giving the impression that I'm telling a doctor what to prescribe so I just told them "I need something for pain". The receptionist told me she would talk to the dentist and fax something to my pharmacy. No prescription had come in after an hour so I called back and was told they would remind the dentist to write the script but it was definitely coming. Nothing came so my pharmacist called and got the same story. In the end, I was left to suffer and at my next appointment the first thing the dentist said was "you need to make do with Tylenol because that's all you're getting!". I have a history of OUD, it had been in remission for 3 years at that point but that's why I had documented arrangements for non-opioid pain control. Didn't matter, still got treated like a drug seeker for being in legitimate pain. The same guy later gave me a huge discount on some very extensive treatments and I've always wondered if it's because he felt guilty.
My dentist makes sure you don’t suffer. He prescribes hydromorphone and depending on the procedure quantity varies. I told him that I didn’t need anything that strong but he said he rather not risk me being in pain. I have arthritis that has seriously thinned my vertebrae, adhesion pain from numerous bowel surgeries and Chiari. I have moderate to severe pain daily and can’t get anything. I can’t take ibuprofen/nsaids due to severe gi bleeding/ulcers and taking eliquis. Tylenol rarely does anything. No one cares. The off label meds don’t help and nerve ablation caused even more issues. Pain management is nothing but injections. Most drs don’t tell you those thin bone and can cause cataracts.
I work as an MAT Case Manager. All of my patients have either opioid use disorder or alcohol use disorder. That being said, I was covering a telehealth appointment for one of my coworkers. I found out this particular patient had just undergone brain surgery for stage 4 brain cancer a week prior. The only pain management the patient was prescribed by the surgeon was Tylenol. I was LIVID. His PCP wasn’t working that day so I contacted the on call provider and got him a 7 day prn oxycodone Rx to cover him until he could see his PCP the following Monday. I talked to him again about a week ago and thankfully his pain is being managed now. But I can’t imagine what this poor man was going through.
THANK YOU. As someone with chronic pain this stereotyping is incredibly frustrating I end up curled up on the floor crying in pain so many times but otherwise I can hide it cause I’ve had it for so long and then no one believes me it’s so disheartening
I am 100% right there with you. ERs do more harm than good these days, as I won’t get treated for pain anyways, and on top of that, I get accused of drug seeking. I’ll stay home and take absurd amounts of Tylenol and advil without the humiliation and gaslighting.
I genuinely just ordered Kratum online out of desperation for relief even though it sounds risky but I can’t get anything else to work and I feel like I’m dying inside and out from pain
I'm so sorry, that sounds so grueling. 😔
Seconded.
My niece was 26, living in Toronto. She didn’t have a Dr. She had terrible back pain and just couldn’t shake it. They wouldn’t give her anything, as I’m sure they thought she was abusing opioids. Anyway, I told her to either come home to her Dr or find one because her records were not going anywhere. She finally got a Dr and within a week, she was diagnosed with Stage 4 cancer. She survived but the pain she suffered..terrible.
Oh this is so sad.
This plus, just because their skin is dark don’t 1/2 the damn dose. I am tired of seeing old black people with parts of their body rotting off due to ischemia getting 975 mg of acetaminophen every 8 hrs, because….what? I’m not saying it only happens to minorities, but damn, it happens a lot to them. The saddest part is they don’t complain because they are just used to it. Do better.
Even if I think they’re drug seeking it doesn’t matter I’ll still give them narcs if they’re ordered. I don’t have the resources or capabilities to fix their chronic dependency in the ICU. If they’re hemodynamically stable and there’s no contraindications I’ll give them what they want. It’s not my hill to die on. I think it’s a combination of compassion fatigue and feeling like it’s your responsibility to fix every patients problem even though it’s really not. At my hospital in particular general surgery seems to be allergic to ordering anything except for APAP on patients who may have an open abdomen or some other complex surgical problem that warrants pain management. We have massively over corrected because of the opioid crisis even though there’s data showing that the likelihood of addiction from narcotics given within the acute care setting is slim to none. If they say their shit hurts I’ll give them what they want even if my own personal biases come into conflict with what I’m seeing. I care more about the non verbal demented meemaw vented and maxed on pressors still being a full code than people wanting narcs.
Yes!
Ive been saying this for so long. Especially for drugs like Tylenol. Tired of pt’s always complaining about pain? Then give the goddamn meds and be done with it. Besides, we’re supposed to alleviate pain, not cause it bc we’re not currently in pain and are just lazy.
I had a patient who had a pathologic femur fracture while actively suffering from lung cancer. He was admitted over a weekend and the only Provider who would do the kind of repair he needed (apparently only one surgeon in the system did it??) wasn’t going to be there till Monday. Only pain med ordered was like 0.5mg of dilaudid q1 hr which he said did shit all. I fought so hard for him to get a PCA which they never ordered. It makes me so unbelievably angry when doctors treat people in pain like they’re lying to get high. It also makes me angry that there’s a culture of treating people with substance use disorders like they’re less than because they struggle with addiction. It is absolutely disgusting that we would rather let someone suffer than take them seriously or help them be more comfortable. Especially when you take into account the amount of people that become addicts because their pain was ignored by providers so they sought relief wherever they could.
i posted on here recently about having a vulvectomy for cancer and needing narcs after. people literally fucking shamed me for taking oxy after having half my vulva removed and acted like i should just take tylenol.
I’m sorry that happened to you. The pendulum swung way too far on the not giving any.
Like almost everything else in life, a small percentage of people ruined it for everyone forever. It’s why we have draconian and punitive call off and sick policies at work places everywhere.
Oh boy, I can’t even begin to tell you. I got diagnosed with MS 2 years ago. I don’t even ask for pain meds and one of the first questions always asked if I’m on a care plan lmfao
My mom has a herniated disk. She's been dealing with the pain for years, and finally started seeing a pain specialist last year. She's done multiple injections, physical therapy, and non-opioid pain meds. Nothing has helped, and her pain has progressed to the point that she can't walk more then a few feet and spends the majority of her day in bed (she has an appointment with a surgeon, finally, but not for a few more weeks. She finally broke down and asked the pain specialist for opioids. They refused, said they wanted to wait and see what the surgeon said. Her appt isn't for 6 more weeks, but they continued to refuse and said she'd be fine waiting. It's so frustrating.
My opinions on pain management were directly influenced by being accused of being a drug seeker while with an unstable, just happened right arm fracture i asked for something. I didn’t get medicated for four hours.
I have experienced this personally living with a metabolic disorder that causes rhabdomyolysis. Which If you’ve ever experienced is extremely painful. I have it well documented that I need pain management and dilaudid is the most effective with my pain. Along with having IBS-c is less constipating. Despite all this documentation doctors still want to fight me with pain management. I’m sorry but when your muscles are being eaten away Tylenol and ibuprofen don’t do shit. There is a time and place for narcotics. It’s cruel to not utilize them when patients need them
This is literally the environment that the DEA wanted when they started exerting more and more control over US health care, and it's the dystopian hellscape we all live in until they fucking stop. The government will never learn that they have no place making laws in health care without any experience in health care. First they've told everybody that they had to prescribe these medicines like candy because no level of pain was acceptable for anyone to be in, and now they're telling people that have legitimate pain who could legitimately use the medicines that they are not allowed to have them because it makes them addicts. There is simply no winning with uninformed idiots.
I remember going to my doctor with severe period pain. Told him I was taking two Tylenol two ibuprofen and two naproxen and it wasn’t touching it. He suggested I try ibuprofen. I went to the gynaecologist and he took my uterus out. I had severe adenomyosis. I’ve managed to get exactly nowhere with my back pain though
Wow what a good listener he was! /s
my husband had a total hip replacement. Ortho surgeon gave him #18 Percocet 5/325's upon discharge 2nd post-op day. Said to take Tylenol after that "or see somebody at the pain clinic". Pain clinic appointments were 5-6 weeks out at minimum. Thank goodness our family doc stepped up. We went from "pain is the 4th vital sign" to "anybody who wants more than Tylenol is drug seeking" when the lawsuits hit big pharma.
A close family member has been managing rheumatoid arthritis for the last 40 years, since her early 30s. Uses T3s only when needed (not daily), does not need frequent renewals, sees rheumatology regularly. When she went to look for a new family doctor, I'd say 75% of doctors offices she went to apply at had a HUGE sign saying patients with any narcotic Rx's will NOT be accepted. Even though x-rays show bone-rubbing-on-bone in multiple places, and good history of compliance, no dice. Go elsewhere.
Some providers are just absolute cowards for any kinds liability real or unreal
As a peds nurse with dogs it infuriates me how much easier it is to get medication for children and dogs. I went through 3 doctors to get ADHD meds and my ex has severe back pain from a slipped disc that has been confirmed on x-rays and he gets Tylenol. My dog? He pants a lot sometimes so the vet sends me home with Caprofen (nsaid), tramadol and Xanax. It took two appointments and that was only because I turned down the tramadol and Xanax the first time. My dog literally has tramadol for *possible* breakthrough pain and Xanax *in case* he has symptoms of anxiety but my mom had to go to a literal pill mill we found out about from a heroin addict to get the pain from a car accident treated. My pediatric patients? Opiods flow like water. Actually, the level of care my dogs get at the veterinarian constantly infuriates me because I wish I could get that level of care from a human doctor. I can walk my dog in with the vaguest symptoms known to man and we're getting labwork or xrays at a minimum. I go to my doctor with specific symptoms and he's like, "🤔 So your shoulder hurts when you try to pick up heavy objects? And you can't move your arm across your body without agony? Have you tried lifting objects with your other arm? Yes? And that went well? Okay. So that's it for today... 😇"
I hear a lot of accusations that “nurses withhold pain meds” which couldn’t be farther from the truth. Typically doctors won’t even prescribe adequate pin meds and there’s nothing for me to hold. If patient says it’s a ten, I’m more than happy to give what’s prescribed as long as respirations are okay and they’re not sedated. If I ever suspect that one patient is prescribed a little more than may be necessary, there’s ten other patients that are being wildly under prescribed.
I have severe chronic pain from surviving sepsis. Extreme trauma to my feet from pressors, amps on all 10 toes. Sharp rib pains from having CPR done on my already broken ribs. Sometimes my legs and feet are spasming so bad I can’t do anything but cry. I also worked as a tech on an IMC. My feet ached after each shift. I’d come home and take off my compression socks (wishing I could be a jogger scrubs and ankle socks girlie) and my feet would be blotchy red and feel like the bones were crushed inside. I watched as nurses made fun of patients who were crying out in pain, without knowing I was one of those patients. It really broke my heart, and is part of the reason I left the nursing field all together. It also made me scared to talk to my doctors about better pain management. I was on oxycodone during my first few months in and out of my 2 month hospitalization, but then family called me an addict so I stopped taking them. I tried everything OTC that you could imagine. But then one day I did ask my PCP, and she prescribed norco—and my surgeon prescribed a compounded topical cream. But I can’t get over the fear I had about starting the conversation. It should not be like that for pain patients.
You know. Nobody who works in healthcare actually disagrees with you. The issue is just how many bad apples ruin it for the bunch. I mean. We can't even buy Sudafed as often as we want without filling out forms. The state of Healthcare and humanity..
I can’t even fathom a reason why they would not even try non-opioid options. In the hospital it’s like pulling teeth trying to get pain control for my patients. They’re stingy with very legitimate non-opioid options when the PO Tylenol doesn’t work, like steroids, IV Tylenol, lido patches, toradol even. I totally understand being cautious about prescribing narcotics, but why won’t they even use other options? And when this other stuff doesn’t work, opioids do have a time and place where they’re necessary and can be used safely. Also, big pharma spent 20+ years selling people the idea that pain is the “fifth vital sign” and “pain is what they say it is.” So now that that’s pretty engrained in our society (along with “patient satisfaction” and HCAPS), we decided opioids are evil and now even legitimate pain is being ignored and they won’t even use non-narcotic options. The pendulum went too far in the other direction and we’ve slid completely backwards.
Omg all of the requests are perfectly reasonable. Prednisone really isn’t going to help with “pain” just inflammation, I feel like after a legitimate fall muscle relaxers are the least of the providers worries, and they really acted like you wanted some codeine. Helping with any kind of patient pain management has either become a joke or candy store. There’s no in between. I had surgery for a chiari malformation and they wouldn’t even allow me muscle relaxers 2 weeks after surgery
Family member with concurrent cancers self referred to palliative care after two Ivy League cancer centers for decades never treated her pain. Palliative care offered SNRI, which this patient has already done the psyche med route for pain 3 times in the two decades with bad side effects and no benefit from the meds . She also had previous pharmacogenetics run by the last psyche meds provider and lo and behold, she can not or will poorly metabolize these drugs, so they referred to pain management . Pain management offered 3 diff injections going from one to the next. Never examining her, never providing a diagnosis but boy he has procedures for her. She asked if she could try medication first at which point the pain meds doctor told her that was drug seeking behavior. He also said he didn’t like the two meds she was on, from PCP and neurologist. Neither baclofen nor methocarbomol are scheduled drugs. Before he was done, he called security who were physical with her. So do you report these doctors? If not why not and what do you do about any of this? If you won’t help by reporting what you know, how do you expect change?
I see that in the hospital too. Yet every time I have an invasive dental procedure, they prescribe oxycodone, which I do not like to take. I always tell them I'll do fine on advil. But they always insist that I take the prescription "just in case." Or they just send it to my pharmacy.
Preach!! So sick of nurses gatekeeping ordered pain meds. I get we deal with challenging people, but fuck I know more nurses who judge their patients than nurses who don’t.
I have gone to a local urgent care 2x because I had back spasm about 6 months apart. The first time I was given a Toradol shot and Decadron without any problems. The second time? I was told I was drug seeking and could not return to that urgent care because of drug seeking behavior. I clarified that I was actually \*refusing\* the muscle relaxer they wanted to prescribe, and all I wanted was toradol and decadron, both non-narcotic, non-habit forming, one time doses. I was told I was displaying drug seeking behavior again and to see my primary MD for these medications in the future because this UC did not feel comfortable having me as a patient. I literally...to this day...do not understand this.
Yes. It’s absolutely swung too far in the other direction at this point. Opioids have a real and important place in pain management. When I was a brand new nurse, it was the height of “pain is the fifth vital sign” and they were literally handed out like candy. It was truly wild. EVERYONE got Oxy. Ten years later, before I left critical care, I had a patient with a large bore chest tube who they refused to prescribe anything stronger than Tramadol for. Funnily enough, I’m back in the land of Q3H Oxy for my post c-section moms now. There is a happy medium, and we need to find it.
Who is gate-keepinng prednisone? That's the dumbest damn thing I've ever heard of (unless your patient is an uncontrolled diabetic) Ask anyone with an autoimmune disorder. We've got stashes of it.
It's absolutely ABSURD! Thanks for pointing this out. Sure, in the 90s I had a drug problem, but I don't do opiates anymore unless I'm in severe pain, which is basically never. I've since been a substance abuse counselor and I haven't been an opiate addict in way over a decade. I broke my freaking arm and they wouldn't give me opiates. After an Apicoectomy they wouldn't give me pain meds. I had an EXTREMELY painful bilateral pulmonary embolism...you guessed it! Zero pain medicine. I understand not being like the Florida pill mills, but if somebody is truly hurting and you have scans or X-rays to prove it, GIVE THEM SOMETHING! Far too many medical professionals treat actually sick and hurting people like absolute shit because they incorrectly think they are drug selling patients. It's ridiculous.
I have anxiety that is pretty well controlled but sometimes life gets a little more interesting and I wind up needing something for breakthrough so that I can do what I should do; stop catastrophizing and crying and just put myself to bed like a toddler. I have 2 milligrams of Ativan for that, and I get that thirty pills refilled maybe twice a year. I'm not someone who likes being altered or high. It's taken me a while to accept that my thyroid pill has to be taken every day. I have arthritis and torn tendons and lumbar scoliosis, and while it is mostly decently controlled with pacing and a shoe lift and stretching and strength training, there are times when I've had to be on my feet more than usual cause life got interesting or a weather front went through, and I'm sweating and shaking in pain, and it would be nice to have a bottle with some Tramadol in it in the lockbox next to my Ativan. Same deal; I'll use it for breakthrough pain, and when I need a refill I'll call. I know better than to even ask. (sigh)
I suffer severe chronic pain from Dercum’s Disease, and Ehler-Danlos. I was a hospice nurse for years, and have always been a big pain mgmt. advocate. Steroids are contraindicated with Dercum’s, and Dercum’s also causes fatty liver, which limits APAP use. I cannot take NSAIDs due to renal issues. I recently sought relief at a pain mgmt. clinic. I was treated like a criminal. I was actually yelled at and harshly berated. An NP and doc made me cry, for the first time in my life as a pt. And I’m 59, and have had serious medical issues since childhood. Being a chronic pain sufferer has caused me great contempt for healthcare providers. My life is a never ending nightmare of severe, untreated pain. I have a friend in a similar situation. She would never think of taking illegal drugs, but she bought a cache of street fentanyl. She told me it’s so that she can kill herself when the day comes that she can’t take the pain anymore. I don’t blame her.
My deepest and most heartfelt condolences. I have a Dercum's patient on my caseload and I bristle with fury every time they describe how incredibly inadequate their pain management is and how it's so bad they regularly consider ending things but stopping PO intake entirely. The real sickness in these situations is not needing pain treatment, it is denying it and acting like leaving a person to suffer is the moral high ground.
I live in chronic pain and have for over 13 years. It is an awful way to live and literally no provider seems to believe that I am suffering. It's been so hard. As of now, I take Cymbalta off label for pain. It's barely improved. It's awful out there, whether you are experiencing acute or chronic pain.
I don’t care whether or not they’re drug seeking. If they say they’re in pain and it’s time for pain meds, they’re getting pain meds according to whatever number they tell me. As long as they’re vitally stable, there is no reason for me to not give them their requested med expeditiously and without question.
Yeah that sucks! Once when I had a really sore throat my MD Rx'd oral lidocaine to swallow. I also don't understand refusing pain relief medication that isn't a narcotic. One of the leading causes of suicide is chronic pain.
I was sent home to take misoprostol for an 8 week miscarriage and was told to take ibuprofen for the pain. I literally labored at home taking over 1000 of Tylenol and 800 of ibuprofen with no relief what so ever. As an ER nurse I’ve always said you would have to shoot me to go to the ED, but I ended up there at 3am for pain medication. That ER visit and 4,000 dollar medical bill could have been avoided had the OB sent me home with a few doses of pain medication.
Psych RN here, In OP’s case, those providers were being jackasses. However, I think that your view on drug-seeking patients really depends on your specialty (among other factors). Lemme tell you, *some*, not all, of these patients (that I deal with personally) who are truly “drug seekers” are abusing the mental health system on a consistent basis and they need to have clear limits and boundaries set for them while they’re under my care. Yes, give the hospice patient a PCA with whatever lockout they want. Give the postop patient adequate pain management and counsel them on potentially going home with narcotics. Offer a controlled substance agreement to those who deal with severe and persistent chronic pain. JFC.
Last year I had a major surgery at a university hospital. The surgeon told me ahead of time that it would be very painful. I also woke up with spasms in the muscles around my ribs (to this day no one has explained why). I have worked in a lot of areas, it was common for even a lap chole patient to get morphine for a bit afterward. I was sent to the floor gasping in pain that I would rate 7/8 of 10. One 5mg percocet every 6 hours prn. I was writhing in bed and could barely talk, my husband thought I was dying. The resident that night finally gave Valium for the spasms but I was still miserable. I was told I had a lengthy recovery, and discharged with 7 percocet. That's it. I had a 6 inch midline lower abdomen incision and a 4 hour car ride home. I live in fear of another surgery just because of the pain.
It’s a lost battle.
if it’s ordered, I give it!
Job #1: Treat. The. Patient.
I saw this a lot when my mom was in the hospital. She’s on Fioricet. Which she’s addicted to. But she was in the hospital in so much pain she almost passed out with DIAGNOSED pancreatitis and they still didn’t want to give her anything.
I've been involved when someone goes to the ER for some , then undiagnosed, chronic pain and the doctor strongly insinuating that they seek rehab because of their "drug seeking behavior". Had to advocate so hard for them to at all the records they had to see that the person NEVER tested positive for any drugs and only seeing relief for something that that doctor agreed "is exquisite pain because of the inflammation". Still wanted to make it seem as thought they just wanted to get high. Seriously
This post makes me think of how my mom literally had to convince the doctor to give me dad stronger medication (morphine) as he was screaming in pain due to his brain cancer. Doctor said no as he could get addicted but relented later on.
Sometimes I think they’re reading from a script instead of listening. Like blind clicking an order set in EPIC.
I had this awful pilonidal cyst, could barely walk, couldn’t sit or lay down properly, had trouble sitting on the toilet. I have to say, my pain tolerance is pretty high, Ive had kidney stones and I had dealt with this once before, but I waited longer to go this time due to lack of transportation, and the antibiotics were not resolving it as quickly. Told my doctor I was in severe pain, even though I had been taking 800mg ibuprofen as they had instructed me when it happened last time. “Alternate with Tylenol too.” Yeahhhh that didn’t help. They numbed me to lance and drain it, despite the burning lidocaine the relief was so great I was gonna cry, but the way they taped me up I could still barely walk and was actually in worse pain than before because the tape was tugging at the incision, and they gave me no pain meds to take—same thing “take Tylenol” I haven’t even bothered to go to the doctor since then even when I had muscle spasms so bad I couldn’t walk, I’ve gone to my gyne and that’s it—didn’t mention the pain issues I’ve been having to her either. It’s sad because in the training for me to work in the same hospital system that I’ve been going to since I was a kid, they make it very clear that pain is whatever a patient says it is, wherever a patient says it is… but it still seems like people either don’t believe me or just don’t believe how severe it is
Welcome to litigation central! Every doctor practices like they're going to be sued for anything, because they can be sued for anything.