It is no coincidence that the rise of prescription drug abuse has coincided with the instigation of making pain assessments part of the mandatory vital signs evaluations. Health care providers are often cornered into prescribing the public narcotic pain killers, because now "pain is what the patient says it is" and ignoring a patient's complaints of pain may be a case for litigious pursuits. Now, it is true that many patients do seek relief from genuine complaints of pain in Emergency Room settings with very real and objectively identifiable etiologies of pain, i.e., abnormal lab values, CT scans, X-Rays, biopsies, lumbar punctures, MRI's and abnormal neurological responses. However, there are also many patients who abuse the system with false claims of pain with the intent to obtain prescription pain killers. Because of this, very often health care providers are skeptical of the patient who complains of pain, yet, have no abnormalities to support their claims.
In the hospital setting, subjective 'pain scales' are used to aid the provider with a plan of care that helps determine the types of medications used to provide subjective relief from pain. Unfortunately, many patients abuse this system as well, and although they appear to be in no acute distress, they will rate their level of pain to be a '10/10', which is clinically meant to be "the worst pain imaginable"; and because pain is now "what the patient says it is" clinicians are intimidated into prescribing larger doses of narcotics than may be truly indicated.
It is no unknown secret in medicine that many 'frequent fliers' to emergency rooms are often identified as drug seekers, and many of these people will incessantly go from one ER to another, in order to avoid this type of tracking. But is the system itself not creating these addictions? For example, which comes first: the addict or the prescriptions that create the addicts?
These abusers destroy the claims of people who have honest complaints of pain. Prescribers are often hesitant to medicate a patient with narcotics until an objective abnormality is discovered that may be indicative of pathology, and yet, if they do not, the said patient may attempt to sue the hospital for violating the patient's right to be treated for pain. This is how the system works in favor of the pursuant.
In recent years, there has been an establishment of pain clinics who specialize in pain management. Yet, some clinics may only reinforce the addiction, or in some cases, even help to create the addiction; i.e., the clinics would not be in business if they had no patients to manage.But they also specialize in alternative treatments for pain, for people who are willing to comply with these care plans.
In short, the management of complaints of pain can be a very slippery slope. But statistics do show a sharp rise in the prescribing of narcotics over the past few decades. In particular, Dilaudid, seems to be the drug of choice for many patients, as it is the most potent pain medication on the market. Recently, Demerol, has been removed from many hospital pain protocols for this very reason, that being that it is highly addictive and extremely potent with a strong potential for abuse.
There are no easy answers to remedy these problems. But for safety's sake, I do think it wise to withhold medications until objective evidence is identified to support claims of pain ( unless, the patient is demonstrating real signs of subjective pain, such as guarding or having increased blood pressures and pulses.) This is not a problem that is limited by class, gender, or racial divisions. Yet, this problem is growing in our society, and should rightly be rethought in terms of protocols implemented that only serve to encourage drug seeking type behaviors. Healthcare providers should provide aid to those in need, but not also be stigmatized as 'drug pushers'.
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» left by James P Krehbiel(1,391) James P Krehbiel (88 days 1 hour ago.)
Jennifer, Great article. I have mixed feelings on this one. My bias is that MOST patients who seek pain assistance are not addiction-prone and can safely be treated with narcotics if needed. If a patient is in the hospital and on a morphine pump, many studies show that the patient will actually take LESS than the normative medication. Unfortunately, it's the the one or two percent of "junkies" who give the doctors fits and fears of litigation and may cause doctors to undertreat those who could benefit by narcotics. What do you think?
» left by Jennifer Cuddy (87 days 22 hours ago.)
I would agree with that. But it is true that there are those who play the system, which makes ER clinicians very cynical. For example: those who claim to have allergies to Ibuprofen and/or Toradol; both of which are antimflammatories, and it is basically impossible to be allergic to them.
I am not trying to place blame however, entirely upon the addict. The system feeds the addict, or can even create the addict. And addiction is not something that people purposefully pursue.
But there are those conditions that are privately refuted, such as fibromyalgia. I'm not saying that this is right, it just is.
» left by Susan Thom(8,379) Susan Thom (86 days ago.)
hi jennifer,
this was a well written article filled with facts as i know them. i tried to get a pill pusher out of business, but it is very hard. i know someone who started on percoset after an operation, and progressed to every drug imaginable, leading to Heroin. they haven't seen their kids in 10 years, and live in a drug welfare hotel. i don't know what the answer is, but i know there is a definite problem. thanks for sharing,
best regards,
sue thom Respond to this comment
» left by Jennifer Cuddy(1,178) Jennifer Cuddy (85 days 2 hours ago.)
Sue Thom,
That story, although a bit extreme, is not an unfamiliar one. Let's say, Joe Smith has an accident, and is sent to the ER and is given narcotic medication for pain. Now, let's say Joe also has addictive tendencies, and he grows to like the high that he gets when given the very addictive and oft abused drug, dilaudid. Joe then seeks his fixes by having numerous subsequent complaints, such as chronic neck pain, migraines, or what not. Soon, the problem becomes apparent to one ER, and he no longer goes to this ER, but finds another. This cycle goes on and on, and I see this type of thing atleast one time per shift!
» left by Jeff Brown (85 days 2 hours ago.)
Jennifer, an interesting article concerning a problem that I'm finding goes deeper than most may be aware of. I personally have battled with addiction, but not with drugs or alcohol. And there's the rub. It's a broader problem than most are aware of. Addiction usually is an attempt to replace something that is missing in one's life, oftentimes emotion based lack. Addiction can run the gambit: collecting, sports, gambling, gaming, video games, television viewing, eating, sex, alcohol, drugs, and more. I had a student explain in her paper addiction to video games. As she came off her addiction, she was surly and disrespectful to her parents. We have a daughter who is addicted to television. She wakes an hour early before school to get her fix. We catch her sneaking a few minutes in our bedroom before we have to turn off the TV to send her to bed. I watched a man on Dr. Phil talk about his addiction to collecting. A woman who spoke of her addiction to shopping, running out of places at home to hide her purchases that she rarely used. There is something missing in many Americans that is being replaced by obsession. And it's more than the mere drug addict that we should be concerned about. It runs deeper than that.
» left by Jennifer Cuddy(1,178) Jennifer Cuddy (85 days 2 hours ago.)
Yes, this is all true! i wonder why we are becoming increasingly dependent upon behaviours that aid in avoiding introspection. myspace is one example of this very thing, and also many other social networking sites.
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