Untreated Cancer Pain a ‘Scandal of Global Proportions,’ Survey Shows

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36. Drug Seekers Suck

http://www.epmonthly.com/whitecoat/2008/02/drug-seekers-suck/

Drug Seekers Suck

... A lady with a previous history of chronic neck and back pain now comes in with frontal headaches for the past month. Of course, her pain is a 10 on a 1-10 scale. She gets dizzy at times when she stands. Sometimes she gets nauseous. She says that she has vomited twice in the past 3 days. She used to take Vicodin for her back and neck pain, but she’s out of them now. I look through her old charts. She seems to like Dilaudid and Vicodin.

It’s a busy shift, so she had to wait for a couple of hours. When I walk in the room, she’s laying on the bed with her arms folded. She seems upset with the wait, but she’s playing the “nice” card, I can just tell. She’s sizing me up from in between those fingers over her eyes. Very polite. Says “thank you.” Compliments me on being so nice even though we’re so busy. I engage in some small talk with her and she actually is a nice lady. The little voice in back of my head is literally kicking me in the mastoid right now. “Hey! WhiteCoat! Don’t be a sucker. She may be nice, but remember her history! Being overly “nice” is page 2 of the drug seeker’s handbook!”

Since her headaches are a “new” complaint, I examine her from head to toe. No fever. No sinus pressure. No temporal arteritis. Fundi normal. No photophobia. No meningeal signs. No abdominal problems. No focal neurologic deficits. Oh, by the way, she still has that chronic pain in her back. Can’t find anything abnormal on her exam other than her “10 out of 10″ pain.

I don’t care how nice she is, she isn’t getting Dilaudid. We give her some Phenergan for her nausea and some Imitrex for her headache. Her headache improves to a 5 out of 10. ...