Last night I got a call from the surgical unit regarding one of my partners patients. The nurse explained that the patient was not having good pain control the "10 out of 10" thing. I asked what she had for pain and it seemed very adequate for the surgery. I then asked what the patients home meds where. The patient had admitted that she had "fibro" and was taking oxycodone 4 times a day and had been for years. My partner who is very astute had ordered a drug screen as part of the pre-op labs. This was positive for benzo's and amphetamines. I had to go in and have the talk where I explain that chronic narcotic use causes your pain receptors to go bezerk and that even the slightest pain will be amplified and that it is essential to seek treatment to come off the narcotics. I also had to explain that because of this it will be hard to keep her pain under controlled. We later found out that the patient was taking her kids adderal and what was worse was that she was a teacher! We have no idea where she got the benzos.
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