Pain control for anyone has become a loaded issue. I don't know what the answer is but I wish I did.
A quarter century ago when my mother was dying of cancer and her usual internist had her pain well under control with some wonderful hospice nurses help, the internist left for a conference. His substitute reviewed her meds and pulled most of the ones ordered for pain! His cockeyed rationale? Since my mom was drifting in and out of consciousness, she couldn't POSSIBLY be feeling that much pain. My comment to him (after a try at explaining the hospice pain philosophy to him) would be against the AN TOS to repeat! All I know is that even when she was totally unresponsive, when I'd hold her hand, and ask, "Is your pain severe?" she'd squeeze my hand HARD. That week, her pain meds were provided by a surgeon neighbor. He'd bring when she'd been taking before and, sitting at the kitchen table, filled her Rx bottles. Illegal? Yes. Humane? Unquestionably.
I worked at a state psych hospital for the better part of twenty years. When we'd do an admit, it tended to be a forgone conclusion that the patient had abused both legal and illicit drugs, and that whatever they said about drugs or alcohol was patently fabricated. We were usually right, unfortunately. They'd need to take drugs not only to get well but to stay well for the remainder of their lives. As someone who has had to take meds q 8 hr. my whole life (since 13 months old) that's a huge adjustment! It means that you're always (or so it seems) explaining to someone, why you always have pills in your pocket or always seem to be popping one. "That was so I won't have a seizure." "Oh really?" Believe me, it's much worse for someone who has a mental illness and must take maintenance meds. Now suppose that person has severe knee pain or is in a car accident? Both MDs and nurses tend to underestimate their pain, so they really hurt and that can trigger a relapse of whatever illness they have.
There's also the kind of person who overreacts to pain. I'm not male-bashing deliberately, but many of these tend to be men or BPD young women. When my dad would yell, "OUCH!" we'd never know from his tone of voice, if he had a paper cut or whether his arm had fallen off. People like that don't do well at the ER! The crazy thing about my dad was that he was an MD! He ended up going to law school and that's how he made a living, but he kept his MD license up as well. People who overreact to every injury, tend not to get adequate pain meds because their reaction never ever changes. There was a patient at the state hospital who was in and out, then back in. She would hurt herself badly every chance she had. She could also <shudder> dislodge her eyeballs from their sockets! Occasionally, she'd require some heavy duty pain meds and the MDs would take the "She deserves the pain because it was self-inflicted."
attitude. That's like saying that I deserve seizures because I had a ruptured aneurysm as a baby. Same theory. This teenager was SICK! Just as though she'd had a fractured arm.
Then there are the actual drug seeking addicts out there! Guess what? Annoying and maddening as they are, they are sick too! Addiction is also an illness. Like many other illnesses, the patient has to be willing to enter a program and work it faithfully, just as I sometimes wish I could skip the diuretic that makes me pee (I take four different HTN meds) when I'm going out, I take it anyway. It's called commitment, and that takes time. I wish I had the magical answer to telling an addict from a habituated chronic pain sufferer from a hypochondriac but I don't.