This makes me think of a hospice pt I had. He was in excruciating pain, but nothing would make him take his meds. I think part of this was cultural, but it was so frustrating, because I know he suffered and died in terrible pain. I would talk to him, the family, and they'd all nod their heads that yes, he should take his meds, the pt would agree...and then nothing. Of course, this would come to a crisis on the wk. end, then the on-call nurse would make multiple trips to the home...still, he refused.
We had his doc talk to him, the social worker, we networked with a pain mgmt. nurse in NY who was familiar with this culture...nothing worked. I really felt helpless and felt like I didn't do anything for him.
What really threw me off, was that after he died, his family sent me a lovely card saying how much they appreciated all I'd done for him. I really didn't feel like I'd done anything, and it was heartwrenching...he had tons of pain meds right by his recliner that went untouched.
Just because someone refuses pain meds doesn't mean that he/she isn't in pain. All we can do is try to find out the pt's concerns, educate, and the rest is really up to the pt.