We have all seen it.
The patient has a pain response completely disproportionate to the stimulus. An absolutely agonizing sprained ankle. A blood pressure cuff causing 10/10 pain.
Look up the patients history, and sure enough, multiple visits for pain. Dental pain, strained back, headaches, sprains, etc. Often these folks will have a history of complaints with no objective findings, and have subjective symptoms that can be relieved by mind altering drugs. Multiple prescriptions for narcotics.
It is easy to write this off as Drug Seeking Behavior. (I actually think this is a ridiculous term, but that is a different subject) Turns out there is a growingly accepted explanation for the phenomena.
It has become obvious to me over the years that treating minor injuries with narcotics is a truly bad idea. I am very active, and no stranger to injury, yet somehow I manage without narcotics. And, I see the phenomenon of increasing visits once we start giving narcs. It feels to me, like we are writing off these folks, taking the easy way out. Doctors regularly give narcotics to patients that they would never allow for their own family, given the same condition.
It turns out my anecdotal observations are backed by science. Who knew? While the phenomenon is obvious to many, I did not realize, until recently, that it had a name and scientific evidence.
Opioid-induced hyperalgesia (OIH) refers to a phenomenon whereby opioid administration results in a lowering of pain threshold, clinically manifest as apparent opioid tolerance, worsening pain despite accelerating opioid doses, and abnormal pain symptoms such as allodynia.
If, as a nurse with a 2 year degree, this is obvious to me, it has got to be obvious to the docs that contribute to this problem. But, as long as we use The Customer Service Model in healthca.re, it seems unlikely to change. What are the chances that somebody complains about being given percocet for a sprained wrist? But, untreated pain....
For anyone interested, lots of info a quick Google search away.