Pain Management/Seeking

[FloatFNP-C, BSN, MSN, NP]

I have been a nurse for about a year and half... so still pretty fresh! I am looking for some advice from more experienced nurses regarding pain management in patients you suspect are seeking.

I know pain is subjective and we have to treat everyone's pain as they say it is...BUT.

When a patient comes in with "abdominal pain" and there is no clinical evidence of pain AND they are always a 10/10 WHILE they eat their burger, fries, and shake AND they request IV Benedryl because the Toradol they tried in the ED gave them an "allergy" AND don't forget the IV Phenergan because they feel sick. Can't keep anything PO down, yet eating appropriately and talking normally. Oh yeah, and the neighbor next door was faking her vomit with bits of oatmeal, water, apple, and ginger-ale (another nurse smelled it!) -therefore she could only take IV meds. I mean, come on.....

I just get so discouraged. I know we aren't going to make any changes for these patients long term, but why are the docs ordering these meds? My philosophy so far has been that if the doctor orders it and it's on their MAR, I will give it in the allotted time... I don't always tell the patient exactly how often they can get it though.

How do you deal with this? It seems like some nurses are more pushy and some are too nice (I feel like I fit this category) but inside I am burning with anger because I'd much rather be taking care of really sick patients that need me. But instead, I'm pushing narcs q2h or more.

By the way, I work in the float pool. I mainly see this on our observation unit (

[Rocknurse, MSN, APRN, NP]

It's not your call. Your job as a nurse is to assess, document the patient's stated pain, and administer an ordered medication. Just because you suspect someone is drug seeking doesn't mean they are, and does not give you the right to withhold meds. People who suffer chronic pain are very good at tolerating it and may not show the same signs of pain as someone who does not suffer from pain on a daily basis and so yes they may be eating or going about their normal business, or so it may seem. You are also dealing with a population that may be taking narcotic pain meds long term and so they have become tolerant of the dose. This may also mean that they are somewhat dependent on it and if you make a call not to give someone their meds, their pain can quickly get to unmanageable levels. Yes, there are drug seekers but withholding people's meds who are actually not drug seeking is detrimental to their care. People who legitimately take these meds are often judged and lose out on pain control because of the stigma. If a patient is truly drug seeking, it's up to the doctor to address that and offer treatment, but those who are not drug seeking really need that medication and you can't just stop it.

[FloatFNP-C, BSN, MSN, NP]

Thank you for your input... I want to clarify that I've never withheld medications from a patient. Like I said, if it's on the MAR, I give it, and if they need me to call the doctor, I always do. I wonder why this bothers me so much? I guess I feel like I get played as a fool and I worry about feeding addictions. But you seem to be right by its not my call, i am not a doctor, that's why i don't get paid the big bucks! [emoji3]

[twozer0, NP]

Drug seeking behavior and dealing with patients as such will eventually lead to you feeling burned out. I did ER nursing for almost 5 years. I went through a period and I think all nurses do around that year mark about drug seekers. It does get annoying and eventually you just learn to live with it. It's hard because you want to be able to get other things done and are pulled for frivilous things such as pain. People will be people, and they will continue to abuse the system, just let them. I would rather go in, give some meds and then go do whatever it is I needed to get done than deal with them over and over. It will be against your best judgement and you're personal morals but its just easier to give them what they want and move on.

Good luck!

[LadyFree28, BSN, LPN, RN]

Thank you for your input... I want to clarify that I've never withheld medications from a patient. Like I said, if it's on the MAR, I give it, and if they need me to call the doctor, I always do. I wonder why this bothers me so much? I guess I feel like I get played as a fool and I worry about feeding addictions. But you seem to be right by its not my call, i am not a doctor, that's why i don't get paid the big bucks! [emoji3]

My suggestion is as long as their VSS-give it.

I had the wonderful exposure to being on a ortho trauma unit in nursing school (as a practical nursing student) where pts who engage in already risky behavior who have use drugs have their pain receptors fried and nothing would touch them...they still could eat and everything else, but no matter what medication they used it would work for 15 mins and then they would be back to being in pain, breaking a sweat, etc...I ended up working in an Acute Rehab hospital where pts were in their most gutter moments with substance abuse issue and had traumatic and SCIs...I worked at night, so most of the time, at night, their trauma would be at their highest peak, and pain would come along with it-I would give them their antipsychotics or antidepressants, and then give them their pain meds-100% of the time the VSS, and they had psych involved, or I would give an ear when necessary, some would wean off, others were far gone that their need to pain meds was their way of coping and surviving; along with potential side effects that are detrimental if they didn't get their meds-I'm on to side on the benefits vs the risks, and above all, stable vital signs.