No pain meds for drug-seekers?

[Megsd]

I'm had my general orientation for my psych rotation today. I heard some advice from my clinical instructor that is not sitting well with me and I am hoping for some feedback so I can handle the situation appropriately.

We were talking about pain management and how it is mandatory to assess pain every 4 hours. My CI told us to go ahead and do a pain assessment and intervention in the morning, but for the noon assessment "if they're a drug seeker -- and you can spot a drug seeker -- just mark them as a zero for pain if they look ok" because "if they're just looking for drugs you don't want to give them the meds they want every 4 hours, do you?"

We have been taught repeatedly in every nursing class that pain is a subjective experience, that we must assess pain and if the pt says they are in pain, we must intervene. Marking zero on a pain scale because my pt "looks ok" and is supposedly only going to report pain in order to get drugs sounds really unethical to me, but my CI assures us that "psych is different" and we need to remember that. I asked if we should be asking our RN before every pain assessment whether we need to do one and she said we only need to skip the pain assessment if the staff says the pt is a drug-seeker.

So do I do as my CI says and deny pain meds to drug seekers, or do I go with what I have been taught in every other course and give pain meds if pt states they are in pain?

[MB37]

We were taught that chronic pain patients frequently show no observable signs of pain. Our instructor for this area is a PhD oncology nurse in the area, and has conducted several studies in the area on how nurses treat pain. Large percentages - more than half - of nurses in my area, for example, do not give pain meds if a patient is seen laughing with visitors. She taught us that since chronic pain patients, by definition, are in pain all the time, they have learned to adjust and show no outward signs or anything physiologically (raised BP, etc.). You can not document a 0/10 because the pt doesn't "look like" he's in pain. The falsifying of documentation is a pretty big deal. It's one thing if a facility has determined that certain of their known psych patients are "drug-seeking" as a result of their mental illness, but you still wouldn't document that the patient reported a 0/10. Did you take an ethical/legal class? We did, and I would talk to that instructor privately if I had a similar problem.

[xNursePinkx2b]

This reminds me of when I had my first child. I had a 4th degree episiotomy and had hemorraged, and was in so much pain. I had this snobby nurse for night shift, she came in and asked me to rate the pain. I said it was a 10, I was in tears here. It was the worst pain I had been in my life, worst then the labor itself! She ROLLED HER EYES AT ME and said "10? As in your leg has been cut off and your screaming in pain?" I said I don't know I've never had my leg cut off. Then she said, "Well you don't seem to be in that much pain". Then I said whatever, it's a 6, 8, whatever you want it to be, just give me something to ease the pain at bit.

I wanted to punch her!! But anyway, I agree that the pain is what the patient says it is, they may not look like they are in pain,but that doesn't necessarily mean they aren't.

[Megsd, BSN, RN]

Okay, update. I called one of my favorite professors to ask her opinion on the subject. This professor doesn't have a psych background per se, but I figured she would at least be a good second opinion.

She pretty much agreed that this didn't sound right and she recommended I contact my psych lecture professor to seek "clarification" on this issue. She said I should bring up my concern of not assessing pain and charting that I did so from a legal and ethical standpoint, and she said as long as I go about it that way, it shouldn't seem like I'm tattling on the CI (which is not my intention).

So I'm glad to know that she agrees with my assessment and I plan to talk to my lecture professor when the opportunity arises. Thanks for all the feedback. :)