Well, like so many have already written here, we are certainly taught that if the patient says they are in pain, they are in pain. Personally, I like that idea for a number of reasons. If they are, and I "guess" wrong, I will have been instrumental in continuing someone's discomfort. I don't like that. Also, the onus must be on the patient. If we think they are dependent, we can certainly teach about alternatives that can render their pain med more effective, and we can refer them for counseling, etc., to learn some of those techniques.
Isn't it true that someone who is dependent is in fact in physical pain when their blood levels drop enough?
In my previous life as a psychotherapist, I had a client whose cc was intractible pain. She reported a hx of a work injury, and so favored her back and neck in my office and anytime I saw her that I would almost wince. I felt so bad for her! And then our secretary (we lived in a very small town) saw the client *skipping* to the drug store to get the scrip filled! Boy, did I have a hard time not confronting her.
Same town, same MHC, I had another client who just seemed to have all kinds of vague complaints, and went from doc to doc, and no one could ever find a cause. She was also depressed, had some other mild MH problems, and I really didn't have a lot of patience for her aches and complaints. I didn't confront her, I didn't treat her any differently I (I don't think), but I didn't have the empathy for her that I might have, had I really believed her. Later, much too late, she was dx'd with multiple myeloma. Had she been in "real" pain? Uh, yeah.
Interestingly, the second lady is very much responsible for my finally going into nursing, and for my interest in pain management and hospice type work. The day I was moving from that small town, I went to see her at the nursing home she was then living in. She was bedridden, in constant pain, and only "with it" some of the time. She knew I was there, though. She had a BM (incontinent, of course) while I was there and the NH staff was short, so I helped clean her up, not wanting her to suffer the indignity (and more, I know now) of lying in her own poop.
This was a first for me--the belief that I could not stomach taking care of someone that way had kept me out of nursing school (along with a couple of other minor things). So today, when I think of Sylvia, I am grateful for several things, not the least of which is the lesson of believing when someone says they hurt.
BTW, she died about four hours later. And what a gift she had given to me in those last hours.
Okay, enough rambling--thanks for your "ear." Gotta love this BB!!