If in any doubt, the senior nurses I've worked with call the APS (Acute Pain Service).
Of course we get drug seekers - despite what people think, these people are chronic drug seekers as most have chronic pain. Also everyone's pain is very different. My brother cannot stand any pain at all - he is never ill - but any pain he can't handle. My Dad can handle lots of pain and narcs don't usually work on him (I've seen this with my own eyes in an ED). So we are all different.
I nursed a woman in a large ED once. She had had back pain for about 20 years I think. She had diabetes, hypertension, God knows what else. She was hugely overweight. She wouldn't even move off the bed to use a bedpan. She wailed & moaned in pain. She had had pain relief (can't remember what). She would have defecated in the bed, but I made her use the bedpan. We were incredibly busy that night & she took up a lot of our time; I think she was a frequent flyer, probably hadn't visited her pain specialist or whatever.
The whole point is some patients WILL have pain, but if they've had something for it, they still need to move as much as they can. If they don't their muscles & joints lock up, blood flow is decreased, etc & they can't then do anything at all. We still need to encourage them to move around at least a little.
I get horrid pain from long-standing endometriosis. Some days I get pelvic pain, pain going to the toilet, back aches etc from scar tissue. I have miserable, heavy periods. But I still make myself do things after taking some pain killers - I HAVE to or I will eventually wither up and die. I keep thinking positive thoughts and do positive things. On really bad days, I have to call in sick for work & just basically rest and look after myself.
Yes we are all judgemental it's human nature. But it does get wearying when u know who the drug seekers are. They also take up A LOT of time in any department you work in, whether it's ED or the wards. And they are never satisfied with the treatment they are given, they also get lazy.
As a RN I think it IS up to us to question these patients, and to r/v pain meds with the doc when we get hold of them. In the end, you don't do patients a favour by piling more meds onto them as it leads to more complications and problems.
Having worked with pain doctors & nurses, I can also tell you that when patients DO stop their meds - maybe in a trial or something - they have as much pain as when they're on their meds. Some also found better relief with OTC pain medicine too and using other methods, ie: stretching, gentle walking, water aerobics is fantastic for pain pts, yoga/pilates, and being referred to a pain clinic can help (though most pts don't go for follow up t/ment). If you can suggest these things, these may help chronic pain patients as well.
I also nursed MH pt with long standing neck pain, think she'd had 2 or 1 disc removed?? (can't remember). No pain killer had helped her except narcs but I noticed that the physio & doc thought it was psychosomatic. When I went in to assess her, I noticed she was holding her head to the side at an odd angle; this was how she 'coped' with the pain. I explained that the muscles on that side had probably tightened up & the pain would/had got worse. She kept insisting that how she held her head HELPED the pain, but I was trying to reiterate that yes it would for a while, but when she went to straighten her neck, the pain would get worse, due to tight muscles being stretched. She refused any help, just wanted the narcs. I think this is sad in a way as she (and the doc etc had written this) she would not do anything to help herself. Being scared is a big factor too.
So yes it is very, very difficult to help people sometimes. We have to accept their right to refuse t/ment as well.