Pain Management-a vent


So I've been practicing as an NP for a whopping 7 months, and the chief complaint I have come to hate the most is "pain". I work in an urgent care department in an urban community health center, and unfortunately, we have more than our share of narcotic abusers. I have been yelled at, threatened, manipulated, etc by a number of patients, all in the name of obtaining Percocet. Unfortunately, I have now become skeptical of anyone who reports moderate to severe pain, and I'm very reluctant to prescribe opioids. Some people are clear cut abusers, and I will not prescribe narcotics for them, while for others it's just not that clear. Our patients can never get same day or next day appointments with their PCPs, so it often falls to the urgent care providers to manage acute pain for patients we aren't familiar with. Sometimes there is an obvious cause for the pain, and that can be dealt with and the patient treated appropriately. But many times there is no physical proof (imaging results or what have you), and we know that pain can exist without an obvious etiology. We are taught as nurses that pain is whatever the patient says it is, but my recent experiences have soured me on that principle. As a result, I'm concerned that I may be undermedicating people who really do need narcotic pain relief. I do try to utilize pain management services and get people in to see their PCPs when the pain is ongoing, but there's still a wait. My state has a lousy system for tracking frequent narcotic users, so it's next to impossible to get info on any new patients in real time. I know there's no easy answers to dealing with this, but I'd love to hear from those who have more experience in prescribing narcotics, and who might have some advice.



44 Posts

Sorry I can't give any insight. I just know I have a lot more empathy and respect for someone who admits they are addicted and will be honest about their situation than the manipulator who feels entitled. Funny, the few who have been humble enough to admit they are dependent get theirs just like the ones pounding their fists on the desks. Why can't people just be truthful?

Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,229 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

I feel for you....I have the same issue.

Like you, I try to get them appts with their PCP, get them into the low income clinic, etc..

I'm not a fan of opiods anyway for pain and lean more towards NSAIDs and/or ultram.

My feeling is that it will tide them over till they see their PCP.

IL does have a great website for controlled substances so I do use it frequently too. Plus, we have had a rash of suits over the overuse of narcotics in our area so we as providers are becoming quite conservative with narcotics.

allnurses Guide

BCgradnurse, MSN, RN, NP

1 Article; 1,678 Posts

Specializes in allergy and asthma, urgent care. Has 14 years experience.

Thank you both for your replies. This is an issue that I'm going to have to walk a fine line on. I know that several of the patients we see are not using the drugs themselves, but are trying to get them to sell on the street. That is even more upsetting, as there is a huge opioid problem in the city I work in. No way do I want to be "helping" that business!! These sales have even happened on clinic property (caught on security cameras), but our administration won't press criminal charges or discharge the patients from the practice. Makes me crazy!! I've started requesting tox screens on everyone that has had an rx for narcotics in the past couple of months. The 24 hour turnaround for results isn't great, but it's better than nothing (we don't have an on site lab). Maybe I'll do some research on the availability of a CLIA waived tox screen we can do on site.


13 Posts

Specializes in L&D, ER, PACU.

I wish I could offer a simple solution for pain control for all people, however it is not a simple issue. Each patient must be evaluated individually. Obtaining a good history is key. Some people are "seeking", while others are in need of pain control. And, I will remind all practioners that pain is the 5th vital sign. Uncontrolled pain can delay healing and increase pontential for infection. And even "seekers" have legitimate pain control issues. You are a short term solution for most. I would suggest referral to primary care resources, pain clinics, etc. for long term solutions. As your experience increases, your radar will improve on how to deal with patient's pain related issues. My opinion is, we do tend on under medicate.