Pain is subjective?

Yup, unfortunately, I feel the same way with some pts. I had one of our frequent flyers (had every possible test for every possilbe disease that could cause chest pain/abdominal pain/headache, never found anything) come in one night. Across from him, I had a pt that was actively dying from prostate cancer. Instead of being able to spend my time comforting my dying pt, I'm being paged to pt jerk's room q5

I too have been in this situation. One way I handled it was to speak to the physician and have the amount of time between the narcotics be extended from 4 to 6-8 hours with Motrin or Tylenol in between. Seemed to work well. For those who were not just seeking, if the pain was indeed real we would again have the physician again see the patient and change the time back to 4 hours.

Unfortunately prescription drug abuse is out there. Patients sometimes don't think it is wrong because it is PRESCRIBED for them.

I try not to be judgemental because 90% of the time these patients have been on PO/ IVP narcs and have built up tolerances to them. I'm not there to detox them.

Yep, been there and done that MANY times. It ticks me off that docs will prescribe Dilaudid or Morphine q1h. OMG, Im in their room more than anyone elses. But I try to look at it other ways too. When I was in the hospital (after colectomy and hysterectomy) I was asking for my pain medicine on the dot when it was due. I was truely hurting. I am now in constant chronic pain but you wouldnt know it by looking at me. I laugh and talk at work, while deep down my abdomen is churning. And for those who are terminal, who am I to say anything. And for those who have been on it for years, who am I to say anything. Its hard these days to tell the true pain from the drug seekers, but sometimes there are those that you just KNOW are drug seeking. It also angers me when docs order strong narcs for pt's with a minor dx and with hx of drug abuse...knowing this will send them spiraling down that pathway again once discharged. The other day I had a patient who had been imprisoned 4 times for drug abuse. He was prescribed Dilauded 4 mg every 2 hours! He would come to the nurses station asking for it, then leave and smoke. I asked him at 12:15 if there was anything else I could do for him, his response?...."just bring me my pain med at 2:00". I finally blew. I told him that he cant PLAN to be hurting 2 hours later.

Why are they there? I also work in long term care and a lot of our subacute patients are hip or joint replacements or pelvic fractures and get PO meds. They are in pain. When people suffer with pain for a long time they are able to live life through it and may be able to hold a conversation with 8/10 pain and even laugh. Especially if they are with family- they don't want them to worry them or be rude. If they are asking for pain medication on the dot it's probably because their pain isn't being controlled well. Addiction is highly unlikely. There bodies may have become dependent on pain meds and their tolerance may have increased, but that's doesn't make them drug seekers. Pain IS subjective and I think it's important as nurses we treat is as such.

Pain is very subjective and a very idividual thing. I have a very low pain threshold, give me the least little bit of a narc and I'm gone. Yet, when I had my choly they were giving me very duty narcs and it didn't touch my pain. When I had my appy, the ER Doc said he didn't think any thing was wrong with me because I was talking to my husband. (Had an emergency appy the next day at a different hospital, WBC thru the roof).

Anyway, I have learned over the years, that you have to try and stay nonjudgemental as best you can. It's not always easy, especially when you have to take care of a patient who has a hx of drug abuse and you are trying to control their pain. It can be difficult and frustrating.

Very often adding med like Tylenol, Mortin or Toradol can help.

there are pts who will seek their meds when truly in pain.

there are pts who will seek their meds because they love their meds.

and then there are pts who will request their meds to keep ahead of the pain. (as they've been taught?)

2 out of 3 are valid reasons.

i'll take my chances.

leslie

there are pts who will seek their meds when truly in pain.

there are pts who will seek their meds because they love their meds.

and then there are pts who will request their meds to keep ahead of the pain. (as they've been taught?)

2 out of 3 are valid reasons.

i'll take my chances.

:yeahthat:

I feel like a legal drug pusher almost every day. It's really something when they go "AHHHH" as it's being pushed. That happens ALOT !!!

Do anybody have any article that suggests I can objectively assess pain?

You can objectively assess pain.....in those who cannot communicate! Otherwise, it is not your place to decide whether someone is in pain or not. Imagine all the people really in pain that might slip through the cracks if we were able to decide based on our "intuition". We arent Columbo.:)

My sister recently had a tumor the size of a softball removed from her colon. I was with my sister through both of her natural delivery pregnancies and I know how she deals with pain. She is very quiet and basically meditates to "Go out of herself" as she describes it to deal with severe pain. Well, after surgery I spoke with my mother who was there with her and my mother told me my sister was in severe pain. I spoke to the nurse and the nurse said to me "Your sister is sleeping and I am not going to wake her up to give her pain medication" When my sister is in severe pain it is difficult for her to deal with anything but concentrating and so yes it may seem like she was sleeping but I told the nurse she is not sleeping and I told her how she deals with her pain. Assuming the nurse would medicate her I hung up and called back later. I found out that no indeed the nurse had not medicated her and my sister had been laying there for hours in agonizing pain! So I got in the car with my 2 little boys and drove the 2 1/2-3 hour drive to get there and dealt with the nurse myself. Believe me as soon as I got there the nurse got the doctor on the phone and they got the appropriate dose and timing (not PRN) and my sister was not pain free but she could tolerate it for the rest of her post op stay. The doctor came in the next morning and apologized for my sister not having adequate pain control the day before. I was really angry that the nurse didn't try to assess my sister more thoroughly than just see she had her eyes closed and assume "Oh if she is sleeping she can't be in pain". I know you are a new nurse and you have a lot to learn in the real world but I think a pain seminar would be a great investment. You can not think you know or assume what another person's pain level is no matter the circumstances. You really have to believe what the patient is telling you. We are not there to judge our patients but to assist in treating them. If the doctor has written the order for pain medication then that is between the patient and the doctor.