Pain is subjective?

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I have been a nurse for only one year and I am already questioning the idea/assumption that pain is subjective. I work in the LTC ward where we have subacute patients (including acute rehab and extended care) and hospice patients. I administer vicodin, morphine, oxycodone, tramadol, tylenol #3, etc. at least 8-10 per shift and I work an 8-hour shift. I do have patients that I know without a doubt are really in pain, but 75% of my patients ask for PRN pain medication right on the hour everytime it is due not knowing that I am outside their door and I can hear them laughing and/or carry on an entertaining conversation with another person. Yes, I do believe that pain can be subjective but how am I suppose to assess pain for my drug-seeking/addicted patients? I find it hard to believe that they are telling me that their pain level is 8/10 every single time. Lately, I have been feeling less like a nurse and more like a street drug pusher in a hospital setting. Can anyone relate to what I am saying? Do anybody have any article that suggests I can objectively assess pain?

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Specializes in ICU, Telemetry.

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

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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.

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Specializes in ICU/Critical Care.

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.

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Specializes in Med/Surg, Home Health.

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.

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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.

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Specializes in ER, ICU, Neuro, Ortho, Med/Surg, Travele.

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.

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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

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Some people are more stoical than others when grappling with pain. They can laugh, watch television, and chat with loved ones while experiencing excruciating pain. A person who has experienced chronic pain for years no longer reacts to it with crying or emotional "outbursts."

Judging these patients is not my place. While I cannot guarantee that all claims of pain will be believed, I'll try my best to medicate in a timely manner.

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Specializes in Oncology, Triage, Tele, Med-Surg.
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:

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Specializes in Med Surg, Ortho.

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 !!!

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Specializes in Med Surg, LTC, Home Health.
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.:)

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