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?

Specializes in Spinal Cord injuries, Emergency+EMS.
As nurses, it is not our job to assess iif the patients pain is real or not. It is the physicians job to decide if they are drug seeking or not. Even if you are able to find an easier way to assess objectively we cannot in good faith deny them meds that they are entitled to especially if it is a valid order that is not contraindicated.

interesting given the nurse is accountable for the use of Controlled Drugs on the unit they work on and accountable for the administration of any medication theysign for as given...

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Specializes in telemetry, med-surg, home health, psych.
interesting given the nurse is accountable for the use of Controlled Drugs on the unit they work on and accountable for the administration of any medication theysign for as given...

I am accountable for giving them to the correct person and signing them out....I am not accountable for accurately assessing the need for them...the Dr. made that decision when he ordered them for the pt.

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Specializes in Spinal Cord injuries, Emergency+EMS.
I am accountable for giving them to the correct person and signing them out....I am not accountable for accurately assessing the need for them...the Dr. made that decision when he ordered them for the pt.

if only it was that simple

'just following orders' floats about as far in a modern courtroom as it did in nuremburg...

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Specializes in telemetry, med-surg, home health, psych.
if only it was that simple

'just following orders' floats about as far in a modern courtroom as it did in nuremburg...

Are you going to deny someone their pain meds that were ordered for them because you "think" that they don't need them????

I'm not....

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I would love to know how "you just know" when somone is a drug seeker?

You know when the pt you are seeing is a 3X a week ER pt with different complaints each time and you recently recieved a call from a local pharmacy who questioned the Dr. prescribing 120 Lortab and the chart revealed he had attempted to change the "12" as written to 120 and didn't read that the Dr. also wrote "twelve" in parentheses beside it. Need more examples- I got quite a few.

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Specializes in neuro, critical care, open heart..

One of the ways that I can tell is the pt that is "allergic" to ALL types of pain meds from Tylenol and Motrin all the way up to Demerol and Morphine. The only thing that works is "4mg of Dilaudid every 2 hours"!! Now, tell me that this pt is not seeking!!!

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Specializes in Acute Care, Rehab, Palliative.

It is not our place to judge.

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Specializes in cardiac, psychiatric emergency, rehab.

Amen..:)

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Specializes in ER,ICU,L+D,OR.
One of the ways that I can tell is the pt that is "allergic" to ALL types of pain meds from Tylenol and Motrin all the way up to Demerol and Morphine. The only thing that works is "4mg of Dilaudid every 2 hours"!! Now, tell me that this pt is not seeking!!!

Or the patient has a serious illness. I have treated some patients in such intractable pain that they truly required 10 mg dilaudid IV every 2 hours. And yes they had multiple allergies. Some injuries and chronic illnesses mess around the immunoallergy systems very seriously

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Specializes in ER, PACU, Med-Surg, Hospice, LTC.
I would love to know how "you just know" when somone is a drug seeker?

You know when the pt you are seeing is a 3X a week ER pt with different complaints each time and you recently recieved a call from a local pharmacy who questioned the Dr. prescribing 120 Lortab and the chart revealed he had attempted to change the "12" as written to 120 and didn't read that the Dr. also wrote "twelve" in parentheses beside it. Need more examples- I got quite a few.

Well, to play devils advocate here...maybe this patient IS in chronic pain, but does not have health Insurance. As a result, they do not have a PCP to follow them and they will never be able to afford a Pain Management MD. They've tried OTC drugs. Tylenol does nothing and they've developed ulcers from the Ibuprofen.

They are desperate. What's left? Well, they go to the ER. They start lying about their pain issues because they are grasping at straws hoping that someone will believe in them. They get 12 Lortab (which, a person in chronic pain can go through in a couple of days). They alter the prescription, hoping to get more of the medication to treat their pain level and tolerance....

I'm just saying, there are always two sides to a story. :redbeathe

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Specializes in telemetry, med-surg, home health, psych.
One of the ways that I can tell is the pt that is "allergic" to ALL types of pain meds from Tylenol and Motrin all the way up to Demerol and Morphine. The only thing that works is "4mg of Dilaudid every 2 hours"!! Now, tell me that this pt is not seeking!!!

Could it possibly be that they have had such chronic pain and developed a high tolerance to the usual pain meds that they really do need the dilaudid......after long term use of meds we all know that it takes a much higher dose or stronger drug to be effective.....maybe some ARE med seeking, but maybe some ARE NOT.......who are we to judge??

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UK_cats_rule...

After reading this thread for days, I am not sure that anyone said that there were not drug-seekers in healthcare. The point is, how well do you know the patient's full history? Does the patient have an addictive personality? You know, this can lead to seeking behaviors of many sorts. What about his full medical history? Does he have chronic pain? This certainly can effect his tolerance of medications. As nurses, we tell the patient to know their bodies and their health. Who better to know what does work, and what doesn't? Are you willing to try to give Toradol to a patient that has an allergy to prove that they really do have that allergy? After having worked in the ED for years, I acknoledge that there are drug seekers...Just like there are stoic people who infarct and do not complain. Maybe that is why I try not to question what they are telling me. But I agree, that we ought to give the same respect to the nurse who works beside us...I try not to queestion her judgment either.

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