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?

re: "Patients in a lot of pain will usually show some signs other than just verbally telling you they have severe pain. Some signs are: restlessness, grimacing, guarding, elevated HR & BP, elevated resp rate, diaphoresis. "

Not with chronic pain. I was a hospice nurse for a few years and I learned that this is true only with acute pain. The signs and symptoms for severe chronic pain can include sleeplessness or sleeping a lot, depression, agitation, withdrawal, and other mood-related changes.

Also pain descriptors change with personal experience. I thought a 10 was when I had my face cut up by glass in an accident (piercing, burning pain) until I gave birth (horrible pain- made me cry out)and also experienced passing a kidney stone (like giving birth but only on one side of the body).

Still, as nurses you are in no position to judge. That is diagnosing. I drove myself to the hospital with a kidney stone and checked myself in. I had to keep pulling over to throw up and scream all the way there. They probably thought I was drug-seeking.

I have heard terrible comments from patients at home who had cruel nurses in the hospital who would not bring their pain medicines when they asked for them, or who made rude comments and tried to make the patient feel guilty for asking for their pain meds. I always tell them to report these things to hospital administration. We do not need people like that in nursing.

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Sometimes I am glad I work in a Surgical ICU.

I have no trouble believing pain on these badly injured people and patients who have had extensive surgeries.

Broken pelvis? Burns? Here, sir, let me get you some more Morphine.

Some patients have chronic pain and do require higher doses, but I have had no trouble believing patients have real pain here.

I have also worked Med-surg and am familiar with the more ambiguous situations.

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Specializes in cardiac, psychiatric emergency, rehab.

Cx: You Go Girl!@!!!!!:)

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My goodness, we seem to revert to the role of police control when it comes to pain, why would you choose to give a placebo, to soothe your need to control? To show the patient you know best or to again, just control the patient? Put yourself in the place of your patient, as a nurse you probably are very stoic or you know the importance of maintaining an adequate blood level og pain medication to keep pain under control, but you enter the hospital as a patient and you are faced with the pain control detective who labels you med seeking, or just decides you aren't in pain because it's too soon or the detective that says you can't be in pain because you aren't writhing around on the floor or bed or you are able to converse with your visitors. Would you be amenable to a placebo or a delay in getting your medication? Just a question...nanacarol

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there nis an interesting article on Medscape Plus dealing with pain if anyone is interested in reading it and learning about new information about pain control. nanacarol

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well.. i didn't actually said withhold the meds. What i am trying to point out was give the meds at the right time.. i clearly know that using placeabo is not right..but as far as i it is not also right over dosing meds..:wink2: Our job is very complicated.. we are being ordered to give medication to our patients..but is this everything we can do?how about the good samaritan law?

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I know I've just got my license...but it won't stop me in searching and trying new things to help my patients with their needs. I know it is very risky but is more risky to give them pain meds if they really don't need it..they might be addicted to it..or worse, they will be dead.. If the pain is real, give the right medication.

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well..that's the idea..faith healing sometimes work..:wink2:

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well.. i didn't actually said withhold the meds. What i am trying to point out was give the meds at the right time.. i clearly know that using placeabo is not right..but as far as i it is not also right over dosing meds..:wink2: Our job is very complicated.. we are being ordered to give medication to our patients..but is this everything we can do?how about the good samaritan law?

This post is REALLY confusing to me, lol. You're supposed to give meds as doctor ordered right? So if you were overdosing, it would be because the doctor had ordered them that way, so you would just call the doctor to verify the order and double check it with a supervisor if necessary like any other med that seemed off, not change the order to what *you* think is the right dose, right?

As far as the "Good Samaratin Laws" are you just pulling words out of a hat? lol... because this has NOTHING to do with medication administration what so ever. It regards the laws in place to protect people from persecution if they try to help someone in an accident/emergency situation.

Per Wikipedia:

"Under the common law, Good Samaritan laws provide a defence against torts over the activity of attempted rescue. Such laws do not constitute a duty to rescue, such as exists in some civil law countries, and in the common law under certain circumstances. "

I'm trying to follow your logic, but I just CANNOT seem to connect medication distribution and the protection of passersby who help in rescue attempts.

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Specializes in telemetry, med-surg, home health, psych.
well.. i didn't actually said withhold the meds. What i am trying to point out was give the meds at the right time.. i clearly know that using placeabo is not right..but as far as i it is not also right over dosing meds..:wink2: Our job is very complicated.. we are being ordered to give medication to our patients..but is this everything we can do?how about the good samaritan law?

Be a "good samaritan" and give a pt. their pain meds on schedule. as ordered, without questioning their need.....

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I know I've just got my license...but it won't stop me in searching and trying new things to help my patients with their needs. I know it is very risky but is more risky to give them pain meds if they really don't need it..they might be addicted to it..or worse, they will be dead.. If the pain is real, give the right medication.

I agree we should use all the tools we have to treat pain. We need to use things like heat, cold, massage, change of position, etc.

If someone is addicted to medication I don't think it is our job to withhold meds. This means they are physiologically dependent upon them. You are probably not in the position to safely detox a person if they are in an acute setting. This is a medical job and if you are withholding thinking they are addicted you could be accused of working out of your scope of practice.

Many people are physiologically dependent upon narcotics. Abrupt withdrawal can be fatal if it causes arrhythmias, etc. At best it will place the person in much more pain that someone has to deal with.

I get very concerned when I see addiction used as a reason not to give pain meds. What can we accomplish short term in terms of stopping the addiction process when the reason they are with us is not addiction? If the plan is to do a medically supervised detox it is critical that the directions be followed. Most nurses do not know much about dealing with medically supervised withdrawal and during hospitalization is not the time.

Just a reminder that being physiologically dependent is not the same as addicted. Many elders are physiologically dependent but you don't see them out robbing for their drugs. The difference is what values systems are broken by the need to acquire drugs.

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Specializes in ER, PACU, Med-Surg, Hospice, LTC.
I know I've just got my license...but it won't stop me in searching and trying new things to help my patients with their needs. I know it is very risky but is more risky to give them pain meds if they really don't need it..they might be addicted to it..or worse, they will be dead.. If the pain is real, give the right medication.

That's smart to look for different ways to help alleviate a patients pain. I remember how much my neck hurt when I was in the Hospital. A neck massage was a dream come true!

Remember, a true addiction to prescribed Opioids is around 3%. That is really, really low, IMHO.

Death from prescribed Opioids is very unlikely if you are monitoring VS and administering the meds as ordered by the Physician.

Also, remember that you do not know a person's pain. You might think a person doesn't need pain control, but in reality, only the patient knows the pain that they are experiencing.

Adequate Pain Control IS A HUMAN RIGHT

From Article:

"Newswise-A growing international consensus urges change in several areas--including increased availability of controlled medications such as opioids--toward the goal of recognizing effective treatment for pain as a fundamental human right, according to a special article in the July issue of Anesthesia & Analgesia, the official publication of the International Anesthesia Research Society and published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Dr. Frank Brennan of Calvary Hospital in Kogarah, N.S.W., Australia and colleagues summarize the medical, legal, and ethical arguments for transforming access to pain management into a global human right. They write, "Medicine is at an inflection point, at which a coherent international consensus is emerging: the unreasonable failure to treat pain is poor medicine, unethical practice, and is an abrogation of a fundamental right."

Inadequate pain treatment is an entrenched problem around the world, related to cultural, societal, religious, and political factors--including, the authors believe, the acceptance of torture. Poorly controlled pain has many and potentially serious adverse effects, both physical and psychological, as well as "massive social and economic costs to society," Dr. Brennan and coauthors write. Cancer pain is a special concern, with up to 70 percent of cancer patients experiencing severe pain caused by their disease or its treatment.

Contributors to inadequate management of pain from cancer and other causes include "opiophobia and opioignorance": fear and ignorance of the strong pain medications classified as opioids--morphine and related drugs."

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Just another note, it is easy to confuse addiction with dependence or tolerance. Many people use these interchangeably when talking about Opioids. They are very different.

Also check my prior post regarding Pseudo-Addiction. Google it, too. There's a lot of info out there about it.

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