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 Med surg, Critical Care, LTC.

Look, I never said I was "the creator" or "a mind reader", sticks and stones.... I also do not take blindly whatever my patients tell me. I have had patient who tell EMS one story, me another and the doctor yet a third. Which story do you believe??? Go on, tell me!!

Again, all we have is our judgment and our education. I'm not sorry I choose to use my judgment - not my crystal ball.

Enough of this mindless nonsense, my pain is now a 10/10, I want my Dilaudid!! Boy, you nurses must be popular!!

Now I will use my "remove myself from this post" option. Night all!

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Specializes in telemetry, med-surg, home health, psych.
I have to say something to all of you who believe everyone who says they are in severe pain. should be medicated, and we should believe what they say, no matter what. WHAAAAT do you mean????

Look, I'm a very liberal person with pain medication, but lets be real here. There are people, believe it or not, who just like the narc's, or who just want to experiment legally with drugs. I usually will believe nearly everyone who say's they are in pain. It's the degree of pain that I usually question.

Like in my previous post, if you can laugh with your friends while eating a Burger King value meal and dance the jig at the same time, well, I just won't believe your pain is 10/10!

We were educated to use our judgment, we can't go giving narcs out willy nilly and stop someone from breathing just because no matter what we give them their pain is always a 10/10. I have had many, many people who always say 10/10 or 20/10 when they can barely slurr their words out, with a HR of 49, resp rate of 12 and a BP of 92/59!! Oh, and you have to WAKE them to get them to rate their pain.

Again, I believe people have pain, but come on, we MUST use our judgement and parameters in order to treat a person safely.

Blessings

Oh My !!! Basic nursing tells us all that we don't give strong narcs to someone with vitals you speak of.....no one here, I doubt, is suggesting that.....what we are saying is that when someone states they are in pain and we don't think they are, it is not our job to withhold their pain meds just because we don't THINK they are in pain....granted if vitals stable to allow them to have.....needless to say.....

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Specializes in Med/Surg, Home Health.

I wish the mods would close this thread. Its getting out of hand. Some are slamming others or name-calling. Some are on a "high horse" and feel they need to educate another. We all have been in different situations that give us our opinions and reasons for what we have said. I dont know why I came into this thread again, curiousity I guess.

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Specializes in Med/Surg - Pain Management.

"We can give placebo meds"

NEVER give placebos:no:. They are not scantioned by any professional organization unless the client is enrolled in a study and has given informed consent and is aware that they may receive placebos as part of the study. If you want more please go to www.aspmn.org (Am Soc for Pain Management Nursing) and read the placebo position statement that was developed in conjunction with other professional organizations (yes, some of them were physician organizations!).

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Specializes in ER,ICU,L+D,OR.

Pain can be such a pain ehh. Who would have thought that.

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look, i never said i was "the creator" or "a mind reader", sticks and stones.... i also do not take blindly whatever my patients tell me. i have had patient who tell ems one story, me another and the doctor yet a third. which story do you believe??? go on, tell me!!

again, all we have is our judgment and our education. i'm not sorry i choose to use my judgment - not my crystal ball.

enough of this mindless nonsense, my pain is now a 10/10, i want my dilaudid!! boy, you nurses must be popular!!

now i will use my "remove myself from this post" option. night all!

i know you are probably gone but i just loved the sentence highlighted above.

i'm a hospice nurse and we have extensive training regarding pain meds and pain is what the patient says it is.

steph

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Specializes in ER, PACU, Med-Surg, Hospice, LTC.
I wish the mods would close this thread. Its getting out of hand. Some are slamming others or name-calling. Some are on a "high horse" and feel they need to educate another. We all have been in different situations that give us our opinions and reasons for what we have said.

Please, do not close this thread. If you don't like it, don't read it. If you don't like some of the responses from certain people, just put them on your ignore list (like I'm, sure I was just put on...LOL!!!)

Yup. I guess if providing links to educate people is being on a "high horse" then I am guilty as charged. I always try to post valid and objective links for people whenever I can. People can read them and open their minds to other schools of thought and stay current on the rapid changes that occur in the Medical Field OR they can choose to ignore them.

I dont know why I came into this thread again, curiousity I guess.

:clown:

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Specializes in Med/Surg - Pain Management.

Sorry if I offened with my post regarding placebos. As you can tell that is one of my "buttons". Being a pain educator I know that placebos have been a HUGE issue in medical care. Litagation, ethics etc! I would hope that no nurse or physician would be giving placebos outside of a clinical study with informed consent. Now with this said I admit that many eons ago, as a new grad, we had docs who prescribed placebos and they were given....yes, by me also. That was the 'dark ages' of nursing (yep....I remember crank beds and three bottles for chest drainage) and since that time it has become a point of study in nursing and medicine. We have come to recognize that giving a placebo will produce the 1/3 rule....1/3 will have good response, 1/3 will have limited response, and 1/3 will have no response. The bioethicists would be very upset over the thought of use of placebos in pain management as this is no longer accepted standard of practice. On another note there is a M*A*S*H episode where they give placebos in the Korean war. I cringe when I see it (and I love MASH). As I stated earlier...in the 1950s, when we were fighting in Korea, this was still accepted practice. It was in the early 70s when I was new to nursing. It isn't now. That is the 'take home point'.

Again...sorry if I offended some :uhoh21: but wanted to get the point out there as I am sure the person who posted the comment isn't the only one who is unaware of the ban on placebos outside of studies.

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Specializes in surg/tele.
The bioethicists would be very upset over the thought of use of placebos in pain management as this is no longer accepted standard of practice

As I stated earlier...in the 1950s, when we were fighting in Korea, this was still accepted practice. It was in the early 70s when I was new to nursing. It isn't now. That is the 'take home point'.

Your post reminded me that medicine and nursing are always changing. All we can do is try to keep up with the changes, know why we do the things we do, and evaluate whether they are working well. We can go push forward, but we must start from where we are right now. A Maya Angelou quote that I love says it well,

"You did what you knew how to do, and when you knew better, you did better."

Emma "Evidence-based" Peel

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Specializes in General nursing, ER, ICU.

Is pain subjective? Over my many years of nursing this is a constant debate with nurses. At one time I questioned a doc about the amount of pain medication that I was administering to a patient. He took me aside and told me that I could not judge someones elses pain tolerance. I was judging this person on my values. I did refuse once to give a narcotic to a person, who visited the emerg regularly for pain medication, that I was sure was only drug seeking. The doc gave it to this person. At that time I asked the administration what could be done about the physician ordering for this patient and was told nothing would be done.

Regarding those patients who watch the clock and call exactly on the time ordered, I choose to believe that they are managing their pain by keeping on top of it.

I no longer work in the emerg area but do try to teach my students not to judge others. Having said all this it is truly hard to manage time around administering narcotics and spending time with that patient who is dying because the art of caring is what nursing is all about.

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Specializes in Hospice.

Let me start by admitting that I've not read each and every post in this thread ... mostly skimmed through. So ... if something I have to say offends, please accept my apology, it wasn't intentional.

Those nurses who resent "drug seekers" have a point ... being on the receiving end of drug-seeking (by this I mean seeking drugs for the high, not the pain relief) can be brutal. Their emotional response to this behavior is valid and healthy. To respond with "Oh, you poor thing ... here, let me help ... relieve your pain ... give you more drug ... " is enabling and has more to do with the nurse's own emotional need to rescue than real concern for the addict.

The trick is knowing what the patient is seeking ... a high or pain relief. Are we treating pain or mood???

If anyone can give me a foolproof method of differentiating the two by objective findings (as opposed to subjective pt. reports) I'll be the first to nominate for a Nobel Prize.

And so we circle around yet again to the point that pain is subjective.

What I find frustrating is that information on pain has been around for thirty years, at least: what it is, how to manage it, the behaviors associated with it, addiction, pseudo-addiction, on and on.

Every time this subject comes up in a thread, someone has to spell out the difference in behaviors between pts. in chronic vs. acute pain.

Every time this subject comes up in a thread, someone has to re-iterate that meds are most effective when used to PREVENT pain rather than play catch-up ... so of course a well-taught pt will ask BEFORE pain becomes severe.

Every time this subject comes up in a thread, someone has to clarify the difference between tolerance and addiction ... yes, there is a difference.

Treating pain in the addicted or potentially addicted pt. is a major challenge which calls for serious care planning with everyone, including an addictions specialist, on board (yeah, hold your breath ...).

Nurses who bear the brunt of drug-seeking behaviors need and deserve support (hold your breath even longer ...).

But ... can we stop re-inventing the wheel? Get a book, go online ... the information is out there!

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Specializes in Spinal Cord injuries, Emergency+EMS.

heron has extracted some important points

holistic assessment rather than just following orders

effective analgesia prescribing AND proactive adminstration (nothing annoys me more than those who don't educate patients about the WHO analgesic ladder and the fact it's about adding things to the base of paracetamol and an NSAID not jumping up the steps and leaving the none opiate approaches behind

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