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 - Pain Management.

At this September's national convention of the American Society of Pain Management Nursing Margo McCaffery received recognition for the 40th (yes, that would make it 1968) anniversary of the definition we all know that she created:

Pain is what the patient says it is and exists when the patient says it exists.

Heron is exactly right - all the information in this post has been around for a very long time. She also threw out a term that I am sure many don't understand...."pseudoaddiction". We as healthcare professionals create pseudoaddicts. If you don't know what this is then find a book on pain management. I HIGHLY recommend Pain: Clinical Manual by Chris Pasero & Margo McCaffery. Most everything that has been discussed on this discussion forum is covered in that book.It is a great reference to have on hand. My copy is quite worn so I am thrilled to hear they are working on a new edition.

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Heron- if you don't like the discussion, don't read it. Lots of nurses get so ingrained in their own specialty area that they don't look at other aspects such as long-term pain needs, etc. We represent nurses from many specialties and we have a right to speak up for our areas of expertise. Yes, it is available in books, but if we depended on books we would be back in 1980. People want instant information, and instant access to others with knowledge. That is what the internet does. We all know that this is opinion, not necessarily fact on this website, but soemtimes it is great just to have an educated discussion with other nurses. Who has time to do that at work?

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Specializes in ICU Neuro.
typo's response: i got an attitude? where did you get this from? i do not recall seeing you there! so i should calling the doctor to request heave duty pain meds for a 21 day old baby that is rooting and sucking on anything he can get into his mouth and has not eaten in 48 hours? we should risk major damage to undeveloped kidneys and liver when he is showing every sign of being hungry? i had already given him the normal dose of the normal pain medications the doctor had ordered. by the way, i did call the doctor and he agreed with my request to start the baby on clear liquids, from then on the baby was fine. you know, babies do cry when they are hungry.

lady, i do not know where you come from, but maybe you should back up and read my first post before you attack me. my point was that sometimes you get parents of sick kids who make unreasionalbe requests for pain meds. they ask for pain meds that you, the rest of your staff, and even the doctor think are unreasonable or not needed. part of my job is to do what i can to not risk damage to a very young, underdeveloped biological system. i asked for feedback on that situation.

but instead of thoughtful, intellegent feedback for you, i get you standing on your soapbox ranting, accusing me of breaking the law, questioning my judgment, and accusing me of getting an attitude. you want see me to get an attitude, i can not think of a better way for you to do it.

typo, i am not going to attack you or jump on you. i am going to say that hunger is pain. while i am not a peds nurse and i would not choose demerol, i would have sought an rx for mso4 to reduce the infants pain if the npo order was going to continue. morphine is often given to infants, as is fentanyl. it is considered safe and effective. also, i would like to remind you that comfort is a distinguishing feature of nursing. you are a professional and only you can make the decision to give a prn. however you are required by law to treat pain not to mention joint commission as well as your own conscious.

good luck with your tough decisions.

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Specializes in ER, PACU, Med-Surg, Hospice, LTC.
Nursing Margo McCaffery received recognition for the 40th (yes, that would make it 1968) anniversary of the definition we all know that she created:

Pain is what the patient says it is and exists when the patient says it exists.

Heron is exactly right - all the information in this post has been around for a very long time. She also threw out a term that I am sure many don't understand...."pseudoaddiction". We as healthcare professionals create pseudoaddicts.

Thank you for posting that! I talked about Pseudoaddiction in another thread. I think everyone who deals with patients in pain should educate themselves with what it means.

Here is a quick link (same one I posted in another thread r/t pain):

Pseudoaddiction

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