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 Cardiac Telemetry, ED.

Acute pain and chronic pain are different, with different strategies for appropriately managing them. Add to the mix someone who has chronic pain and is admitted for an acute event, such as abdominal surgery, and that has the potential to complicate things quite a bit. I am particularly grateful to doctors who take the time to explain to a chronic pain patient undergoing surgery that due to their high tolerance to pain medications, it may not be possible to control their pain as well as we would like to, but that we will do our best, walking that fine line between providing adequate pain relief and avoiding completely snowing them. I try to work together with my patients, actively involving them in their own pain control. If they tell me a certain medication works best, that's what I'll give them. As I mentioned in a previous post, I've only had to put my foot down once, when the patient wanted more meds despite barely breathing. The doctors were aware of the situation, and there was nothing more we could do.

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Specializes in Acute Care, Rehab, Palliative.
Oh, I agree. Sometimes I really hate the pain scale. There are times where I feel I'm badgering some poor little old lady for a number (thank you, Joint Commission!). Patients can't always give a number. I was simply pointing out in my post that educating your patients on the pain scale can assist them in evaluating their own pain and assigning a number that reflects what they are experiencing, and if there is a protocol in place with standing orders, you can use that number to assist you in selecting an appropriate medication. This works well for the vast majority of patients that I work with.

However, the pain scale doesn't always fit, and people don't always fit the pain scale. That's where that thing called "nursing judgment" comes into play; learning to recognize those situations and act appropriately. :nurse:

Where I work we do computer charting and the screen for pain assessment(Q shift) has a section for pts not able to verbalize their pain. We can as nurses use body language and behaviour as tools to assess for pain.

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Specializes in L&D, OB Triage.

"Pain is what the patient says it is."

'nuff said

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I truly understand what everyone is saying and thank you so much for your honest replies. But, there is currently a patient that is driving everyone crazy including the the MDs and the ARNP. He was transferred to a med-surg floor last month due to complications and apparently, he had a very hard time there because he was not receiving his PRN as often as he was getting it from us. As soon as he returned back to our ward, the MD increased his PRN hoping that it will better control his pain. It worked at first, but (a week and a half later) I guess his body developed tolerance. He was offered a PCA but he refused and whenever he gets his PRN "10-15 minutes late" he refuses to take it and prefer to yell and curse at whoever happens to be his medication nurse.

I do believe pain is subjective because there is no way I can know/assume how you feel. But I do believe that if you are in sooooo much pain (acute or chronic) and the MD offered you a more "efficient" method, at least try it or think about trying it. Why would you prefer to wallow in pain?

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Specializes in Acute Care, Rehab, Palliative.

We had a pt like that recently and the problem was that when he was in pain he couldn't focus and was completely unreasonable. He would deny outright that he had pain but obviously was.Once he had his morphine he could talk to you reasonably.

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I don't think its my job to determine if a patient is truely in pain or drug seeking.

My job is to give the meds that are prescribed, and to make sure those meds that are prescribed are safe for the patient (right, dose, no allergies, etc) etc and don't have harmful effects to patient when they are taken, and to monitor their effectiveness (like bringing down a high BP, relieving pain etc)

Everyone handles pain differently. Myself when around others and in pain, I act like I"m not. Joking laughing etc, its a cover up to not be seen as a "wuss". Alone I could be dying and you wouldn't know it because I will sleep do anything to not show my "weakness".

I actually just had a patient last night she and I were talking,laughing,joking etc. Except I know she was in pain, I could see it on her face and how she moved (very guarded). I also had another that was on her call like every 2 hours like clockwork for her dilaudid.

Drug seekers, addicts and many with chronic pain may truely need more meds because they have built up tolerances.

I think its sad when nurses become the judge of pain and refuse meds, when they truely may be needed. I also think its sad some nurses can also be pushing meds on patients where the process of pain is totally normal, expected etc.(Childbirth).

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Specializes in ER, PACU, Med-Surg, Hospice, LTC.
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?

My first guess would be that your patients are probably not being medicated for their pain adequately (not your fault, but the prescribing Physicians). Just a guess.

Maybe they state their pain level is an '8' when it might be a '6' because that is the difference between getting medicated or not? Or maybe it is really an '8'. Only they really know.

I posted an article a few weeks ago stating how there are literally millions of people in the USA with under-treated pain.

Your patients may be laughing and talking as a means of distraction from their pain.

This is a good thing!

It is much, much easier to control a persons pain at this level than it is when they are writhing and screaming in agony.

Remember, we encourage patients to ask for medication when they need it and not to wait.

Studies have proven that addiction amongst those who take prescribed opioids is around 3%.

......and don't confuse addiction with tolerance. It's easy to do.

Do anybody have any article that suggests I can objectively assess pain?

Here is a great article to understand pseudo-addiction. Pseudo-addiction appears to be addiction, but it is usually just an under-medicated person in pain.

Pseudoaddiction

I am a huge advocate for pain management. :redbeathe

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Thank you so much for that article. That actually helps. I am going to bring a copy to work and have others read it. Thanks again.

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Specializes in Med/Surg, Home Health.
I would love to know how "you just know" when somone is a drug seeker? :banghead:

Just like I said on my post....when a person asks for next dose as they are receiving a dose. And like my patient who was caught crusing a percocet and mixing with a saline flush in the trash and pushing it into her Port-A-Cath. I still medicate, but with some you CAN tell.

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Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
Just like I said on my post....when a person asks for next dose as they are receiving a dose. And like my patient who was caught crusing a percocet and mixing with a saline flush in the trash and pushing it into her Port-A-Cath. I still medicate, but with some you CAN tell.

I would be very careful about thinking (assuming) you know someone else's pain. You can't possibly no matter what you think.

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HELLOOO, Most of the people in long term care, will never leave unless they are on a stretcher with no pulse. If they want some extra medications, than give them to them. Try and put yourself in their shoes. You are young and healthy now, but wait until you are their age. How would you like someone to come around who was about 40 years younger than you, and tell you what you needed or did not need, and then make you feel bad about it. Maybe they have pain, that you can not even imagine because you are not in their shoes.

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Specializes in Med/Surg, Home Health.
I would be very careful about thinking (assuming) you know someone else's pain. You can't possibly no matter what you think.

Well, I dont know why I need to be careful about what I think as long as I treat the pain just as Im supposed to. Ive never withheld pain medications based on my assumption. I dont act on my assumptions but I am entitled to my opinion. I think everyone on here has, at one time or another, encountered a patient suspected of drug seeking behavior. They are out there, unfortunately.

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