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, Home Health.
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.

Ive been in their shoes and still am at times. And no Ive never told anyone they didnt need pain medication and Ive never made anyone feel bad about it. But when I have a patient crushing percocet and pushing it into her portacath and Im the one who has to report it to the doc and then try to re-access that port, I get pretty upset. And I can guarantee you that action wasnt based on pain. The saddest part?....she was a nurse who lost her license due to drug abuse. I found that out LATER.

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Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
Yep, been there and done that MANY times. It ticks me off that docs will prescribe Dilaudid or Morphine q1h. OMG, Im in their room more than anyone elses. But I try to look at it other ways too. When I was in the hospital (after colectomy and hysterectomy) I was asking for my pain medicine on the dot when it was due. I was truely hurting. I am now in constant chronic pain but you wouldnt know it by looking at me. I laugh and talk at work, while deep down my abdomen is churning. And for those who are terminal, who am I to say anything. And for those who have been on it for years, who am I to say anything. Its hard these days to tell the true pain from the drug seekers, but sometimes there are those that you just KNOW are drug seeking. It also angers me when docs order strong narcs for pt's with a minor dx and with hx of drug abuse...knowing this will send them spiraling down that pathway again once discharged. The other day I had a patient who had been imprisoned 4 times for drug abuse. He was prescribed Dilauded 4 mg every 2 hours! He would come to the nurses station asking for it, then leave and smoke. I asked him at 12:15 if there was anything else I could do for him, his response?...."just bring me my pain med at 2:00". I finally blew. I told him that he cant PLAN to be hurting 2 hours later.

How about the quote "I finally blew"? No someone can not plan to be in pain but if they are a chronic pain patient/sufferer then they can pretty well set their time by the pain returning as the med begins to wear off and request a pain med before that occurs. That is not an unreasonable request. So sounds like your opinion did get the best of you in that instance. Enough said though sounds like you got the point. As nurses we can not assume what another persons pain is and if they have orders then it is our job to medicate the patient period.

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YES, Pain is Subjective and there's really nothing we can do about it, we can't feel what a patient feel but we can actually ask them what they are experiencing (although most of the time we are in doubt).. and True, sometimes we try to look for an OBJECTIVE way to support the Pain complaints like guarding, grimaces etc.. we can't seem to find one...

But pain is there for real...

When you see a patient complaining for pain and manifesting differently, let's just say the patient is STARTING to divert his/her attention of the said Pain (although a pain intensity of 7 and up mostly cannot be diverted).. Meaning pain is tolerable, but still there..

Yes, we can't judge if a patient is abusing and just pretending to be in pain.. we could actually think clear and put up ways not to make them depend on medication.. if possible..

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Specializes in Med/Surg, Home Health.
How about the quote "I finally blew"? No someone can not plan to be in pain but if they are a chronic pain patient/sufferer then they can pretty well set their time by the pain returning as the med begins to wear off and request a pain med before that occurs. That is not an unreasonable request. So sounds like your opinion did get the best of you in that instance. Enough said though sounds like you got the point. As nurses we can not assume what another persons pain is and if they have orders than it is our job to medicate the patient period.

When I said I "blew" didnt mean I blew on the patient. I do get aggrivated as well as most of us do sometimes. I do not make my patients feel bad and I will not be made to feel bad either just because I have encountered drugseeking behavior, just as all of us have at times. I did NOT say that I didnt medicate him, did I? I can think whatever I want to. My actions are what matters. And I medicate whenever asked. Now if anyone says they have never suspected drugseeking behavior is lying. We all have suspected it. But as long as we treat it just as we are supposed to... Dont take my words so literal and dont twist my words around.

Like I said, I have a right to suspect, I never said I have a right to decide if a patient is hurting or not. I have given backrubs, massaged legs, etc to help anyone who c/o pain.

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Specializes in ub-Acute/LTC, Home Health, L&D, Peds.

Chenoaspirit,

I did not twist your words around, just quoted it as you wrote it.

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Specializes in Med/Surg, Home Health.

Yes, and ignored the rest. Im done with this. I can find better ways to entertain myself.

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Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
How about the quote "I finally blew"? No someone can not plan to be in pain but if they are a chronic pain patient/sufferer then they can pretty well set their time by the pain returning as the med begins to wear off and request a pain med before that occurs. That is not an unreasonable request. So sounds like your opinion did get the best of you in that instance. Enough said though sounds like you got the point. As nurses we can not assume what another persons pain is and if they have orders then it is our job to medicate the patient period.

Chenoaspirit,

If you read this correctly I clearly did not ignore the complete content of your post. I am glad you were just "entertaining" yourself because I actually take this subject quite seriously. I don't know why you have taken the time to argue with me when it seems on the whole we agree that nurses have the responsibility to medicate a patient when requested without assuming we know what their pain level is. Now I am through beating a dead horse. GOD Bless

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Specializes in Med Surg, Ortho.
Yes, and ignored the rest. Im done with this. I can find better ways to entertain myself.

Chenoaspirit,

I understand what you mean. There are several nurses where I work that get into the conversation about who we think are seekers. We have a lot of pts that have hx of IVDA, so those are basically the one's we believe are seeking. However, we still medicate because we don't know for sure. However, I also believe that pain is what the pt says it is, and by all means I always medicated accordingly. But I understand what you're saying. :up:

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Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
Chenoaspirit,

I understand what you mean. There are several nurses where I work that get into the conversation about who we think are seekers. We have a lot of pts that have hx of IVDA, so those are basically the one's we believe are seeking. However, we still medicate because we don't know for sure. However, I also believe that pain is what the pt says it is, and by all means I always medicated accordingly. But I understand what you're saying. :up:

So you "still medicate because you don't know for sure." To play devil's advocate, what if you did know for sure? Would you not medicate them? How would you know for sure? I honestly don't think there is anyway to know for sure. That is the entire point. So I just don't understand the reason nurses try to figure out which ones they think are drug seeking. I really think everyone should read the link in "I love my cat!"'s post.

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Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
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.

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

This is a great article!! Please give it a look. (I am not speaking to anyone specifically) I am also a huge pain management advocate and I do take this subject quite seriously. Nobody should have to live with pain.

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Specializes in Med Surg, Ortho.
So you "still medicate because you don't know for sure." To play devil's advocate, what if you did know for sure? Would you not medicate them? How would you know for sure? I honestly don't think there is anyway to know for sure. That is the entire point. So I just don't understand the reason nurses try to figure out which ones they think are drug seeking. I really think everyone should read the link in "I love my cat!"'s post.

I'm not sure I understand your message, but I'll give it a shot. I still medicate because I was taught that pain is what the pt says it is and because it's ordered by the physician. I won't play devils advocate, because there is no possible way I could ever know a pts true pain for sure. I won't even go there. I just know there are people with history of IVDA and are probably seeking at some point, but maybe not,

That, my friend, is why I still medicate. :D

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Specializes in Med Surg, Ortho.

:up:

This is a great article!! Please give it a look. (I am not speaking to anyone specifically) I am also a huge pain management advocate and I do take this subject quite seriously. Nobody should have to live with pain.

I AGREE ! I'm too am a huge pain management advocate, my husband lives in chronic pain which is very hard for him to control even with meds.

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