Yes it is very disheartening, and I understand I won't cure them; nor would I want to put my energy into doing so, simply because I'm not an addiction nurse. Any time I have a patient who generally has normal baseline vitals and I suspect they may be drug seeking, I always check their vitals after they request something for pain. I do this because many times, their bp and pulse ox will fall out of normal; especially on IV pain meds. I take this as an opportunity to discuss the dangers of the adverse effects of these meds and inform them the physician will be notified of the abnormal vitals. If they claim to be allergic to acetaminophen or nsaids, then we will work together to seek alternative methods of relief, at least until their vitals reach normal values. I also set boundaries making it clear I'm not going to stand there continuing to take their vitals until they're wnl.
On the other hand, if their vitals are stable and they can handle the meds, then I just give it to them, on one condition: that the pain is not a headache. If it's a headache, then most likely it's a rebound pain from the opioids and obviously giving more of those will only make their headache linger, so they get a non-narcotic for that or an ice pack or no meds until the headache subsides.
There's a lot of individual factors that must be investigated before giving pain meds just because the patient asks for them. Thats our job as a nurse: investigate within the constraints of your time, and within the subjective and objective data.
After a combined 7 years of ED and floor nursing, I've decided to venture into homecare. I love it because there's rarely any of that drug seeking behavior you have to deal with, and if there is, you educate, inform the doc, their family member, and other staff; and of course, make sure you chart your *** off.