If a patient says their pain is 10/10 and they are sleeping when I return to the room with pain medication, or some other observable trait I will put that in a comment on a pain assessment especially if I decided to delay pain medication due to nursing judgement for sedation/vitals. I have also written progress notes when patients routinely have 10/10 pain that never gets better no matter what I'm doing or what other medications I get ordered, etc. Since clearly we all need a new plan. I admit that these situations do frustrate me, mainly because I want to help and I feel helpless....but that's about me, not the patient, and I know that and handle it appropriately.