Pain is what the patient says, bottom line, even if their physical demeanor or perception does not meet "your" idea of what "you" should be able to see. I give oral before IV when possible, especially if IV is ordered for breakthrough and you can not experienced breakthrough is there is not a barrier already being used. Have I had patients that I have thought are seeking? Yes, all the time. My job however is not to render judgment on whether they "need" the meds or not, but to take care of them. If the patient is calling before I can give or asking for different meds in addition to, I reevaluate the situation and ask the doc for a different order, some of the time the patient does not want the meds messed with and then suddenly their pain is better managed. If a patient is stating their pain is not controlled and they are referencing their chronic pain, they get educated on pain management methods and not being able to receive IV meds at home for the chronic pain.