As a nurse we are taught that patient reported pain is what the patient says it is, where it is, and how it’s perceived.

All nurses can tell the difference between a patient with ‘real’ reported pain and a patient seeking narcotic abuse. We are all required (by law and ethical duty) to say we do not have any knowledge of ‘drug seekers’, and that we treat all patients with pain the same, regardless of OUR perception.

This is the difference between textbook nursing and the ‘real world’ of nursing.

Ask any nurse who has some experience under their belt. We can spot a ’seeker’ just as fast as we can recognize a patient having a breathing emergency.

In my limited experience there are ‘red flags’ that raise my awareness of a possible ’seeker’. It’s nothing written in a textbook, but within the closed circles of certain healthcare professionals we can all agree on these ‘red flags’:

Red Flags:

A patient will request a specific narcotic medication before they are even asked if they are in pain

A patient will deny any other forms of analgesia except for the ’strong-armed’ narcotic medications

A patient will request pain medication even though they are having a difficult time maintaining mental alertness (they can’t stay awake)

A patient’s pain will never be relieved. (even if you give enough narcotics to kill a horse)

A patient will know exactly what you are going to ask them and how you are going to ask them to rate their pain.

After you waken the patient from a sonorous sleep, and ask the patient to rate their pain. They state their pain is at it’s maximum, it’s intolerable, unbearable and makes them sick. (except when they fall back asleep)

A patient will become overly dramatic about the most minimal of things. ( the pulse oximeter on their index finger is causing severe numbing pain to their finger)

I cannot help my reaction some times. I DO try my best NOT to jump to conclusions and be the bigoted jerk that we all can be. I pride myself on my fair, ethical and genuine caring attitude towards my patient. I constantly remind myself what it’s like to BE the patient.

But when a patient arrives to the PACU. They are still in their fog of anesthesia. Their mouth still bone dry from the airway equipment used during the surgical case. They can only open one eye. And before you can finish your interview assessment the patient, in their foggy-slurred intoxicated-like speech, asks for a specific narcotic. Not only asks for a specific narcotic but then proceeds to name 3 other narcotics that will NOT relieve her pain.

I tried. I really did.

The patient continued to recover from her anesthesia in the ‘expected’ or dare I say ‘normal’ manner. Her pain was attended to. Medication was administered. Position changes were made frequently. Adjunct analgesic therapies were initiated (ice, compression, elevation). Each time medication was administered, the patient would drift off to sleep. As part of my responsibility, I would have to actually wake the patient up to re-assess and ask about their pain.

“Oh, it’s still 10/10″

I tried. I really tried.

I won’t give the details, but in the end the patient got everything they asked for.

A patient’s pain, is sometimes a Patient Pain.

Carpe Diem

Tags: pain, patient