According to Dr. Margo McCaffery (pain guru), “Pain is whatever the experiencing person says it is”.  However, members of the healthcare team (nurses and physicians) DON’T BELIEVE PATIENTS!! We think many patients are drug seeking and may actually withhold pain medications instead of actively treating patients for pain.

Here’s a typical situation: Your 42 year-old patient puts her light on and asks for yet another dose of pain medication. When you ask what level her pain is, she says that it’s a 9 out of 10. You walk into the room as she starts laughing on the phone. You think, “Yeah right! Drug seeker!”
Do you know what? Sometimes we are right and patients are drug seeking. But, sometimes we’re wrong.

How do I know?
For three years I suffered from severe TMJ. There were times when I couldn’t open my mouth wide enough to eat a blueberry or chew oatmeal. It was horrible. I had pain EVERYDAY. The pain would shoot into my eye, ear, teeth and neck. I can’t tell you how many times I thought I had a massive ear or tooth infection but it was just referred pain from my jaw. After a while, I just got used to the pain.
One day I was having lunch with a friend and she commented that my TMJ must be better because I didn’t look like I was in pain. The truth was that I had 8/10 pain at that moment but because I was so used to it, I guess I stopped lookinglike I was in pain.
In that split second, I had a moment of clarity. I finally understood how a patient could say that his pain was a 9 out of 10 but could talk on the phone or laugh at a joke. I was one of the hundreds of thousands of people who go through life with chronic pain without holding a neon sign saying, “I’m in pain!!”

The chronic pain masquerade
We tend to consider all pain the same. But like at a masquerade ball, some pains are hidden under a mask of deception. The way to “see” the man behind the mask is to understand the difference between acute and chronic pain.
Patients who have acute pain LOOK like they are in pain – facial grimacing, crying, yelling, etc. Acute pain typically occurs abruptly and is short term. Fractures, small bowel obstructions and traumas are a few examples of things that can result in acute pain.  Taking care of patients with acute isn’t the problem.
The problem is when we are taking care of patients with chronic pain. Patients who have chronic pain do NOT look like they are in pain. Why? Because like me, their bodies adapt and they stop looking like they are in pain. Chronic pain is long-term and generally the result of a chronic condition like arthritis, degenerative disc disease, etc. They are the patients who might have the same level of pain as the acute trauma patient yet you’d never know it by looking at them. They are the patients who nurses typically accuse as drug seeking and we’re wrong.
Consider this: Wouldn’t you rather give pain meds to a drug seeker than to withhold them from someone who doesn’t look like he/she is in pain but really is?
Bottom line: Believe the patient. No matter what. As long as he/she is breathing, give pain meds! 
As for me, I’m happy to say that although not 100% normal (still can’t bite into an apple and have low level of pain daily), I’m much much better. Going through this experience gave me a new perspective and appreciation for our patients who suffer from chronic pain because I walk among them –  and I now believe them!
Thanks so much for reading. Would love to read your comments about giving patients pain medications.
Take care and stay connected

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