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Feature: Sharing

Pain and addiction

Confronting my skepticism

Hughes, Jonathan BSN, MSN; Gantioque, Raymund DNP, RN, ACNP

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doi: 10.1097/01.NURSE.0000651616.79399.ae
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HEALTHCARE WORKERS in the ED, myself included, often become jaded when treating patients with complaints of pain, particularly if the patient has a history of substance abuse. When my brother, who has such a history, developed chronic back pain following a work-related injury, I was hyperaware that he might not receive much empathy when he sought medical care for an acute pain exacerbation.

My brother is 2 years postlumbar fusion and has been in recovery since 2001. But from time to time, pain from his injuries flares up and he requires opioids to help him cope. Having been conditioned in the ED, I reflexively meet his complaints of pain with doubts. Even when I observe him wincing with pain and complaining through gritted teeth, I have to make a conscious effort to acknowledge his pain as legitimate. It saddens me that my knee-jerk reaction to my brother's misery is suspicion. How, as a nurse, can I be devoid of empathy, even when witnessing someone I love in need?

Shift after shift of interacting with patients demonstrating drug-seeking behaviors can build up one's cynicism regarding the legitimacy of pain complaints. We are often quick to label patients as “drug seekers” who complain disingenuously of pain to get opioid medications. I know my eyebrows rise when a patient with a history of drug abuse reports a 10/10 rating on the pain scale. We develop the belief that they take resources and time from other patients with seemingly more legitimate concerns. Additionally, providing opioids to a suspected drug-seeker can leave the nurse feeling like an enabler to someone with a harmful addiction. However, the thought of my brother, who is sincere in his complaints of pain, facing this stigmatization because of his history saddens me and makes me reconsider my practices and attitudes.

When my brother recounted a recent ED experience, I couldn't help but reflect on my own behaviors as a nurse. As he described to me how a nurse asked him repeatedly, in an accusatory tone, if he had taken any opioids before coming in, I couldn't help but recall times that I may have treated a patient in a similar fashion. He told me he felt like the nurse “didn't care” about his pain and took a long time to give him any medications.

I remember instances when I thought of my patients' pain as a lower priority. As a skeptic working in the ED, I hate to think of times when I might have treated someone in a situation similar to my brother's in this fashion.

My brother survived his struggles with addiction and has been in recovery for over 18 years. That should be celebrated. Yet during this recent ED visit, he was regarded with suspicion, undertreated, and discharged without having his pain properly addressed. That breaks my heart.

At times, we nurses have to be reminded that our patients should be treated as we would want our family members to be treated. Not meeting our patients with empathy does a disservice to our patients and our profession. I can do better; we all can.

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