Pain, is a completely subjective sensation, and only by believing the report of the patient, can their doctor identify if they are in pain. Does the patient with nail sticking out of his foot have pain? One would think so, but during my training at Hopkins, I saw patients with severe diabetic neuropathy come to the ER with a needle or nail in their foot and they did not complain of any pain. Why? Their neuropathy had so deadened their nerves that they did not even feel the nail’s presence (in fact…they had come into the ER for a completely different reason and the nail had only incidentally been identified!)
What about the patient who looks ‘fine and dandy’, but complains about severe back pain. There is nothing objective to see on exam, but still, they complain vociferously. Are they in pain?
Withholding pain medication from someone who is suffering is is to be avoided at all costs, but promoting addiction and dependence in someone who is ‘playing the systems’ is likewise a concern in some settings.
Read more about this dilemma in this well-written article >>>>HERE<<<<