Pain Bias Toward Patients
By Diane M. Goodman, APRN, BC, CCRN, CNRN
Most of our healthcare providers believe they deliver professional, deliberate and unbiased care to patients no matter the ethnicity or socioeconomic status of the patient.
This may be true. When the patient has had experience with pain, though, and/or is known to be a "frequent flyer," eyebrows begin to raise and assumptions are made, often before the patient can begin to be assessed.
Woe to the patient who has the audacity to show up in our healthcare system(s), asking for hydromorphone, diphenhydramine or morphine sulfate by name. They must be drug-seekers, for how else would they know what to ask for, especially the dose, frequency and method by which the drug(s) should be delivered? These patients are usually labeled as "challenging" right out of the gate, often before a history has been taken or the patient has been asked to undress.
What happens to our compassion when these instances occur? Is it a lack of overall education related to pain, or has the "territory" of nurse/patient geography been breached? Why is it so difficult for nurses to comprehend the concept of chronicity, particularly for the patient who may have lived months or even years with unrelenting pain?
Patients with chronic pain may demonstrate behaviors consistent with pseudoaddiction, such as doctor shopping, drug hoarding frequent utilization of healthcare services and (gasp!) knowing the names of which medications work best for them during acute exacerbations of symptoms. Patients who are pseudoaddicted are typically undertreated for pain pharmacologically, which often translates into an improvement in behavior once pain is adequately treated.
Beware of demonstrating your pain biases the next time your patient seems to know a little more about pain numbers, pain assessment and pain medications than your comfort level can take. Take a deep breath and remember patients have a right to effective pain management. At no time should this be more important than to the patient whose pain has been present a long time, and who may be exposed to the type of bias where medications are withheld for fear of adding to an "addiction" problem that probably does not exist.
Be compassionate and talk to the patient about his pain needs. It is likely the patient will be very willing to share her symptoms and discuss the severity of her pain, as well as the frustration of being so easily misunderstood. They may also recognize you for the true professional you have become, someone who is willing to defer biases until all the facts are in.