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Navigating Pain Management Challenges: Assessing and Addressing Chronic Pain in Patients with High Tolerance for Medications

Navigating Pain Management Challenges: Assessing and Addressing Chronic Pain in Patients with High Tolerance for Medications


Assessing and managing pain in patients with chronic pain issues and a high tolerance for pain medications can be difficult. In such cases, it is critical to take a comprehensive approach that considers objective and subjective factors. Here are some strategies for accurately assessing and managing pain in these patients:

1. Establish trust and open communication: Establish rapport with the patient by listening to and empathizing with their concerns. Encourage them to openly and honestly express their pain.

2. Employ a multidimensional pain assessment strategy: Consider incorporating additional assessment tools in addition to relying solely on the patient’s self-report. These could include:

– Observational assessment: Look for physical signs of pain in the patient, such as grimacing, guarding specific body parts, changes in posture, or restlessness.

– Functional evaluation: Determine how pain impacts the patient’s daily activities and functionality. Inquire about their ability to perform routine tasks, hobbies, and social interactions.

– Pain scales and diaries: Instruct the patient to keep a pain diary to record their pain’s intensity, duration, and characteristics. To quantify pain intensity, use standardized scales such as numerical rating scales (NRS) or visual analog scales (VAS).

3. Consider the patient’s baseline pain level: Chronic pain patients may have a higher baseline pain level because of their condition. When assessing their present pain experience, consider their previous pain ratings and response to pain medications.

4. Monitor nonverbal cues and subjective indicators: Pay attention to nonverbal indicators such as changes in facial expressions and body language or physiological signs such as elevated heart rate or blood pressure that may suggest suffering. Consider subjective indicators such as verbal descriptions of pain quality or characteristics (for example, sharp, throbbing, burning).

5. Evaluate how pain affects the patient’s overall well-being, emotions, sleep habits, and capacity to work. This assessment can provide useful insights beyond the obvious about the patient’s pain experience.

Here are some measures you can take if the patient asks for more pain medication:

1. Reassess the pain: Inquire about changes in pain intensity or features with the patient. To acquire more information, use the same assessment tools indicated earlier.

2. Examine possible causes: Determine whether underlying issues, such as disease progression or new injuries, may contribute to the increased pain. If required, perform a complete physical examination or arrange pertinent diagnostic tests.

3. Think of non-pharmacological approaches: Investigate complementary therapies or non-drug interventions that may aid in pain relief. Some examples include physical therapy, acupuncture, relaxation techniques, and cognitive-behavioral therapy.

4. Collaborate with a pain professional: If the patient persists, see a pain specialist or a multidisciplinary pain management team for further evaluation and treatment recommendations. They can offer knowledge in the management of difficult pain conditions.

5. Adjust pain medication regimen cautiously: If increasing pain medication is deemed appropriate, do it with the patient based on their unique circumstances. Under appropriate medical supervision, consider titrating the dosage or investigating other drugs or delivery systems.

Remember that each patient’s pain experience is unique and that tailored therapy is essential. Regular reassessment, open communication, and collaboration with the patient are required for effective pain management.


Pain tolerance and perception is different in every individual. You will care for patients that have chronic pain issues and develop a high tolerance for pain medications. The patient rates his pain as a 8-9/10 but does not look like they are in pain!! How can you accurately assess these type of patients and what do you do if they ask for more pain medication?

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