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Thanks for posting this. I embarrassed myself very early in my career as a paramedic by withholding analgesia from a 20 year old woman who called from a very divey motel, asking for morphine for her cholecystitis. I told the staff that she seemed like she was med-seeking, because she had a vague abdominal complaint, requesting analgesia within seconds of my entering her room, had a psych history, and was unkempt and living in a dum, oh, an her heart rate was 70 and her blood pressure was normal. A resident took me aside, and instead of telling me exactly what an ignorant fool I was, took the time to explain to me that pain, especially from hollow organ injury, often comes with a vagal component, and that heart rate and blood pressure changes are insensitive and nonspecific. Some years later, I've formed the opinion that there will always be medseekers and drug addicts. Many of them will be very manipulative, and very convincing actors. And this leaves me with two choices; (1) I can try investigate all complaints of pain, and see if they qualify to meet my subjective standards for what acute pain should look like, and withhold analgesia from people with questionable histories. This comes with accepting that I will inevitably withhold analgesia from some people in acute pain. (2) I can stop judging people, and accept that pain is what the patient says it is. This comes with the risk of giving opiates/opiods to someone who is drug seeking, and potentially encouraging further system abuse. But, given the fairly trivial amounts of analgesia that I'm giving, it's unlikely anyone is getting too euphoric from 5-10mg of morphine, given that a lot of the addicts I meet are using over 200 morphine equivalent milligrams of diverted prescription opiod per day. I'm probably just easing their withdrawal symptoms. This comes with the benefit that I no longer have to be as judgmental towards my patients, and no longer run the risk of failing to provide analgesia to someone in severe pain, and giving them a label that will likely follow them through the ER, and probably into other areas of the healthcare system, all because theiir presentation doesn't meet my entirely subjective, culturally-biased and ill-educated opinion of what acute pain should look like. As a paramedic I am always appalled when I see articles like these being published: http://www.ncbi.nlm.nih.gov/pubmed/23478179 http://www.ncbi.nlm.nih.gov/pubmed/17920974 http://www.ncbi.nlm.nih.gov/pubmed/16036826 http://www.ncbi.nlm.nih.gov/pubmed/12385607 http://www.ncbi.nlm.nih.gov/pubmed/16036825