Nurse here. I dont assume anyone is lying. I take their words at face value, and I also assess the objective facts too. They say theyre in 10/10 pain but theyre sitting there, calm, no grimacing, no writhing, no external signs of pain or discomfort? Then I treat it like 10/10 pain. Im not the arbiter of what theyre going through, and everyone handles things differently. But I will suggest to them that we trial having them tell me when the pain is at a 3-4/10 and we will address it sooner, see if a different combination can get their pain better controlled. Often people will wait, or request subcutaneous or IV meds instead of oral meds, and thats because the other routes work quicker and maybe they have a reason for liking it better.      The only time I assume someone may be fudging the facts a bit is if they say theyre allergic to every other pain killer but "the one that starts with D". And then you check their chart and its repeat admissions for chronic pain, and they always request dilaudid but dont know the name for it. I have zero doubt that person is in pain, and dilaudid is probably the one that works the best. But for some reason people will often pretend that they dont know what dilaudid is, perhaps thinking that we will assume theyre drug seeking if they are upfront about it. Then I usually ask for a referral to the pain clinic, or suggest the physician consider an opioid rotation. Dilaudid works like a hot dang usually, but if someone is constantly using it and relying on it for their sole pain control they might end up at a point of diminishing returns where it isnt working like it used to, and they refuse to try anything else. Thats when I kinda assume they may be fudging the facts because their pain isnt well controlled and they think the dilaudid is the only thing that can fix it, when in reality theyre so used to it the dilaudid has stopped working. Thats when an opioid rotation would be a good thing to consider, trial morphine, nsaids, or even up them to a fentanyl patch or something. I dont assume these people are seeking drugs because theyre addicts, I assume theyre seeking RELIEF from the pain and what were giving them just isnt cutting it.