10/10 pain..venting!

stidget99 · Mar 3, 2005

When I originally made my comment re: allergies to pain meds....what I intended to say (which obviously I didn't do a very good job communicating) was this.........when we get the frequent flyers in who list allergies to the pain meds that are generally offered at first (T#3, darvocet, Toradol, or any others who don't give the "really good buzz") so as to bypass those just to get to "the good stuff" more quickly----those are the pts who bug the beejeebers out of me. They watch the clock...call for it 10 mins before it's due asking for "my demerol and phenergan". Now, I truly believe in pain being what the pt says it is. I understand that some ppl are able to sleep out of sheer exhaustion even though in severe pain. What I do have a problem w/ are those pts who are overexaggerating their pain for the nurse's benefit and as soon as you walk out of the room....they start laughing and talking - no longer exhibiting those s/sx of pain or those who you see returning to their room after going outside to smoke laughing and joking around and within less than 2-3 mins are in "20 out of 10" pain....those are the pts that I have a hard time taking seriously.

I apoligize to anyone whom I may have offended.

casper1 · Mar 3, 2005

Oh this patient sounds familier. His abdominal pain is probably the result of his overuse

of narcotics at home. The narcotics have caused his constipation resulting in his abdominal pain. I see this all the time and these patients never want to listen to reason. They yell and abuse the nurse when you try to tell them how they are contributing to their problem. What he need is laxatives and an enema.

Iam46yearsold · Nov 2, 2008

The pain is as the pain is stated. Keep it simple. Why give yourself grey hair arguing.

Guest219794 · Nov 6, 2008

My 2 cents:1-10 pain scale does not generally help me treat pain in the ER. Asking questions, and looking at signs help me. The 1-10 scale can be useful in titrating drips, adjusting PCA's, and other long term pain management. I believe the 1-10 scale is used in ER's because it makes it quick and easy to do before and after assesments.On my one ambulance to ER experience, I rated my pain 5/10. The pain was so bad I could not walk, or even roll over to urinate. I figured it could easily be twice as bad, so, 5/10.So- Here is a question: If somebody's pain is 10/10, and you kick them, will it hurt?HHERN

TraumaNurseRN · Nov 8, 2008

Oh this patient sounds familier. His abdominal pain is probably the result of his overuse
of narcotics at home. The narcotics have caused his constipation resulting in his abdominal pain. I see this all the time and these patients never want to listen to reason. They yell and abuse the nurse when you try to tell them how they are contributing to their problem. What he need is laxatives and an enema.

Abuse is no fun that's for sure....

It's up to nurses to educate the patient's they send home with narcotics that unless not indicated by their primary physician, a stool softener and increasing the H2O intake will help negate the effects the narcs give with constipation.

AngelfireRN, MSN, RN, APRN · Nov 11, 2008

Question: I was hospitalized this past summer with a GI bleed that was believed to be the result of NSAID use. I lost 6 pints of blood and required a transfusion. I now list NSAIDs as an allergy simply because I'd rather not repeat that lovely experience.

If I am unable to explain myself, (the only other allergies I have are to 2 abx), do y'all think that, God forbid, if I wind up in some ER where they DON'T know me, they will write me off as a crackpot and give me NSAIDs anyway? I know it's usually the laundry list that raises the flag,but it was a thought. Just curious. Thanks.

TraumaNurseRN · Nov 11, 2008

Question: I was hospitalized this past summer with a GI bleed that was believed to be the result of NSAID use. I lost 6 pints of blood and required a transfusion. I now list NSAIDs as an allergy simply because I'd rather not repeat that lovely experience.
If I am unable to explain myself, (the only other allergies I have are to 2 abx), do y'all think that, God forbid, if I wind up in some ER where they DON'T know me, they will write me off as a crackpot and give me NSAIDs anyway? I know it's usually the laundry list that raises the flag,but it was a thought. Just curious. Thanks.

Angelfirern: in Our ER there are allergy distinctions....rash, nausea, psychosis., etc....that are typed in....Or perhpas wear a medical alert bracelet hand engraved, and carry allregy card in purse.

**canoehead, BSN, RN** · Nov 11, 2008

Question: I was hospitalized this past summer with a GI bleed that was believed to be the result of NSAID use. I lost 6 pints of blood and required a transfusion. I now list NSAIDs as an allergy simply because I'd rather not repeat that lovely experience.
If I am unable to explain myself, (the only other allergies I have are to 2 abx), do y'all think that, God forbid, if I wind up in some ER where they DON'T know me, they will write me off as a crackpot and give me NSAIDs anyway? I know it's usually the laundry list that raises the flag,but it was a thought. Just curious. Thanks.

Just explain you were hospitalized with a GI bleed when you took NSAIDS if they ask about allergies. Pretty clearly they won't want to put you on ibuprofen three times a day, but a shot of Toradol so you can tolerate an Xray might be acceptable.

KaroSnowQueen, RN · Nov 11, 2008

i used to think i had a low pain tolerance. for many years, my subjective measurement of #10 pain was childbirth. until i had two nephrostomies, and god only knows why but they hurt so bad, so that was a new #10. i also had had over 10 years of chronic pain in this time frame, so was very familiar with rating my pain.

this past july, i fell in a kind of freak accident, and broke my leg, and immediately went into compartment syndrome and shock. that was not a 10, it was a 117, and yes, if someone had a gun nearby, i would have begged them to shoot me. that pain was so bad it altered my very personality for weeks and weeks afterward.

the point being, that pain is what someone thinks it is. my perception of pain is permanently altered, and 10 will be pretty hard to get to again, i think/hope. and although i have all along, thought i knew what severe pain is, i keep revising my opinion.

someone else may have only had a bad headache or a little low-grade tummyache before, so even though they seem functional, this may be the worst pain they know of, and we have no way of truly giving them our experiences for comparison.

and i have to say with that compartment syndrome and four hours of surgery, i was very vocal about my need for pain medication. very vocal and if they thought i was a drug seeker, well, by golly, they were right --> i was seeking all the drugs they could give me so i could stop hurting.

twinmommy+2, ADN, BSN, MSN · Nov 12, 2008

Earlier this week I had a patient that apparently comes into the ED frequently always with abd pain, they can never find anything wrong with him. He must have thought I was an easy target because I have never seen him before. (I only started on the unit in August) Chief complaint? Constipation x 2 days. Takes multiple narcotics, hx of abuse, ect. He is complaining that he has 10/10 pain, as he is sitting up calmly, and is asking for pain meds. I went to the doc and was like, this guy claims 10/10 pain, but look at him. So he goes and does the abd exam with no tenderness on palpation. I had 9 patients that night (some of them really sick) and his wife was harrassing me every minute for something, I was like (in front of the patient too) I have a lot of patients, many sicker than him, that I need to attend to right now, I cant get a pill/give him dilaudid/get him another blanket. The nice lady in bed 2 is about to be intubated and she needs my attention right now. Give me a minute please. He starts saying to me that he is very sick and dying and that I need to focus my attention to him mainly. Than he tells me that I need to order Klonopin for him NOW because he takes it at home and he missed his dose and if he doesnt take now it its "very dangerous". (The doc was getting the d/c papers as we were speaking). He than becomes mad when he finds out he was being d/c'd, he "demanded" to be admitted. Sorry, but a clear CT and x-ray is not going to buy you a day or two free drug stay!
Thank you all for listening to my vent!! I love this site, I can vent about this and you all have been there done that and understand!

We also have a frequent flyer who comes in at least once a day if not twice a day, and the latest kick has been chest pain. Well all of the docs have been coming down on him for coming in so often for this one complaint when every day his enzymes are normal, ekg normal for him, you see the picture.

So this week I was in triage and he comes in (thankfully not by ambulance, thats another story), for back pain. Oh looky, a new complaint. So I sent him directly on to the Minor Emergency Clinic with all the rest of the back pains.

He caught on and the next day I was in triage again and "Oh my chest is hurting bad and so is my back":banghead: