How Would You Rate Your Pain???? - page 2

I was with a friend recently who was awaiting a craniotomy. We were in the OR holding area when the nurse came in and asked him "How would you rate your pain on a scale of zero to ten with zero... Read More

  1. Visit  Ntheboat2 profile page
    1
    Quote from VivaLasViejas
    I hate the 'faces' scale.......it's demeaning when you're dealing with adults. Not really a fan of the 0-10 scale either, especially when working with the elderly---a lot of times they really can't put a number on their discomfort. For that matter, neither can I; kidney-stone pain is the gold standard against which I compare every other kind of pain, and that is a 10 and then some! Nothing else compares, not post-op pain, not chronic arthritis pain, not even childbirth (although that last one was probably a 9.5). OTOH, I hurt every day of my life, yet I probably wouldn't rate it as more than a 3 while someone else might rate it as a 5 or 6. It's all relative.....and thus, not very accurate.
    It's definitely not accurate when dealing with the elderly. Even if they are able to understand, I've noticed that a lot of elderly people (especially men) don't like to "complain." So, they'll say they're not having any pain when they clearly are. I've also had a lot of elderly people say that they "don't wanna take DRUGS."

    I had this discussion with an RN when I was working as an intern. This poor man just looked like he was in excrutiating pain from his facial expressions, etc., and when I told the nurse she said, "Oh, he said he's not having any pain." Of course, I was just an intern (about 10 years older than this new nurse who never had a job before) so what did I know.

    Luckily, the man's son showed up very shortly after and almost immediately asked if his father could have something for pain. Thank goodness.
    VivaLasViejas likes this.
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  3. Visit  wooh profile page
    7
    The thing that annoys me most about the pain scale is that it doesn't account for how different pains are more or less tolerable. Ankle pain that's the same intensity as back pain is more tolerable to me than the back pain. The back pain is more tolerable than the head pain. Least tolerable pain for me? Sinus pressure in my teeth. Even if it's really only a "2" I'd like full anesthesia knock out when I've got it going on.

    In peds, I FLACC everyone that I can get away with FLACCing. Or OPS. FACES is ridiculous. Even for kids. All the pain scales are ridiculous, because you can't make something as subjective as pain into an objective number.

    Do you hurt? Lot or a little? Tolerable or do you need medicine?
    That's all the "scale" we really need. Too bad that's not considered "objective" but "Pick a random number/picture" is considered objective.
    annietart, DSkelton711, sharpeimom, and 4 others like this.
  4. Visit  CloudySue profile page
    1
    My husband has severe RA and describes some of his worse pain as if someone took a blowtorch to his ankle. However he is so used the steady, chronic pain and he is not the type of person to complain, so every time he went to his rheumatologist he'd say 3-5, so they didn't really pay much attention to his need for pain relief. Every time he'd come home empty-handed for a better pain med scrip and I'd flip out. Now I've instructed him to give a 7 or 8 so they'd take him seriously. On bad days, his FLACC looks like he's popping out a kid!
    poppycat likes this.
  5. Visit  poppycat profile page
    0
    I don't think I ever had "real" pain until a year ago when the symptoms of RA started. Now I have pain every day. When I was in the hospital over the summer, the nurses asked me constantly to rate my pain. I told them my knee pain is always at least a 5. They kept pushing me to take something for it but I told them I live with that degree of pain every day & as long as I'm able to function I'm not going to take pain meds because I hate how they make me feel. Like someone else said, pain is relative.
  6. Visit  BostonTerrierLoverRN profile page
    0
    The pain that is experienced "now" is always "worse" because it's "now." Who wants to think about past pain when your in pain "now." This is like my dad asking faithfully (to gross us out) after finishing a large meal, "Hey, y'all want a Hardee's Burger?" Same difference.

    As for the faces, many cultures mask their pain, some are open, I think we mask 1-5 here, (but you, and all your colleagues will be aware of 7-8+), i.e. "Terms of Endearment- Scene: Give her the damn shot!! (While Shirley "Ms. Greenbrier" McClain chases the Nurses around the desk), because Debra Wenger is having Cancer associated breakthrough pain.

    Movies like that and "My Sisters Keeper" should have warning stickers on box- but that's another thread!!
  7. Visit  PRICHARILLAisMISSED profile page
    1
    HA!!! OK, Ntheboat2... I never heard of "Catfish" until I just looked it up on wiki right now, but (RESOUNDING!!!) "YES!", I am in fact a man. A fairly solid (though not completeley lol) 5'9" 215 pound MAN who is the quintessential MAAAAAAAN. And "NO," I have no emotional pain for this same reason. That reason being that I am a man.

    But seriously, I think a far better tool for measuring pain is the questionnaire given to pt's. I mean, if someone checks off "No" to the question asking if they can brush their teeth without the pain interfering with it to the point of disallowing it, I would imagine that this would be an indicator of some serious pain. For a baseline, I can describe the pain that has made me check "No" to this box, but it would only make sense to the ALLNURSER's that have had a bad back spasm at some point. Here it goes;

    Ok, do you know how when a really bad back spasm hits, how if the pain was graphed it would be a steep (near verticle) upward climb to the peak, followed by a slooooow decent to the baseline? Well, for me it happens with a slight difference-The "Peak" is actually a plateau that last from several weeks to several months. I'm not exaggerating, either. During these plateaus, even simple movements like making a fist or simple hand gestures sends pain shooting through my entire body. And moving my legs... "OH SWEETLORD!!!!"

    This is what it takes to get me to seek medical attention. Because again, Ntheboat2, I'm a MAN! But yes, it sucks lol.
    Last edit by PRICHARILLAisMISSED on Nov 20, '12
    BostonTerrierLoverRN likes this.
  8. Visit  AR_RN profile page
    0
    If I feel that the number pain rating I'm getting (say from an elderly patient) doesn't mesh with what I'm seeing, I'll FLACC them, while also making a note of the number they rated it. I also do this on occasion with that patient that rates their pain a 10 while giggling on the cell phone and painting their nails.
  9. Visit  Ntheboat2 profile page
    1
    Quote from PRICHARILLAisMISSED
    HA!!! OK, Ntheboat2... I never heard of "Catfish" until I just looked it up on wiki right now, but (RESOUNDING!!!) "YES!", I am in fact a man. A fairly solid (though not completeley lol) 5'9" 215 pound MAN who is the quintessential MAAAAAAAN. And "NO," I have no emotional pain for this same reason. That reason being that I am a man.

    But seriously, I think a far better tool for measuring pain is the questionnaire given to pt's. I mean, if someone checks off "No" to the question asking if they can brush their teeth without the pain interfering with it to the point of disallowing it, I would imagine that this would be an indicator of some serious pain. For a baseline, I can describe the pain that has made me check "No" to this box, but it would only make sense to the ALLNURSER's that have had a bad back spasm at some point. Here it goes;

    Ok, do you know how when a really bad back spasm hits, how if the pain was graphed it would be a steep (near verticle) upward climb to the peak, followed by a slooooow decent to the baseline? Well, for me it happens with a slight difference-The "Peak" is actually a plateau that last from several weeks to several months. I'm not exaggerating, either. During these plateaus, even simple movements like making a fist or simple hand gestures sends pain shooting through my entire body. And moving my legs... "OH SWEETLORD!!!!"

    This is what it takes to get me to seek medical attention. Because again, Ntheboat2, I'm a MAN! But yes, it sucks lol.
    You might wanna keep all that crying to yourself when going for a pre employment physical

    (It's descent, not decent to the baseline btw) So, how was the litter-chore?
    BostonTerrierLoverRN likes this.
  10. Visit  BostonTerrierLoverRN profile page
    5
    Omg, I have been spelling that wrong all my life too

    On that other great point, a 10/10 painting toe nails and giggling on phone- I document that because these are the same ones that will fill out the questionnaire and always put their pain was not managed well.

    This is as bad as the patient who says, "Could you bring me two grape juices, two packs of graham crackers, and two peanut butters,....oh! And is it time for my nausea medicine?" (Working on a bag of chips and a dill pickle with chocolate milk). No, I checked, lab said she wasn't pregnant
    Last edit by BostonTerrierLoverRN on Nov 20, '12
  11. Visit  BluegrassRN profile page
    2
    It's no good asking what someone's pain is unless you've established what their comfort goal is. If their pain is a 3, but their comfort goal is a 1, you need to be giving pain meds. I think the comfort goal works really well with chronic pain sufferers. When I introduce the pain and comfort scales, I actually use the hyperbole and a half scale: " What would you rate your pain right now on a scale of 0-10, with 0 being no pain, and 10 being actively mauled by a bear type of pain?" "And for a comfort goal, on a scale of 0-10, at what number would you feel decently comfortable, like you don't need any additional pain medication?"

    If you don't know their comfort goal, you don't know how to medicate them. And frankly, with all the obvious confusion on pain, even if someone says they are at a 3, and their goal is a 2, I still let them know what they have available and discuss what they want to bring their pain down lower. Like a new post op, I'm NEVER going to give them just a tylenol unless they really do just want that, even if their pain is only one or two points away from their comfort goal. Soon to be discharged pts are going to receive a discussion regarding home pain control if they are insisting upon something IV, as well. Big picture, and all that.
    Hoozdo and tewdles like this.
  12. Visit  RockinChick66 profile page
    0
    What bugs me is when a pt says their pain is. 10/10 and theyre sitting up in bed talking on telephone normally. To me, a 10 is crying sobbing or something other than carrying on normal conversation. I know what a 10 feels like and I sure wasn't able to have a phone convo. :/
  13. Visit  classicdame profile page
    1
    The 1-10 scale is NOT objective. The nurse would like it to be but there is no way anyone can judge another person's pain. Think of the scale as being entirely relative to what the patient says it is. If the patient starts out at "4" and after your intervention is a "2" then the intervention was a success. The next patient may start out at a higher number but it does not matter. All that matters is that you have some way to document that the intervention was a success. The actual number is not relevant. Regardless of what the nurse has personally experienced or observed as a nurse, the scale will NEVER coincide with what the patient is presently experiencing. I believe that is where we mess up. We want the scale to be objective, but the numbers simply mean different things to different people. Example: "down the road" meant a mile or two when I lived in TN. Now I live in TX and "down the road" can be many miles. All relative.
    tewdles likes this.
  14. Visit  classicdame profile page
    0
    but the patient is not having the same experience as you did when you had a 10. When we give the patient the scale we are asking them to relate to their OWN memories, not ours. So if the worst pain they have ever had prior to this experience was a bee sting it is hard for the patient to imagine, and report, more than that.


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