How Would You Rate Your Pain???? - page 3

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 being no pain and ten being the... Read More

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    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.

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    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
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    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.
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    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. :/
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    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.
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    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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    I don't know, I've I had that kind of pain talking to AT&T

    I remember when I was sprout, and my dad had his back surgery, following a terrible accident where he was nearly crushed. I was soooooo worried when he would try to reposition in bed and moan or grunt,...

    I would push his PCA button

    When his doctor made rounds, he would ask,

    "...So, how is the PCA doing on your pain?"

    Dad would say, "Well, I'm surprised! I haven't had to press it but once to go to the bathroom yesterday. I don't think I've hit it once today."

    The doctor looked really puzzled! (Thank God and Science for Lock-Outs!!!
    hecallsmeDuchess and nrsang97 like this.
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    It doesn't even make any sense if we think pain number 10 is only for someone screaming, moaning, unable to talk, laugh, etc.. It makes 10 an impossible goal, for lack of a better word, and all the rest of the numbers meaningless.

    I always compare my patients current pain to its source and how it feels right now. "If at its worse your back pain is a 10 what number is it now.".... "If the worst your incision could hurt is a 10 what number is it now."...."if at their worst your cramps are a 10 what number are they now," etc. It validates to the patient that yes I am in pain now, yes it hurts a lot, maybe even number 10, but no, I don't have to be moaning and writhing on the bed to validate that it hurts.
    PRICHARILLAisMISSED likes this.
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    Well it doesn't help that we all describe the pain scale differently. If the patient rates based on what the last nurse explained the rating as, but we interpret via our own explanation, how on earth is that supposed to work?
    BostonTerrierLoverRN likes this.
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    First...we shouldn't use the FLACC for adults, use the PAINAD instead.

    The pain scale works because it allows the patient to give their perspective of the pain, which is the most important part. If the number doesn't seem to match our assessment and observations then we can correlate with chronic vs. acute distinctions, emotional/psycho/spiritual state, and current health status.

    Perhaps the person is having a difficult time with their pain because they have little personal experience with pain and could use some help coping. There are nonpharmacologic interventions for discomfort that we might be able to address.

    If we don't,cant' ask our patients about their level of discomfort we cannot possibly address it adequately.
    BostonTerrierLoverRN likes this.

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