Pain shots are us, not this nurse! - page 2

Are you ever enraged by patients who really show no visual signs of pain but say that their pain scale is 10/10 and demand their pain shot every time it's due (thinking that they should know when it... Read More

  1. by   CaLLaCoDe
    LOL o.k. somewhat annoyed...thanks for contributing! Cool that you all are sinking your teeths into this tender topic!
  2. by   flashpoint
    I've never really been enraged, I have been very frustrated. When I worked in the hospital, we had a lot of patients who would rate their pain at 10/10. yet be talking and laughing and have perfectly normal vital signs. We also had patients who rated their pain at 2/10 and had escalting B/P and pulse rates, were diphoretic and in tears.

    Whether we like it or not and whether we agree or not, pain is what the patient says it is. What would be a 2/10 for some people may be a 10/10 for others...we have no scientific method of determining whether someone is in pain or not...until we can accurately measure it like a B/P, we have to treat according to what our patients tell us.

    As far as sleeping through pain...when I had kidney stones, the pain would get bad enough that I was simply exhausted and fell asleep. Yes, the meds helped me to sleep, but a lot of the time they sedated me to the point that I was snoring, but did very little for the pain. I've had similar experience with migraines...the pain gets so exhausting that all I can do is sleep.
  3. by   Valanda
    Quote from cotjockey

    As far as sleeping through pain...when I had kidney stones, the pain would get bad enough that I was simply exhausted and fell asleep. Yes, the meds helped me to sleep, but a lot of the time they sedated me to the point that I was snoring, but did very little for the pain. I've had similar experience with migraines...the pain gets so exhausting that all I can do is sleep.
    Thank you for saying this about sleeping through pain. I've found that I can use sleep very effectively as an escape from pain. Just because a patient is asleep does not mean they are not in pain! I'm told that I slept through most of my contractions while in active unmedicated labor.
  4. by   lauralassie
    I try not to judge. I know it's really hard sometimes though ! I think our er adds to the problem though. Now we are giving IV dilaudid (I was informed by a pt the other day that is the liqued form of dilada - HA !) and percocet in triage. The liability for that worries me. I do find myself getting frustrated with people who are allergic to Toradol, ultram, nsaids, thorazine. But that drug that starts wit D...something , always works . Imagine that. Heck , I remember the days when we could give NACAL injections. (saline). It was amazing the people that thought it was demerol because it stung so badly. And , they felt better !!!!!! Then the dr was able to say to them they think their pain may have a psyc aspect , and have the proof for the pt. If they had NACAL every 4 hours and felt better then obviously they don't need narcs to feel better. Too bad we can't do that now days. Not to be mean but to make it easier to evaluate the root of the pt's pain.
  5. by   Tweety
    Quote from TeleRNer
    LOL o.k. somewhat annoyed...thanks for contributing! Cool that you all are sinking your teeths into this tender topic!
    You didn't say that you were denying them their ordered pain medicine and I don't either.

    I practice the way most everyone else on the board does. It's order, they say they are in pain, I give it. If it doesn't work, I call the doctor.

    Pain is so interesting to me. Yesterday I had a patient with his belly cut open from a bowel resect and two chest tubes for plueral effusions taking nothing for pain. Nothing. I hurt just looking at him. Next door was a guy that couldn't deal with his one chest tube without morphine q1h, after three days, but yet could carry it with him down to smoke frequently (water seal).

    I think a very human reaction would be to be "somewhat annoyed", (engraged definately not) and to be honest I was. I felt like I was a drug pusher shooting up a junkie when he asked me to push it fast and questioned why I diluted it so much. But I held those judgments and feelings inside of course, and approached the patient with concern giving it to him whenever he asked without fail and with professionalism.

    The lesson to me is we all have a different response. Some patients scream when you take off a piece of tape, others like my patient above survive major surgery with little pain meds. Some spleep through pain, some don't. Some rate a lap chole a 10/10, some take a tylenol and go home. It's just too subjective for me to have a feel for what a "normal reaction" is. I have to believe what the pain experts have been telling me for dozens of years.........."it's what the patient says it is" and leave it at that.

    But to deny that we aren't human and annoyed with some patients manipulation, demands and histrionics, well that wouldn't be healthy either. I think we can still be compassionate and treat pain appropriate while acknowledging our feelings and dealing with them. If I'm making any sense.
    Last edit by Tweety on Jan 2, '07
  6. by   dorieabsLPN
    I am a huge pain advocate. I have seen many people suffer needlesly. PAIN IS NOT OUR FRIEND. If someone tells me they are in pain I beleive them. I will medicate and do other things to help them reposition,massage,enviormental factors. Pain is so subjective adn some people can be absolutely stoic and be in excrutiating pain and others have low thresholds and are screaming at a splinter. My motto is noone should die alone and noone should be in pain. just my 2c
  7. by   EmerNurse
    Sure, I get frustrated but the patient will never know it. If it's ordered, and they are reporting pain, they get medicated, and I document the patient's report of pain and the response and if they're on the buzzer exactly when they know it's due, I ask the doc for something more effective (longer duration, whatever). My job is to take care of the pain the patient reports with whatever the doc orders and to get new orders if the originals aren't working.

    I've learned over time simply to not worry about who's REALLY in pain and who's not. How am I supposed to know that? The same way I can read their minds when they're too cold and want a blanket, or uncomfortable and want to change positions? We need to go by what the patient says.
  8. by   ceecel.dee
    Quote from Valanda
    Thank you for saying this about sleeping through pain. I've found that I can use sleep very effectively as an escape from pain. Just because a patient is asleep does not mean they are not in pain!.
    This is what I was thinking as I read through the thread too.
  9. by   GardenDove
    No, I'm not enraged. I just figure they are exaggerating and give them their med. Believe me, if you had the worst pain possible you would in no way be just sitting there. I have experienced 10/10 which was in unmedicated childbirth, it's extremely painful and there is no way to sit still.

    Some people just say 10/10 to get their med. The pain scale is very imperfect, I don't know who came up with it as some sort of more subjective guide for pts to use, but many people don't like to quantify their pain with a number and a large percentage just say 10 when they want their med. Probably 25% of people find it a useful tool and use it accurately.

    The pts I totally push the pain scale on are my R/O chest pains. I tell them that it's very important for us to carefully track their pain, and I go to great lengths to explain the scale.
  10. by   all4schwa
    Quote from Tweety
    Yesterday I had a patient ...taking nothing for pain. Nothing. I hurt just looking at him. Next door was a guy that couldn't deal with his one chest tube without morphine q1h.

    I think a very human reaction would be to be "somewhat annoyed", (engraged definately not) and to be honest I was.

    Some patients scream when you take off a piece of tape, others like my patient above survive major surgery with little pain meds. It's just too subjective for me to have a feel for what a "normal reaction" is. I have to believe what the pain experts have been telling me for dozens of years.........."it's what the patient says it is" and leave it at that.

    But to deny that we aren't human and annoyed with some patients manipulation, demands and histrionics, well that wouldn't be healthy either. I think we can still be compassionate and treat pain appropriate while acknowledging our feelings and dealing with them. If I'm making any sense.
    Are you making any sense? Perfect!
    Yeah, the ones screaming about the tape really annoys me, i know it stings, but c'mon!
    And the thing I find about pain meds is they don't really ever take away all the pain, eventually they just sedate and nauseate. Pt's expect if they take more meds the pain will go away.
  11. by   JentheRN05
    I live with major pain every day. About 8/10. But for many other people it would be a strong 10/10 and hospitalization. I don't take meds for it currently, and even then you couldn't tell I was in pain unless you knew me REALLY well, even my husband can't tell most times.
  12. by   JohnBearPA
    I have a pt in my LTC who is in her 40's, a former nurse who got her license suspended because of diverting, and who is A&Ox3, no assist, walking the halls on her own. Yet this pt gets a HUGE dose of morphine Q8H (takes several pills to get the required dosage), and also has a PRN for roxanol Q2H, along with Ativan, Phenergan and Xanax Q4H. I'm sure this pt has pain, and I'm sure to her it IS a 10 out of 10, but yet she's always walking around, going out to smoke, etc. She sets an alarm to know when it's time for more meds, and never misses a PRN. It's frustrating, but I admin as she asks, because it's her level of pain, not mine. However, I do stagger the times, and DON'T admin a pain med, ativan, xanax, and a sleeper all at one time, which really pisses her off. I informed her as a former nurse, she knows the reasons I prefer to do it this way, and even if "the other nurses" give it to her all at once, I'm NOT the other nurses. She's now used to this routine on my shift, and tho she still follows the med cart like a puppy, respects that I will not give her everything she's "entitled" to at once.

    Bottom line tho, it's HER pain, not mine, and it's MY job to keep her relatively pain free, although I refuse to get her legally stoned as she wishes.

    I did speak to the MD about this, and he's fine with me staggerring the meds and actually admitted she's a drug-seeker getting stoned on our tax dollars.

    Frustrating? H*ll yeah! But pain is in the eye of the beholder.
  13. by   Tweety
    Quote from JohnBearPA
    I have a pt in my LTC who is in her 40's, a former nurse who got her license suspended because of diverting, and who is A&Ox3, no assist, walking the halls on her own. Yet this pt gets a HUGE dose of morphine Q8H (takes several pills to get the required dosage), and also has a PRN for roxanol Q2H, along with Ativan, Phenergan and Xanax Q4H. I'm sure this pt has pain, and I'm sure to her it IS a 10 out of 10, but yet she's always walking around, going out to smoke, etc. She sets an alarm to know when it's time for more meds, and never misses a PRN. It's frustrating, but I admin as she asks, because it's her level of pain, not mine. However, I do stagger the times, and DON'T admin a pain med, ativan, xanax, and a sleeper all at one time, which really pisses her off. I informed her as a former nurse, she knows the reasons I prefer to do it this way, and even if "the other nurses" give it to her all at once, I'm NOT the other nurses. She's now used to this routine on my shift, and tho she still follows the med cart like a puppy, respects that I will not give her everything she's "entitled" to at once.

    Bottom line tho, it's HER pain, not mine, and it's MY job to keep her relatively pain free, although I refuse to get her legally stoned as she wishes.

    I did speak to the MD about this, and he's fine with me staggerring the meds and actually admitted she's a drug-seeker getting stoned on our tax dollars.

    Frustrating? H*ll yeah! But pain is in the eye of the beholder.


    You must be doing a good job with pain control if she's walking around comfortably. Chronic patients shouldn't have to wait until they are in pain before they get pain medicines. It's best to give the meds while they are functioning well and comfortable, so they can live life. It's frustrating to hear a 10/10 however, but perhaps she knows if she says anything less someone might argue with her and not give it. What's wrong with a patient saying "my pain is a zero and I need to keep it that way and get pain medicine now so I can function".

    Overall, you have a great attitude about it.

close