Rate Your Pain - page 2

by jadelpn Guide

6,994 Views | 24 Comments

There's all sorts of pain. There's physical, emotional or a combination of both (and probably a lot more descriptive words that can be used). The most difficult part of pain for a nurse is to put aside some of their own... Read More


  1. 5
    Quote from Steve123
    ...prescription meds such as narcotics, antidepressants and all other garbage like that...
    Wow Steve, what's your suggested alternative then? Get rid of all narcotics and leave all those patients writhing in pain? Snatch away all those antidepressants with which many people finally found a control of their lives?

    There are devastating effects on healing process if pain is not controlled. I shudder at the thought of patients denied of adequate pain meds on oncology wards or in hospice especially.

    On a side note, there is no ceiling effect on opioids. A patient may receive 100mg of Dilaudid a day (an extreme example but possible) and exhibit no side effect. An opioid-naive patient might get knocked out from 0.5mg push. Calling MD should dependent on thorough assessment and history of the patient, not just based on the amount patient receives.
    Glycerine82, Munch, Nurse_Diane, and 2 others like this.
  2. 4
    First of all. I used to struggle with this. How can they say 10/10 and be texting and laughing and joking?!?

    It's not our place as healthcare providers to decide what a patient's pain really is. We need to look at our patients as whole people and assess carefully.

    I have had opioid addicted patients in my care, and I always get their baseline dose ordered. So what if they take x amount of oxycodone at home? I gave it to the guy, and he was actually comfortable for the first time in days. Other nurses, myself included, shook our heads and said "if I took that much, I'd be dead". Maybe we would, but that gentleman took that much every day and was able to function after an incredibly debilitating injury. Not my place to tell him, no he can't have it, if that's what he needs to function. And yes, FUNCTION, as in, he was not comatose or obtunded or even sleepy or out of it. He was able to make progress towards his discharge goals.
    Ir15hd4nc3r_RN, jadelpn, Munch, and 1 other like this.
  3. 2
    Quote from tokebi
    A patient may receive 100mg of Dilaudid a day (an extreme example but possible) and exhibit no side effect. An opioid-naive patient might get knocked out from 0.5mg push. Calling MD should dependent on thorough assessment and history of the patient, not just based on the amount patient receives.
    We had patients who would get that kind of narcotic between their PCA, epidural and PO meds. No joke. Oncology pain is nasty stuff.
    jadelpn and Nurse_Diane like this.
  4. 3
    I have a hospice pt who was an Oxycontin addict (heavy user) for several years prior to his dx. He is now is hospice care for Lung CA w metastases pretty much everywhere. He weighs about 80#. I am continually titrating his po Oxycontin and Oxy IR for his comfort. He is on very large doses of each. He takes 270mg of Oxycontin qd and receives 40mg doses of Oxyfast q1 hour prn for breakthru.

    To NOT give him these large doses because "he's an addict" is not only unethical I feel, would be malpractice on my part. I advocate for him w our hospice Doc. and titrate his meds as needed.
    Munch, jadelpn, and SoldierNurse22 like this.
  5. 2
    Quote from Nurse_Diane
    I have a hospice pt who was an Oxycontin addict (heavy user) for several years prior to his dx. He is now is hospice care for Lung CA w metastases pretty much everywhere. He weighs about 80#. I am continually titrating his po Oxycontin and Oxy IR for his comfort. He is on very large doses of each. He takes 270mg of Oxycontin qd and receives 40mg doses of Oxyfast q1 hour prn for breakthru.

    To NOT give him these large doses because "he's an addict" is not only unethical I feel, would be malpractice on my part. I advocate for him w our hospice Doc. and titrate his meds as needed.
    EXACTLY. Addicts get sick, too.
    jadelpn and Nurse_Diane like this.
  6. 0
    Quote from tokebi
    Wow Steve, what's your suggested alternative then? Get rid of all narcotics and leave all those patients writhing in pain? Snatch away all those antidepressants with which many people finally found a control of their lives?

    There are devastating effects on healing process if pain is not controlled. I shudder at the thought of patients denied of adequate pain meds on oncology wards or in hospice especially.
    Agreed...I thought the days of surgery without anesthesia went out the window with the bullets patients used to bite on.

    I forgot to add in my original post...I know a pretty famous quote by an English Judge named William Blackstone: "It is better that ten guilty persons escape than that one innocent suffer." This is obvious in regards to the criminal justice system..better to have guilty people out on the street than someone who did not commit any wrongdoing locked up for life. I feel the same in regards to medicating patients;

    I would rather give 2mgs of dilaudid IVP with 2mgs of ativan IVP to what turned out to be 100 drug addicts(of course without knowing at the time they were addicts) than to deny one person in legitimate, severe pain.

    Maybe I am still bitter about being burned that one time of being accused of drug seeking in the ER and then after the accusations turned out I had a really bad bowel infection...or maybe I am a left-sided nut job...call it what you want. But I think it's more criminal to deny a LEGIT suffering patient more than to medicate a suspected drug addict. That being said...if it's in my face someone is malingering I will be the first to bring my suspicions to the MD. If they have had twenty ER visits in the past three weeks for the same thing with no concrete evidence..maybe they do have pain..then the doctor needs to refer them to a pain management clinic. Also if you are on the fence on someone being a seeker then you can always check their controlled substance history(well nurses can't but doctors can...at least here in NY state, they have a data base with a patients name, the actual name of the controlled substance(s)(schedule II-V) they had filled, the strength, quantity, if they were from different prescribers(it doesn't give the ACTUAL name of who prescribed it, just if it they were from different people), the date it was filled and the pharmacy. I mean I have better things to do than play detective and chances are if I am on the fence about someone I will probably not go out of my way.

    But then again, I don't work in the ED so I can't really speak of the frustration of how many patients I see daily trying to get a free "fix" off the hospital. Most of the people I take care of are really sick, genuinely hurting a need a lot of meds for their recovery. Of course I am sure one or two bad apples slip through...but I am not going to let them ruin my day(totally not worth it) I was going to go into law enforcement but I didn't(that being said...I don't go around breaking the law either...I worked way too hard to get to where I am to throw my license away)...

    We can try to get them help...detox, rehab, NA meeting referrals..but unless they hit bottom and are ready to get clean for THEMSELVES, nothing will change. By not giving them their 150mgs of Demerol or 3mgs of Dilaudid isn't going to give them that "AHA" moment and ask for detox and rehab...bets are they are going to go elsewhere to score. That being said...I have to repeat myself...I will NOT medicate a known drug fiend with no medical issues...a drug fiend with a legit medical problem.say cancer or a gunshot wound is a whole different story.
    Last edit by Munch on Jun 13, '13
  7. 1
    Quote from Munch
    Agreed...I thought the days of surgery without anesthesia went out the window with the bullets patients used to bite on.

    I forgot to add in my original post...I know a pretty famous quote by an English Judge named William Blackstone: "It is better that ten guilty persons escape than that one innocent suffer." This is obvious in regards to the criminal justice system..better to have guilty people out on the street than someone who did not commit any wrongdoing locked up for life. I feel the same in regards to medicating patients;

    I would rather give 2mgs of dilaudid IVP with 2mgs of ativan IVP to what turned out to be 100 drug addicts(of course without knowing at the time they were addicts) than to deny one person in legitimate, severe pain.

    Maybe I am still bitter about being burned that one time of being accused of drug seeking in the ER and then after the accusations turned out I had a really bad bowel infection...or maybe I am a left-sided nut job...call it what you want. But I think it's more criminal to deny a LEGIT suffering patient more than to medicate a suspected drug addict. That being said...if it's in my face someone is malingering I will be the first to bring my suspicions to the MD. If they have had twenty ER visits in the past three weeks for the same thing with no concrete evidence..maybe they do have pain..then the doctor needs to refer them to a pain management clinic. Also if you are on the fence on someone being a seeker then you can always check their controlled substance history(well nurses can't but doctors can...at least here in NY state, they have a data base with a patients name, the actual name of the controlled substance(s)(schedule II-V) they had filled, the strength, quantity, if they were from different prescribers(it doesn't give the ACTUAL name of who prescribed it, just if it they were from different people), the date it was filled and the pharmacy. I mean I have better things to do than play detective and chances are if I am on the fence about someone I will probably not go out of my way.

    But then again, I don't work in the ED so I can't really speak of the frustration of how many patients I see daily trying to get a free "fix" off the hospital. Most of the people I take care of are really sick, genuinely hurting a need a lot of meds for their recovery. Of course I am sure one or two bad apples slip through...but I am not going to let them ruin my day(totally not worth it) I was going to go into law enforcement but I didn't(that being said...I don't go around breaking the law either...I worked way too hard to get to where I am to throw my license away)...

    We can try to get them help...detox, rehab, NA meeting referrals..but unless they hit bottom and are ready to get clean for THEMSELVES, nothing will change. By not giving them their 150mgs of Demerol or 3mgs of Dilaudid isn't going to give them that "AHA" moment and ask for detox and rehab...bets are they are going to go elsewhere to score. That being said...I have to repeat myself...I will NOT medicate a known drug fiend with no medical issues...a drug fiend with a legit medical problem.say cancer or a gunshot wound is a whole different story.
    "Drug fiend"? Really? One cannot be a "drug fiend" and not have a medical issue. It IS a medical issue - among psychological and spiritual deficits.
    jadelpn likes this.
  8. 0
    I've been working on a 30-bed orthopedics unit for a little under a year...so I am very familiar with pain assessments. I had a doc explain to me that bone pain is one of the worst types of pain and I took that to heart. Many of our patients come out of surgery with epidurals, perineurals, PCA pumps (dilaudid, fentanyl), Q pumps, around-the-clock pain med administration, etc. But I worry sometimes about causing low BP and respiratory depression. In our older patients I have that fear of delayed renal function. I once administered PO pain med and then breakthrough IV pain meds as well as oxycontin, to a patient post-op day #1 hip replacement; she was a&ox4, RR WNL. She also received BP meds in the AM; her BP and HR were WNL. But then the physical therapist came to get her out of bed and her BP plummeted. We put her in reverse Trendelenberg and bolus-ed her. Fortunately her LOC didn't change throughout. But it really worried me about administering pain medications in addition to BP meds & PT. Any advice or tips or experiences regarding safe pain medication administration? Thanks!
  9. 2
    I personally dislike the pain rating sysytem. It know it is subjective. I know it is all we have. But when you have patients rating pain at an 11 on a 1-10 scale, that is having too much fun. It isn't anywhere close to being accurate.
    Ir15hd4nc3r_RN and canoehead like this.
  10. 2
    Quote from Kidrn911
    I personally dislike the pain rating sysytem. It know it is subjective. I know it is all we have. But when you have patients rating pain at an 11 on a 1-10 scale, that is having too much fun. It isn't anywhere close to being accurate.
    I agree. The conversation goes like this:

    Me to pt who c/o cough x2 days and is laughing with friends and texting: So how would you number your pain if 0 is no pain and 10 is the worst pain of your entire life?
    Pt: 10. Tee hee.
    Me: ok, so this the worst pain in your life. I'll let the provider know.

    Sigh.
    Ir15hd4nc3r_RN and canoehead like this.


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