The way we ask for someone's pain level?

Nurses General Nursing

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I've come across patients, usually post op, that needs to be routinely assessed on their pain levels.

Now I'm trying to look for a way to ask them on their pain level without planting into their minds the idea that they're actually feeling pain. Of course we can plan a response from their report, but we might be addressing pain that is actually not present in that moment.

Can we ask a general question of "how are you feeling right now?", instead of "are you feeling any pain right now?" Should we be direct or indirect in these kind of situations?

Is that possible? Thanks for your time! :)

Specializes in Wilderness Medicine, ICU, Adult Ed..
I had been Rx'd some Physical Therapy to assess for efficacy of therapy vs manipulation under anesthesia.

The Therapist was assessing for range of motion, said he, and proceeded to move my (L) biceps to my toward my left ear and saying, "Tell me if this hurts on a scale of 1-10. He pushed hard.

I had sparks in my eyes. I could not breathe and he was lifting my hips against the resistance (along with my trying to decrease the searing pain caused by his "assessment") and managed to barely squeak out "50!".

Sounds like the therapist was attempting to go old school: "manipulation without anesthesia." He could have at least given you a shot of whisky and a bullet to bite on.

Oh, and good comments on assessing pain Ned.

Specializes in Emergency, Telemetry, Transplant.

The other thing that I find interesting is pain is pt reports pain 10/10 for a sore throat and then they say "it gets way worse when I swallow." I explained to them 10 is "the worst pain ever," so by definition it should not be able to get worse. I don't correct them when they say this. I simply chart their score of 10/10 on the pain assessment part of our assessment. In my "free text" assessment, I chart "10/10 throat pain" (I hate double charting, but here I make an exception) that "gets way worse" with swallowing." If whomever reads it wants to draw conclusions they can, but I have just put down what the patient told me.

Plus, for sore throat in the ER, pain score doesn't really matter. Some docs will give motrin for "10/10" throat pain, one doc I know will give dilaudid for "5/10" throat pain.

On my floor (renal), we can ask how they are feeling. I still have to ask them to rate their pain level by number a couple times a shift.

But when I get a post-op patient, I don't avoid talking about pain. Usually only when they're still under PACU meds are they pain-free, and I'd rather medicate them early than play catch-up on their pain later.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

I had throat pain once that was 10/10...then I swallowed!!! Holy **** batman, if that was 10 before it is 15 now! Chemo induced mucositis is NOT a walk in the park.

Specializes in Emergency, Telemetry, Transplant.
Chemo induced mucositis is NOT a walk in the park.

That is quite a bit different than a 20 year old male with "1,000/10" pain when he swallows and then asks me for a ham sandwich.

Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.

Pain, whether real or perceived, is PAIN for the patient experiencing it. It doesn't actually matter one way or the other, and should be medicated all the same. Pain, being subjective, I've always had a problem with the pain scale, especially after having gone through L&D in Nursing School and witnessing the miracle of childbirth. One of the mothers I had suffered thru 18 hours of excruciating pain prior to delivery. I can't imagine that fitting on the 10 scale anywhere. Also, I spent a lot of time in the jungles of Southeast Asia trying to put body parts back together, where did the smiley-face fit into that scenario? I'm not trying to be inappropriate, but to ask reasonable questions. I get a little glimmer of PTSD whenever this pops up when I go to the VA now, and thankfully, I am retired so I don't have to deal with it as far as my patients are concerned. One more point I'd like you to consider though, before you write me off completely, please consider Phantom Pain in amputated limbs. That pain is as real as the pain of a fractured femur, prior to treatment.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

Part of my point is that the sore throat in the ER may be actual serious pain.

The doc that saw me in the ER poo pooed my pain a bit...the nurse insisted and I got some topical and IV relief!

I could have kissed her. I had endured the pain for as long as I could and I needed relief!

Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.

One thing I think we all need to remember is that we are not DEA or any other sworn LEO’s. We are professional nurses here to take the best possible care of our patients. It is our job to determine if our patients are suffering from pain and if so, to relieve that pain by administering prescribed medications. We are not gatekeepers, we do not get to decide that our patients are not really suffering enough by our standards and therefore not worthy of his or her prescribed medications. Many nurses claim to worry they’ll “turn their patients into addicts if they ‘overmedicate’ them,” which is in fact, a load of bunk, because most patients aren’t hospitalized long enough for that to happen. At best, you’re going to end up with a satisfied, pain free, patient who doesn’t spend his days or nights on the call light the entire shift. I’m not suggesting that everyone gork their patients, simply medicate them appropriately, according to the Doctors orders and the patients request. If a patient asks for his or her meds, I give it to them, they know better what is going on with their body than I do. Until someone invents a machine that can adequately display pain levels within the human body, it’s the best we have to go with. Some might suggest vital signs, but that isn’t always a true indicator of elevated pain levels.

Some might suggest vital signs, but that isn't always a true indicator of elevated pain levels.

I agree one hundred percent. I actually kind of have a personal thing with people who claim if it's real pain it will be reflected in vital signs; you don't know the physiology of their pain or how it will truly affect them.

I have several men in my family who deal with pain amazingly. Just because my dad smiles and shakes your hand doesn't mean his RA isn't killing him at the moment.

And just three weeks ago, a triage nurse in the ED dismissed my husband's RLQ pain since "you're not sweaty or anything and your vitals are great." We had to sit in the waiting room for four hours. Finally, a doctor came out and tore the nurse apart. It was painful to see but I hope she learned from it. He had read our story and came out personally to get us. He got us immediately to CT, but my husband's appendix had already burst and he went in for emergency surgery and a 9 day stay afterwards.

My husband could have gone septic because someone deemed his vital signs the end-all be-all of his pain indication.

Sorry. I'm still mad about it.

Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.

It has really become a problem in our culture today, which many in the field of medicine feel that everyone that comes through the door is drug seeking and unfortunately, they treat everyone that way and it's dead wrong. I do understand that there are many that are, but it reflects badly on the professional that cannot discern the difference in between those who are from those who aren't. It is tantamount to having a horrendous bedside manner if you mistreat those who come to you for care, by overtly suspecting them of seeking drugs, when they are in fact sick, in pain and in need of treatment and relief not remonstration and reprimand. If you wanted to be in Law Enforcement, you should have made that decision long ago, not when you are standing in front of a patient seeking treatment for an illness or acute pain.

Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.

delilas, I'm sorry your husband went through what he did at the hands of an incompetent nurse. It seems to make it all the worse when we know what is going on and are powerless to stop or change it ourselves, we just feel so helpless. Some of the Veterans Hospitals are known for hiring any breathing thing that can walk in under their own power, irregardless of their capabilities, leaving their nursing pool filled with some woeful and wretched creatures that couldn't empty a bedpan with the instruction printed on the bottom, left to care for its patients. If you open the Obituaries in the Newspapers (or Online) of many of the areas that have VA Hospitals you will likely find that most of the deceased will be from the VA. That isn't by coincidence or age, it's because they get sub-par care. I'm sorry, I didn't mean to get so far off topic, and unfortunately, this is a whole different story altogether. Best wishes for your Husbands complete recovery.

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
Some of the Veterans Hospitals are known for hiring any breathing thing that can walk in under their own power, irregardless of their capabilities, leaving their nursing pool filled with some woeful and wretched creatures that couldn't empty a bedpan with the instruction printed on the bottom, left to care for its patients. If you open the Obituaries in the Newspapers (or Online) of many of the areas that have VA Hospitals you will likely find that most of the deceased will be from the VA. That isn't by coincidence or age, it's because they get sub-par care.

*runs for cover, dives, covers head*

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