Pain scale - Page 3

Pain is something that is hard to judge and everyone is correct to say you have to take the patient's word for how bad they hurt. I hurt every day of every week, 24/7 r/t herniated disk with nerve damage and intractable pain. I do not cry about it when it is at a ten, because I cannot cry and moan all the time. Most of the time my pain is somewhere between 5 and 10 and that is with pain meds being taken every 8 hours and between times for breakthrough pain (ms contin and oxycodone). When I take the meds I end up sleeping all day or all day and all night. I am never out of pain, but I do try to put on a happy face for the general public. My husband fusses at me about it, because he said don't try to hide it, if you hurt, it is ok to show it. I am sorry for the long post, but just needed to tell my story.

I guess I need to clarify a bit. I work with a variety of doctors in the ER and they all approach pain in different ways. As a nurse, *I* have no control over what the doctor orders, I can only bring things to the doc's attention and act on orders. One doc gives naprosyn to everyone and I have seen her give lortab ONE time to my knowledge, and never have I seen her order morphine. Another doc gives morphine for almost everything and sends almost everyone home with a script for lortab. The others are somewhere in between, but you see the point, I hope.
I was mentioning the report of a 10/10 not as an indictment against the patient, but more of a perception that the patient has of the doctor's response. This is what I meant by an earlier post about the ART of nursing. We take those non verbal cues seriously, in both directions. Being a small town ER, we see the frequent fliers and know who they are and what they are after. I only report the chief complaint and assessment findings, the doc is the one who actually decides what the pt is going to get, and I give it. There are times when I think a patient needs a shot of demerol and the doc orders motrin....and there are times when the other doc orders MS and I think the pt would do better with Toradol, but I am just the nurse, and it isn't my call....BTW, the generous doc has come up with what he calls a BACC pain study "bellyachers and chronic complainers" cocktail of Ativan 2mg, Haldol 2mg and Benedryl 25mg; in varying dosage levels depending on the patient. I have read the study and it is pretty astounding the results he gets without giving a narcotic. He thinks that some of the chronic pain can be dealt with using haldol and other psych meds.
Am going to stop now....pain control is actually one of my favorite subjects, especially when I found out that Pain is an epidemic in this country, BUT the drug Vicodin/Lortab is #4 most prescribed med in the US and the DEA is constantly on the case of doctors that they think are prescribing too many narcs. It is a contradiction that needs to be addressed.

I just remembered some cases when I worked the floor a few years ago. We had a patient who would be admitted for something or other, usually asthma exacerbation where she was forcing an expiratory wheeze on auscultation. She would get an aminophylline drip and the doc ordered Nubain and Phenergan q4h. She would spend 2 weeks in the hospital, and in the first week she would NOT sleep, but drink coffee 24 hours a day and insist on her pain meds on the minute. I would go into her room and she would be sitting on the bed so drugged she couldn't keep her eyes open, slurred speech, etc. But if we tried to hold the med, she would become one of the meanest people you ever met. The doc had to almost literally force her out by cutting out her coffee and then doing a fluid restriction on her. He started ordering NS and Phenergan and told her it was called placebo, which she thought was a new med until a float nurse got her as a patient and when asked what she was getting, told the pt it was normal saline instead of "nacl" pronounced like a word.
I just wanted to share one of my personal nightmares about pain from the jaundiced side, LOL. It is a pretty good example of a drug seeker.....and of the irresponsible doctor who lets it happen.
THEN there are patients who are in obvious pain that we nurses have to almost insist on medicating and giving them the talk about it not being a problem, and not a weakness on their part, etc. The spectrum is amazing, when you think about it.

Pain is such a touchy subject, because pain is so subjective. I believe in medicating well and listening to the patient, but I don't feel comfortable blindly giving pain medicine based only on what the patient gives for a number on a pain scale. Without using the entire assessment process, plus alternatives such as reducing anxiety, we are only partially completing our job if we medicate based solely on the subjective.

Oh I hate the pain scale due to the fact that an overwhelming number of patients seem to get annoyed with it and many of them don't quite understand it. I would much rather just be able to document that I gave a patient a pain med because they were in pain. In our facility it's a huge deal to do a pain score on every single patient at least once a shift. I find it more annoying than anything else.

I do agree with a lot of what all of you are saying. Some doctors are bad about not giving people pain meds. I am seeing a pain management specialist for my back pain. Because pain meds are so strictly controlled, I had to sign an agreement saying where I buy my meds. I am fortunate that my doctors believe me when I describe my pain. I have worked with some nurses that refuse to give anything other than a tylenol, even with cancer patients. Because I deal with pain myself everyday, it is a very touchy subject with me and I try to avoid discussing it with others because of that. However all of you have brought up good points.

I have to say I tend to err on the side of giving too much pain/anxiety meds rather than not enough. OK, I'm not giving so much that I completely knock out my patients (unless they're on vents ), but I want to make sure they are not in pain, because I know what it's like.

I have endometriosis and I'm having surgery next week. I can only pray that my doctor will give me some good drugs for the post-op period because I am too nervous to actually talk to him about it. I've only seen him once (had to change because my old doctor moved to CA) and I don't want to be labeled a drug-seeker. I tend to only take narcotics when I absolutely have to, and I usually take them with motrin or just one lortab or percocet with a tylenol to make them last longer because it's so rare that the doctor will actually trust me, a grown woman, enough to write me a Rx. With my last doctor I actually gave up asking her at visits and I'd call her (or one of her associates on call) after hours when the pain was unbearable so she'd call in a Rx for 5 lortabs. She'd always say, "Now I can't have you getting addicted to these." So I pretty much live in pain. I guess I've learned to get used to it. I'm having surgery again hoping that this time he will get it all and I'll be pain-free. The last time I had this surgery, the doctor told me I was "cured" and I was in pain again six weeks later. I moved to a different state, so I didn't even have a chance to follow up and let him know that I was NOT cured.

How funny it is that my first experience with Rx pain pills was after getting my teeth drilled and the dentist called in a Rx for 20 vicodin and I think I took two. Now I have "legitimate" pain and I can't get anyone to believe me. Or else they believe me but are afraid I'll get "addicted."

I actually got the "addicted" speech one time from my doctor on the very DAY that we'd talked about pain at school, how it's subjective, it is what the patient says it is, only 1% of people who are prescribed pain meds who are actually in pain get addicted. I brought it up to her, it was like talking to a brick wall. Maybe it's a good thing she moved to CA. The more I think about it, she wasn't that great a doctor. She certainly wasn't meeting my needs.

pain in the elderly is perhaps the most under treated problem in our population.
there are many misconceptions about pain medication tolerence and lack of
pain, therefore our elder population is commonly undertreated and often times ignored.
this problem is widespread and causes great suffering for many elderly people in the world.
lack of education and knowledge cause many people to spend their last years
in agonizing pain and many have a poor quality of life.The new pain management
standards set up by JACHO will make it part of their critera for passing surveys.
as we are all aware there are many different areas we look into when doing a pain assesment on a patient. some examples 1. location of the pain. 2. pain scale (Faces, numbers ectra) 3. descriptors for pain (dull ache , sharp.shooting, throbbing . fullness)
Before i recived my MSN degree i worked in all areas of a hospital. i have had many
patients who have said they were in pain and not have been grimicing or
any other symptoms as have been disscussed.. but we all handle pain differently and yes i
some times doubt is the pain real or are these people playing me. the fifth vital sign is the hardest to asses .. i love these discussin board and read them often.
and i

One of the things that really bothers me about pain scale documentation is the fact that some nurses get so caught up in having to document a number that they actually make it up. I've admitted patients, from the ER and post-op, and others have helped out on the admission procedures. When I'm following up my documentation, I'll notice that the nurse before me has entered in a number, let's say 5/10, but the patient is not even able to talk (intubated/sedated, etc.).

I think alot of this stems from the fact that we have a case manager who constantly harped on having every blank filled in, especially the pain issue, b/c it's such a JCAHO hotspot. The point is, theres a way to address it (i.e. "unable to assess/pt intubated/sedated") without making it up! A nurse who does that loses all credibility in my book!