Pain scale - page 3
My hospital uses a pain scale of 1-5 with faces. How effective is this, really? I had a patient tell me she was a 5 (worst pain) and yet she was on the phone laughing with a friend. Of course I... Read More
May 14, '03I 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.
May 15, '03I 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.
May 15, '03pain 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.
May 15, '03One 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!
May 15, '03konni,
Good luck with your surgery. I pray that it will be successful and that your new Doctor will treat you appropriately.
May 15, '03Konni, good luck with your surgery. Be sure to let the doctor know if you are hurting and if the med does not work make them give you something that will. You will be in my thoughts and prayers.
May 15, '03We use the pain scale as well. The other night I asked a patient to rate her pain on a scale of 1-10, and she said it was 15. Yep. Love the pain scale!!
May 16, '03konni, I just went thru something similar to what you are going thru and I went the week before surgery and went into the doc's private office, not a room, and we talked about pain. I wanted his assurance that I wouldn't be allowed to hurt and what he normally does for postop patients. I reminded him that I am allergic to NSAIDS (anaphylaxis) so he never made the mistake of giving me toradol and killing me.....and I got a demerol pca pump the first 24 hours. There is nothing wrong with talking to your doc about your pain worries. At some point, you have to just say "screw them all" and not worry about whether they think you are a drug seeker.....I told mine that in this instance, I WAS a drug seeker and after he spent 30 minutes cutting thru scar tissue before he could do the actual hysterectomy, he believed me.
May 16, '03Now we do get the drug seekers, and all that type. Pts. who report a 10, and frequently, really don't look like they're a 10. Most of the I will take the pt's word for it. I mean what if they really are a 10, and I were to disregard what they said and anything were to happen.
Of course there are the pt's who claim they're a 2,3 or4 and clearly they're in agony.
I'll never forget when I was in my 3rd yr of nursing, (still in Aust.), saw a post-op turbinectomy pt - nurse could see pt was in a lot of pain, eyes so red from holding back tears - asked on a scale of 1-10 what the pain was answer - "2" asked again, "3" and again "5", and last time "oh a 7".
When pt was asked "do you want you pain med now?", pt replied "no, not now", nurse "are you SURE? You will be in a lot more pain when the meds they gave you in surg start to wear off". Still pt didn't want anything, nurse ended up giving her the pethidine anyway, soon after pt was a lot more relaxed and sound asleep. Woke 30-40mins later & looking/feeling much better.
May 17, '03My husband fusses at me all the time because I worry about whether I am taking too much pain med. He will ask me how I am hurting on scale of 1 to 10 and when I tell him 8, 9 or 10, he tells me that I really need something and not to worry about taking too much. He cannot stand to see me hurting and I am getting better about taking something when I am hurting worse as I don't take anything when the pain is in the range of 3-6.
May 17, '03Of course pain is subjective, untill we can read our patient's minds we will never REALLY know how they feel.
When I was in nursing school we had a Med-Surg instructor who always talked with us and the patient when we first started learning how to assess a patient's pain. She had told us that 8 times out of 10 we would get patients who said that they didn't want pain medication. And she would show us how we could respond to their needs efficiently without being overbearing.
I walked in with my first post-op day 2 hip replacement patient, upon initial assesment I realized this woman was in more pain than she let on. She stated a level "5" out of ten and said that she didn't think she needed pain medicine just yet. She'll "hold out" for a while. I told my instructor this and here is what I observed.
The instructor wobbled herself into the patients room with a chair to sit on while she talked with my patient. She talked a bit about the weather and shared a couple of her PG13 jokes to gain the patient's rapport. After this she says, "I understand you just had surgery two days ago."
Patient says, "yes, I did.....It was quite painful."
Instructor inquires, "When is the last time you took pain medicine?"
Patient, "About six hours ago." (It was really eight)
Intructor, "I understand you said you were at a level five pain. I'll have Melissa bring you two Percocet for your pain before you get out of bed today. That way you will be more comfortable throughout the day."
Patient says, "Well, if you think it would be a good idea, then, okay. I'll take the medicine."
We walked out of the room and my Instructor turned to me and said that she has never had anyone refuse pain medicine, especially if she could tell that they really needed it. Then she said what she always said, "Use your best judgement!"
While we do struggle with patients who are drug addicts, we do have to realize that these patients can be in pain too. IMHO, I would rather give a patient the pain medication and observe them for adverse signs, than to have someone report me for not taking care of their pain management needs.
Use your best judgement!!!
May 17, '03The pain scales that we use in practice are intended to be tools. Just asking a patient to rate their pain by simply using a numerical scale will never give us an accurate and absolute picture of the patients percieved pain. I dont really like using the scales but it is a good place to start. Not only that but now it is required that we use them.
Pain IS what the patient says it is but we need to equip our patients with more than numbers to rate someting so personally experienced. We need to not only do a subjective assessment but also an objective one. I have seen many nurses who ask patients to rate pain on a scale and simply write that number down and move on to the next task. I agree with the nurse who not only documents the number but also documents what the patient is doing and how they are reacting to the reported pain. (cover your butt-thats always a good plan)
Many patients I have spoken to about pain have a fear of the medications that are given in the hospital or they feel they need to be tough and wait it out. I talk to my patients about pain and the medications that are availible to them and the types of pain that each prescribed medication treats best. I have found that when many of my patients feel more in control of their care and thier pain management they are more compliant with taking medications for pain relief and more honest in their assessments of their percieved pain.
"Use your best judgement" is the best advice. It is our job to make the patient as comfortable as possible. If this means we deliver ordered medications, supply comfort measures or reeducate or patients about pain then that is what we do.
May 17, '03hello
not meaning to sound niave, but occasionally even drug addicts may be sick and in pain....just a thought