Pain scale

[webbiedebbie]

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 documented that she said she was a 5 on the scale, but I also documented what she was doing at the time. And yes, I did make sure she knew that a 5 was the worst pain on the scale.

Why can't we go back to just documenting exactly what their pain level is by what they say, what they are doing, and our assessment? If my notes indicate a 5 (worst pain) and I don't document what is really going on with the patient, then I may be omitting information. Then again, a 5 is an oxymoron to how she is behaving with the laughing.

The 5 may be her worst pain, but the face on the scale says it is unbearable. How reliable are these scales?

[rachel h, BSN, RN]

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.

[webbiedebbie]

"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."

I agree with the above quote.

I started this thread...I do give the pain medication. I am not judging the person about their concept of pain. I'm just trying to say that in my notes, the patient is laughing on the phone, but yet their pain level is a 5 (which is supposed to be the most unbearable pain and showing a "face" that is supposed to mean this). Laughing and that "face" do not match.

I would much rather not have the "faces" on the scale. I have always believed in the pain scale and have used it.

[Disablednurse]

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.

[whipping girl in 07, RN]

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.

[lauren RN MSN]

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

[jadednurse]

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!

[dosamigos76, RN]

konni,

Good luck with your surgery. I pray that it will be successful and that your new Doctor will treat you appropriately.

Cheryl

[Disablednurse]

Konni, 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.

[bigred]

We 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!!

[ScarlettRN]

konni, 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.

[er_nurse_tracey]

Now 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.

Tracey

[Disablednurse]

My 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.