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?

[Flynurse]

Of 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!!!

[Mahema]

The 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.

[ymmatmullo]

hello

not meaning to sound niave, but occasionally even drug addicts may be sick and in pain....just a thought

[RN2007]

KaroSnow Queen, I am very surprised that the ER dr. gave your husband prescription "pain pills, shot, etc." instead of having him first try "conservative methods" such as Advil and ice/heat prn, lol... I say this because a few years ago when I waited many months to finally go to a dr. for severe back pain, that is the way my family physician treated me, and it took me well over 8 months of exhausting their conservative care without ANY Relief, before any dr. would give me any type RX pain pills, etc. In the end, I had to have a fusion / laminectomey of L3-5 and today, still take a very low level of meds to help with pain since the operation did not prove to be a success. And, in the beginning, I went to at least 3 different orthopaedic drs., neurosurgeons, physical therapist for 1 yr on and off, and a chiropractor, of which all of them talked about me going the "conservative route" by exhausting OTC type meds like Advil, ibuprofen, etc. along with an occasional epidureal steroid injection. So, I am glad to see drs. changing some these days and noticing that your husband was in enough pain to give him RX pain meds that probably worked better. And, like you, I have found the 10 pt. pain scale to help me assess my own pain and think it would help others as well. Take Care....April

[hogan4736, BSN, RN]

a definite problem: I have a 21 year old friend that was rear-ended on the freeway. Was c-spined by medics and taken to the ER. She was released after xrays and diagnosed w/ only cervical bruising, and sent home w/ RXs for 30 oxycontin and 30 percocet.

ARE YOU KIDDING ME??? 30 OXYCONTINS???

Not so long ago this med was used for mainly hospice, and now it's first line out of the ED???????????

CRAZY!!!!

This drug is legal heroin. I'm not saying it should never be used. But my friend had no idea what it was. I mean people end up addicted this way.

I have done work in addiction medicine. A thorough history should be done before giving these meds. I beleive in an addiction gene. What if her dad was a heroin addict or an alcoholic. She now has a greater chance of becoming addicted to the oxycontin or percocet after just a few pills.

I had a patient who was a recovering IV heroin addict on methadone (not the best plan, but it can work). anyway, he had developed bronchitis. His PCP (who knew of his history) prescribed him phenergan w/ codeine and vicodin for his cough. OH MY GOD!!!!!!!!!!!!!!!!! Can you say gateway back into heroin?

Another problem: Many pt's w/ C.F.I.D.S. and Fibromyalgia are taking upwards of 160 oxycontins/month. Some show up in the ER because they had breakthrough pain x2 during the month and took a couple extras. Now on a Friday they want 10 for the weekend. What would you do as the ER doc? (his primary isn't on call and the on call doc doesn't know this pt)

The answers aren't easy....

But...

when you as a chronic pain patient (reapeatedly, monthly) don't have the foresight to call your primary on a wednesday WHEN YOU CAN SEE THAT YOU ARE GETTING LOW, and have been on this med for years, to get a refill, then show up at midnight in the ER on a friday demanding your oxys or percs, don't look my way for sympathy.

harsh?

yes...

but all i ask is that you manage your disease responsibly, not through the ER every month...

are all chronic pain sufferers coming to the ERs?

absoultely not!!

I feel for you. I have had 3 knee surgeries, and am bone on bone in my left knee. BUT, I would NEVER, NEVER go to the ER if I ran out of my vikes or percs!