Two Big Questions For Pain Experts

Specialties Pain

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If it's assumed that the patient's pain is ALWAYS what they say it there are two major questions that arise. The questions arise because they are real-life situations.

1. A patient has had surgery that isn't expected to be painful. The patient has had 4mg of Dilaudid for pain that is reported as 10. The patient has a goofy grin and says: "I'm going to say that my pain is a 10 because I like pain medicine." (This actually happened)

Do you continue to administer Dilaudid in this situation? Do you take his report of pain at face value? I was advised by my co-workers to send the fellow home and I did so.....He left smiling......Did we do the wrong thing?

2. A patient is close to being in a Dilaudid coma after receiving 10mg of Dilaudid. The patient appears very comfortable and, when awakened, rates his pain at 10. (This actually happened)

Do we have a pain emergency here? (I've seen many situations that are clearly pain emergencies but this one doesn't seem to be a pain emergency.) Can you in good conscience send the patient to the floor with a pain of 10 under these circumstances?

O.k.....I asked more than two questions but the other questions are tied to the main ones.

Specializes in PACU.
So again what are you looking for in your posts about pain, pain scale, definitions of addiction, abuse of prescription meds, and patient care?

I'm looking for a few things. I'm curious about what others think of the pain scale especially experts.

I think it's important to tell the truth about the pain scale so that everyone knows it's limitations and, perhaps, we'll stop having it shoved down our throats.

I'm very interested in talking about over prescription of opioids in order to help get it stopped. People are being greatly harmed by what is going on.

I think that the definition of addiction needs to be agreed upon and it needs to be a workable definition.......Making the definition of addiction meaningless to prevent addicts from feeling bad for being labeled is silly.....When discussing important issues it's important to speak the truth.

I did that......It didn't give me any information that helped with the situations.

Did I do the wrong thing with the patients or not?

You have over thirty years of nursing experience , you need to figure this out. Ask your boss ? Why are you even a nurse in the pacu if you cannot answer questions about YOUR patients .

Specializes in Pediatrics, Emergency, Trauma.
I'm looking for a few things. I'm curious about what others think of the pain scale especially experts. I think it's important to tell the truth about the pain scale so that everyone knows it's limitations and perhaps, we'll stop having it shoved down our throats.[/quote']

I don't think the pain scale is being "shoved down our throats."

There are MANY ways to assess pain; especially in an AAO person; for example:

Descriptive: mild-moderate-severe along with what the pain is-burning, aching, shooting; pressure, etc; whether it is chronic or not

Numerical: classic 1-10 scale

The next step in pain assessment is assessing the patient's acceptable level of pain tolerance.

I'm very interested in talking about over prescription of opioids in order to help get it stopped. People are being greatly harmed by what is going on. I think that the definition of addiction needs to be agreed upon and it needs to be a workable definition.......****Making the definition of addiction meaningless to prevent addicts from feeling bad for being labeled is silly****.....When discussing important issues it's important to speak the truth.

I started this part of your quote because, based on this response from you, it seems that your discussion is based on your personal feelings of pain management versus chronic pain versus drug addiction...

As a nurse who has had pediatric patients in pain management (one case was a doozie-my assessment skills was the parent of the child was a HUGE contributing factor; it was a family dynamic issue of a parental issue with using prescription medications as a coping tool) and have had successful management of patients that had a history of drug misuse and illicit drug use, my first approach was managing the acute pain first; the collaboration of the interdisciplinary team in terms of a stepped approach in maintaining acceptable pain levels; or if in short term management of patient care, part of teaching is having a goal of "acceptable" pain; assessing coping issues and community resources if needed-quick collaboration with case management if needed; regardless of the setting I am in, I can get a good amount of information while discharge planning.

I also do not make the assumption that a surgery "that normally has no pain" would NOT give someone pain; my purpose my standard of care is to look at ALL my patients OBJECTIVELY at all times. :yes:

Specializes in PACU.
Why are you even a nurse in the pacu if you cannot answer questions about YOUR patients .

That shows a really amazing amount of contempt.....I'll try to respond in kind. I'm impressed that you treat your fellow Nurses with that much contempt....

I'm not the one who came up with the idiotic notion that: "the patient's pain is ALWAYS what they say it is".

It's up to the morons who are shoving that notion down our throats to explain to us how to apply it.

I'm far to smart to "think" that the patient's pain is ALWAYS what they say it is......That notion is one that only very stupid people go in for.

Does that help?

Specializes in PACU.
I don't think the pain scale is being "shoved down our throats."

Of course it's being shoved down our throats. Very few nurses who do patient care think it's workable.

There are MANY ways to assess pain; especially in an AAO person; for example:

There are many ways to assess pain but I'm not allowed to use them because the pain scale is is being shoved down my throat.

it seems that your discussion is based on your personal feelings of pain management versus chronic pain versus drug addiction...

My discussion is based on the reality of pain control. My feelings have little to do with it.

my purpose my standard of care is to look at ALL my patients OBJECTIVELY at all times.

I'm with you there......The pain scale is premised on the notion that reports of pain are objective when, in reality, they are subjective.

I'm happy using objective assessments but I'm not happy being forced to pretend that a subjective report of pain is objective.

We must rely on subjective reports of pain because it really is entirely possible to be in severe pain without showing a single objective symptom.

Specializes in PACU.
We must rely on subjective reports of pain because it really is entirely possible to be in severe pain without showing a single objective symptom.

Subjective reports of pain are usually very good guidelines. In some cases the subjective report of pain is completely unreliable....There is no reason to think it's accurate and every reason to think it isn't in some cases.

As a practical matter it's impossible to always use subjective reports of pain even after we receive them. In a perfect world assessing pain would be simpler than it is.

You're right that assessing pain isn't an exact science. We're making educated guesses about how to treat pain. (most medicine is educated guesswork).

Treating pain involves a lot of educated guesswork as well. I've seen really big guys almost stop breathing after very small doses of Fentanyl and sweet little old ladies receive huge amounts of opioids without batting an eye.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

You clearly have issue with the pain scale which involves personal opinion and feelings...otherwise 103 replies, posts, eleven pages, and additional threads, would be enough to discuss this issue.

So it is personal for you.

The pain scale is a tool....like any other tool...it has flaws. Just like when a monitor says V tach....doesn't mean you should automatically call a code for I have seen beautiful V.Tach on a patient brushing their teeth.

It requires nursing judgement, education and skill to utilize the tool as optimal as possible.

Specializes in PACU.
You clearly have issue with the pain scale which involves personal opinion and feelings...

Everyone has feelings about everything they are involved with but that's not the point.

The point is that forcing us to use the pain scale on all patients is bad patient care. Assessing pain is too individualized for it to work on everyone.

The pain scale is a tool..

It is a tool. The thing is that in many cases we're being forced to use the wrong tool......We're being forced to use a hammer when a hammer won't work.

So it is personal for you.

I really like using the pain scale when it works......I have very warm feelings for the pain scale under certain circumstances.

It's completely irrational to use the pain scale on many patients though and it doesn't make sense to force us to use irrational methods.

Specializes in PACU.
Just like when a monitor says V tach....doesn't mean you should automatically call a code for I have seen beautiful V.Tach on a patient brushing their teeth.

I have seen that too.......I once ran down to a patient's room at top speed (in my younger days) due to a perfect V-Tach waveform, saw the patient brushing their teeth, and said "good morning".

Back to the tool metaphor for a second.

I have a Bass that I love to play. It gives me warm rich tones and is amazingly punchy as well when I want it to be. It's got a nice fast neck and feels really good in my hands.

My bass is a tool that I have a great love for.

If I was told to play a song using only minor 7th chords with high bell-like tone I wouldn't want to use my beloved bass......I'd want to borrow a guitar.

The pain scale policy forces us to use the wrong tool in many cases.

That shows a really amazing amount of contempt.....I'll try to respond in kind. I'm impressed that you treat your fellow Nurses with that much contempt....

I'm not the one who came up with the idiotic notion that: "the patient's pain is ALWAYS what they say it is".

It's up to the morons who are shoving that notion down our throats to explain to us how to apply it.

I'm far to smart to "think" that the patient's pain is ALWAYS what they say it is......That notion is one that only very stupid people go in for.

Does that help?

As I mentioned earlier I was weary when you first called pain management "experts" extremely ignorant among other things and then turned around and started asking "experts" about advice how to manage two patients that had most relevant data missing, such as SBAR information that nurses usually report. Pretty much all we were told were the amound of Dilaudid onboard and their self-reported pain level. The question was asked in such a manner it made me feel that you had a specific response in mind. At the time it seemed to me that you had an agenda rather than just the usual asking fellow nurses "how should I have handled this scenario"? If I'm wrong about this, I apologize.

The post I've quoted shows a large amount of disdain towards nurses who utilize patients self-reported pain scales. Morons. Very stupid people. Really?

At the same time I find this post rather refreshing. To me it has a ring of honesty. I much prefer an honest opinion to what I interpreted as a disingenuous request for answers from a group you clearly have no respect for.

I am one of the very stupid ones. (Along with most of my co-workers, I might add. There seems to be an abundance of idiocy in my workplace). I actually think that pain scales work. It's not the perfect method. It doesn't mean that people never lie about their pain.

People might lie about their pain. The things is, vital signs might also "lie". Pain presents differently in different people and in different circumstances. Normal heart rate and blood pressure does not preclude the presence of pain. Not even seemingly resting comfortably automatically means the absence of pain.

Accepting that pain is what the patient reports doesn't mean that you think that a patient never lies. It does however mean that there is a better chance for the patient experiencing pain to receive adequate treatment as opposed to a scenario where the patient isn't listened to and the judgement to medicate/treat is solely based on another person's interpretation. To me that approach is paternalistic and I do believe that many patients in the past and probably in the present have suffered because of it.

Specializes in PACU.
when you first called pain management "experts" extremely ignorant

Anyone who "thinks" that: "the patient's pain is ALWAYS what they say it is" is, by definition, ignorant. It's extremely obvious that the patient's pain isn't always what they say it is.

The post I've quoted shows a large amount of disdain towards nurses who utilize patients self-reported pain scales.

That's not at all true. I've said many times here that pain scales work quite well in most cases.

Pain scales don't work at all in some cases though.....The "ALWAYS" bit makes for extreme stupidity.

It's not the perfect method. It doesn't mean that people never lie about their pain.

If you don't think that the pain is ALWAYS what the patient says it is then we agree.

There are, in fact, some patients who have reports of pain on the pain scale that have nothing to do with their level of pain.

Pretending that the pain scale ALWAYS works perfectly is idiotic and that is exactly what is being crammed down our throats.

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