Describe your 10/10 pain. Piggybacking off of recent pain discussions.

[0.adamantite]

I have felt 10/10 pain. I had a medical procedure that was incredibly painful, awake and unmedicated. Being a nurse, I wanted to be tough. I closed my eyes, gripped the table, moaned, clenchedd my teeth, every muscle in my body tensed and had "tunnel vision" if I opened my eyes. Sounds also seemed distorted. All I could focus on was the horrific pain. As the nurses and doctor asked me questions I could only get out one-word answers.

When the procedure was over, they encouraged me to rest, but I wanted to be tough. So I got up and had a vasovagal response to the pain. My blood pressure dropped, my hands and feet went cold yet my core felt like I was feverish. I was so pale my lips were ghostly white. I got dizzy and felt as close to blacking out as I have ever been in my life. I was rushed back to bed and had to remain for extra time to recover.

I know everyone reacts differently to pain, but when someone says their finger pain is 10/10, while sitting upright calmly in bed, it makes me wonder. But then again, I am not someone used to pain. Do you think people misunderstand the pain scale? Do you think the 10/10 is over used?

[martymoose, BSN, RN]

That can happen if the pt is getting the wrong type of analgesic for his type of pain. For e.g., opioids for neuropathic pain can be ineff. So yes, it's entirely

poss. for a pt to be zonked and still be in extreme pain.

I find some of the posts of "My pain was really 10/10, but that pt pain wasn't." If a pt says he has pain and he can have something, just save the judge mental attitudes and medicate him. If you think something seems wrong, do some research about his condition and what would be the best pain regimen for him.

True- but this pt specifically asked for dilaudid 4mg iv. Was offered other things, but refused them.

[Alisonisayoshi, LVN]

Pancreatitis with necrosis. Pain was 10/10 and really, until they put me on the PCA it stayed there. I was weak, screaming, eyes shut tight, delusional, and strangely cold all over. That was my first brush with pancreatitis, but as the years have worn on, every once in a great while, as a result of my distal panc I have a horrible bout of chronic pancreatitis. The pain remains 10/10 when it strikes, but my ability to talk, move, distract with a book, has changed. I am not a screaming puddle in a hospital gown, I'm actually pretty darn normal. It hurts, but I've learned how to handle it in a different way. I often ask for very low dose meds because I'd prefer not to be snowed.

[Mandychelle79, ASN, RN]

My worst pain in my life was my first gall bladder attack. It was enough pain that I was willing to go to an ER on a holiday weekend. I think I rated it at a constant 6 that would flare to a 8-9. Though I have found saying Id rather give birth without an epidural again gets more attention than actually rating my pain.

[trishmsn]

In my life, the 10/10 pain has only happened twice, thanks be to the Lord!

First was an induced and unmedicated labor with the Pit accidently set at 10X the ordered (and normal) dose. Did not know how close I had been to a ruptured uterus until seven years later, when nursing school enabled me to read that chart! (Thirteen months after baby #1, I had a totally mellow delivery of a 10+ lb kid, despite back labor. I was a certified 41w6d, but would not let them get near me with Pit...growwwwwlllllll....!)

A kidney stone was the second episode, but it was a blessing in disguise. The flat-plate x-rays done at the ED that night picked up on a 12 cm ovarian mass. I had a TAH/BSO 9 days later, with all the dysplasia still in situ. It would otherwise have gone unnoticed in my obese abdomen with a huge pannus (see 10 lb kid above!) until I had mets and died. To live, I'll take a few hours of 10/10.

[OCNRN63, RN]

True- but this pt specifically asked for dilaudid 4mg iv. Was offered other things, but refused them.

I have no problem with a patient saying what works for him/her. Ultimately, it's up to the attending when it comes to what's ordered.

[Kyrshamarks, BSN, RN]

From personal experience with sever pain, a person can be snowed and still have 10/10 pain. I once got a total of 40 mg morphine over a 3 hour period. Alot I inow and I was flying twenty feet off the bed but the pain was still there just as intense. The nurse refused to call the doc and get something different ordered becasue i her words with that much morphine I could not be in pain. Thankfully her shift ended an hour later, that dayshift nurse came in, I am stikll flyiong high but she took one look at my face and said you are still in pain. She called the doc, got a dilaudid 2mg order and that stopped the poain completely for 13 hours for me. Morphine did zilch other than make me stoned. So next time they say 10/10 even though they look stoned they may still have pain.

sorry about the typos. 2 am posting on a phone with fat fingers.

[delphine22]

When I admit a pt, I explain to them the pain scale, that we use it to describe pain and objectively rate if our interventions are effective. I tell them the scale is 0 to 10, and give extra descriptors such as this:

0 is no pain at all.

2 is very mild pain, slightly annoying, like a small itch

4 is pain that you forget about if there's something good on TV

6 is harder to distract you from; TV won't do it

7 you find it hard to concentrate

8 you can't really carry on a conversation

9 you are openly crying

10 you would literally rather be dead than feel that way.

This cuts the people off who want to yawn and eat cheeseburgers and say they are 10/10. Keep in mind I am talking about ACUTE pain, not chronic pain, we are here to manage the acute. My husband has chronic pain and shows it so little sometimes I am surprised when he tells me how much pain he is in, but I know it's true. But like it or not there are a lot of drug seekers around, or people who just need education, and that's what I'm trying to do.

[musingmom]

I like the way the hospital managed pain where I just finished my preceptorship. A pain assessment included a question about what number was a tolerable number for the client. That's also subjective, some folks will say I want zero pain and others with say I am ok with a 4, but after that I want meds... I even saw one chart that said acceptable level was 8/10.

I think one of the reasons people may overstate their pain is because they are afraid if they say 5/10 no one will do anything. A different hospital I interned at before nursing school instructed us to alert the nurse for any pain rating over 6/10. If you wanted to be offered your PRN, you had better know to say a number over 6/10!

[OCNRN63, RN]

[Cricket183, BSN, RN]

I think the pain scale is very misunderstood not only by patients but also by those of us in healthcare. I think we get too hung up on the number. I know we have to have a way to "quantify" someone's pain and whether or not our interventions are effective but it just seems like there has to be a better way of doing it. That said, I have no idea what that is.

Pain is a very personal, subjective experience. I have RSD/CRPS. I only thought I knew what pain was! Prior to contracting RSD, I would have said a "10" pain was having back labor and then giving birth to a 9+lb. baby completely natural. Now I would rate that experience about a "5". When I experience a "10" now, I am vomiting, contemplating suicide, and have even passed out. Unfortunately, I have experienced this level of pain multiple times. Just a few examples, (1)Having surgery to repair a torn labrum in my RSD-affected shoulder and subsequent physical therapy after that shoulder froze. (2)A pain crisis after working three 12-hour shifts in a row that caused my RSD to flare and spread. At the time, I was not able to take any type of pain medication because of a No Narcotic Policy at the hospital I worked for. I ended up in the ER and then was admitted to the hospital on a PCA-Morphine. (Ironically, that is also the point I was forced to go on permanent disability.)

I live in constant pain. On a typical day my pain is at a constant "5-6". When I am in a flare my pain will be a "8-9". Even on a good day my pain is a "3-4". To look at me one would be hard pressed to know I am in pain. I tend to be very stoic and rarely complain. My husband can usually tell when I am having a bad day (he says my eyes give me away) but anyone else would be unaware.

I really liked what musingmom mentioned about the hospital that had a pain assessment which included a question about what pain level was acceptable to the patient. For me a "5-6" is okay, whereas someone else might require medication at that point.

[lxpatterson]

I have a background in research with chronic pain and psychophysics prior to entering clinical practice as a nurse. Many of you, from your clinical experience, astutely picked out the fact that all of us rate and communicate pain experiences differently depending on our past experiences with pain. While wise nurses have probably known this for as long as the profession has existed, academic psychologists have only started looking deeply into this phenomenon within the last 20-30 years. They like to describe it in these terms: every person has a different "sensory world".

Here is a well-written and concise article looking at the question of how to rate pain (Elsevier). The most important takeaway for clinicians that I can emphasize is that you must anchor the "10" for patients with the phrase "worst IMAGINABLE pain or sensation". The key being that the my "worst imaginable" pain is probably somewhat similar to your "worst imaginable" pain; my "worst experienced" pain is unlikely the same as your "worst experienced" pain. Doing this will bring you closer to some kind of absolute measure of pain that is comparable between patients, where you can say, "hmm 7 is pretty bad, maybe we can consider Dilaudid..."

But as you can know, it's never that easy clinically, and we all know that pain is not only physical (ie. noicioceptive) but also has a other components like psychological, existential, etc. Even with the best pain scales we still have narc seekers and "tough guy" patients who refuse to complain of pain. That's why our best pain assessment is still our clinical judgement, to look for physiological signs like diaphoresis and behavioural signs like agitation and guarding. And that's why nursing can never be replaced by webMD or some other automated process.

[MrChicagoRN, RN]

My 10/10 was back labor. I had terrible back labor. I couldn't feel the contractions just pressure on my back. I seriously thought that my son was trying to come out my back. I was also induced and was not able to get an epidural. I went from 35.-10 in under an hour so I was not able to get the meds.

I just medicate my pt appropriately. If they are saying 10/10 I give what I can, have them rate later. I agree with Rubyvee that the pain scale doesn't always make sense to people either.

No, go, it doesn't always make sense, and sometimes we add to the confusion by not adding a frame of reference. Just asking someone to rate their pain without a point of reference is like looking out the window of a moving vehicle (econo-car, luxury car, train, low flying plane, high flying plane) and asking them to accurately define the speed.

i say something "like 0-1 is little or no pain, 5 is moderate, and 10 is the worst pain imaginable, and might even feel like you'd just as soon die."

That way they can describe their subjective pain is measured against an objective scale.