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

Nurses General Nursing

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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?

Specializes in ER, TRAUMA, MED-SURG.
Pain is subjective. They could have a very low tolerance or that could be the worst pain they've ever been in or they could be trying to keep it contained. Some people will resist the urge to cry or make it obvious because it'd make the pain worse if they acknowledged it (good in theory maybe). I'd considered my labor (before the epidural) as 10/10 until I high-sided my motorcycle and had a 3x4" road rash on my right knee (which was also sprained, along with my ankle) and a huge 8x10" road rash on my right side. The 10/10 pain came when they were cleaning my wounds in the ER--that far exceeded any labor pains I'd experienced!

Oh that hurts just thinking about it!

Anne, RNC

Specializes in peds, allergy-asthma, ob/gyn office.

My unmedicated first delivery. (which was not my choice!) I was in so much pain I did not talk, other than maybe one-word answers to questions. It was all I could do to breath through the ctx. There was no breath for even crying or screaming. Since then, I have never understood how women could do those things in labor! Second delivery... until the epi was on board... and i had ctx q 2 mins for the hour-long car ride... I did utter "ow" almost like a chant. yeh, 10/10 pain is not relaxing and watching your favorite tv show in bed.

Specializes in Oncology; medical specialty website.
I think too many nurses have seen patients complaining of 10/10 abdominal pain while devouring a bucket of fried chicken, or 10/10 post op pain while sitting watching TV, texting friends and laughing loud enough to rouse the nearly dead patient next door. I've seen it, you've seen it. We've all seen it. I also remember being so exhausted I could sleep with 8/10 pain after my cancer surgery . . . and being ever so grateful to the nurses who took me at my word that the pain was 8/10 and gave me dilaudid. Sometimes, it takes wisdom to know the difference between the two, and sometimes all it takes is eyes.

Certainly, but I have seen one too many who are adamant that if you are sleeping, you absolutely cannot be in pain.

I have this weird tendency to incorporate pain into my dreams when I'm sleeping. For e.g., I was sleeping and started to develop a migraine. I dreamed that I was being attacked, and my attacker was beating me on the head. I woke up with a full-blown migraine. And last week when I was in the hospital, the same thing happened (different sort of pain). I mentioned this to the pain specialist that mentored me, and she said she had never heard of that happening before.

Figures...I'm even weird when I'm asleep.

I've never had a patient ask for food/be munching on fast-food while c/o 10/10 pain, but I did have one who requested a sandwich and chips c a CC of N/V. "But if you give me something for the nausea, I won't get sick!"

Me: o_O

Specializes in long term care.

I work in a nursing home--many years ago, had a lady (probably in her 60s) who constantly sought narcotic pain relief. Her all-over pain was always calmly described by her as a "10". One time the CMA was in her room and she requested a PRN pain pill for "terrible pain" rated at a "10". The CMA went out the door to the med-cart (parked right outside the patient's door) to note the MAR and get her med out of the lock-box. Overheard by the CMA was the patient's elderly roommate saying "I'm sorry you're having so much pain, dear!" Also overheard was the patient's hushed reply to her roommate: "I'm not in pain-I just like my happy pills".

Yes, pain is whatever the patient says it is and should be treated, but there ARE those few people who will play you, too!

Specializes in Medical-Surgical - Care of adults.

I've scanned all of the responses and not seen this -- so, please remember that the "pain scale" was developed as a research tool and was NEVER intended as a clinical tool. In general, it's pretty useless except as a way to see if the patient is satisfied with his/her pain relief. Many patients I've seen, regardless of the explanations they've received, do not understand the pain scale concept. I remember one elderly woman whose pain was always a 10 no matter when she was asked and no matter what pain medication she received. She slept well all night after acetaminophen for her pain and would be snowed for hours after 5 mg of hydrocodone during the day. We gave her acetaminophen and watched for behavioral clues for indications that she might need more than that.

I remember a patient in a sickle cell crisis -- I wanted to do more for her but couldn't get more medication ordered -- I didn't care that she was watching TV, talking on the phone, fooling with her hairdo, etc. -- I was working a double, I knew from the report from the day shift nurse that she had not slept during the day; I knew she hadn't slept during the evening shift, because I was there; it was 3 a.m. and she still hadn't slept. I KNEW the amount of dilaudid she was getting wasn't enough -- but couldn't get more for her.

I have once in my career given a pain medication to a person who denied needing it -- I was very young and it was in the early 1970s -- the man had been injured in a car wreck and was lying absolutely still in his bed -- too still -- I offered pain medication and he refused. I waited a while, then prepared the demerol and phenergan (remember, the 1970s) and took it to him saying "The doctor wants you to have this shot." I gave the injection, came back in an hour and said "How do you feel?" -- he said "Much better" -- I said "Easier to breathe?" -- he said "Yes" -- and I said "That's why you need to take your pain medications -- so you can breathe and move a little so you can recover" -- he agreed to ask for his pain meds in the future.

Pain IS subjective -- I prefer having it ordered as X for mild pain, Y for moderate pain, and Z for pain not relieved by Y -- for the initial order -- then nursing judgment based on prior responses. The exception is probably a person who is hospitalized who has excellent reasons to know what works or doesn't -- I remember being in the hospital over night after a surgery and the nurse refusing to give me a second Percocet because the naproxen she'd given would relieve the pain and I wouldn't need the second Percocet. I'd been living in this particular body for over 50 years at that time -- and had enough experience to know that my metabolism wasn't going to get settled for post-op pain by the one Percocet -- regardless of the anti-inflammatory effects of the naproxen. It's very frustrating to be on the receiving end of someone who thinks they know me better than I know me.

I'd advise discussing pain meds with patients as needed and as appropriate. If someone seems "over medicated" discuss the hazards of that, if possible (based on the patient and the situation) and see if the patient will modify the requests for pain medication as needed. Try never to assume you know what's going on with a patient -- be willing to learn from the patient -- and convey your caring. Remember the Golden Rule -- Do unto others as you would have them do unto you" and remember that what YOU almost certainly want is a good assessment and then care based on the results of that assessment. Try only to give care based on what you think the person might want/need when the person really can't or won't tell you what that is.

My favorite is when you ask a pt to rate their pain on a scale of 1-10, blah, blah, blah......and your answer is: "not bad"!

We need a number people!!!

Specializes in PCCN.
My favorite is when you ask a pt to rate their pain on a scale of 1-10, blah, blah, blah......and your answer is: "not bad"!

We need a number people!!!

That's why I like pain-ad or faces scale. Most elderly don't get what I mean by a number on the scale.

Specializes in Med-Surg.

delphine22, I agree that verbal description can be helpful with the pain number rating system. I've heard so many patients say they just don't know what number to say. Where did you get you verbal descriptions? Are they a particular standard?

ive been working with some returning veterans who are using a multi image and verbal description scale. It's from the the Defense and Veterans Center for Integrative Pain Management

(dvcipm.org. The pain rating scale listed under the Clinical Resources tab, as well as others.)

This is getting favorable reviews by my hospital, and is beefing considered as an additional pain assessment tool.

Specializes in Med-Surg.

Also, does anyone know how to post the image of the dvcipm.org pain rating tool here. I didn't know how to attach it to my above post.

thanks.

Specializes in PCCN.

ill give it a go....

sorry if it's too big.......

DVPRSv20.jpg

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

I like the behavioral pain scale, even for verbal patients. Especially for verbal patients who exaggerate their pain because they like their "happy pills." If a person is relaxed and smiling, clearly their pain isn't the focus of their existance. Someone who is writhing, grimacing and crying needs more Dilaudid. Or something.

Specializes in Psych.
Certainly, but I have seen one too many who are adamant that if you are sleeping, you absolutely cannot be in pain.

I have this weird tendency to incorporate pain into my dreams when I'm sleeping. For e.g., I was sleeping and started to develop a migraine. I dreamed that I was being attacked, and my attacker was beating me on the head. I woke up with a full-blown migraine. And last week when I was in the hospital, the same thing happened (different sort of pain). I mentioned this to the pain specialist that mentored me, and she said she had never heard of that happening before.

Figures...I'm even weird when I'm asleep.

I've never had a patient ask for food/be munching on fast-food while c/o 10/10 pain, but I did have one who requested a sandwich and chips c a CC of N/V. "But if you give me something for the nausea, I won't get sick!"

Me: o_O

I do the same thing, with one of my gall bladder attacks ( that start out like the worlds worst indigestion) I dreamed that I stole a patients medication out of the accudose... what did i steal, not the morphine, not the norco, nah, i stole their maalox.

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