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?

[jtmarcy12, BSN, RN]

Pain is whatever the patient says it is!! I feel we as nurses just cannot judge someone about their pain. I would work my unit and my patients would ask for pain medicine and I would see them lying in bed and there were times I wanted to kick them out of that bed and I wanted to lay in bed and get the pain medicine, myback pain was a 9/10 and I was working, smiling, moving along, no one knew because I kept it to myself. So I never judge someone if they say their pain is a 10/10 I medicate if there is an order, I don't care if they are dancing and they say their pain is a 10/10 I will medicate.

[I love my cat!]

I think the main problem is that many people are forgetting that the Pain Scale is 100% subjective.

It's human nature to apply our personal interpretation of what a 2, 5 or 10 pain level is and when the patients doesn't fit into our mold of how someone should be acting or what they should be saying with that stated level, sadly, many don't believe them.

I am always puzzled why so many Nurses really care if the patient wants a pain pill. Over the many years I have been practicing, I have seen Nurses wasting so much time with patients, squabbling and debating about their pain medication.

Who cares?

[lxpatterson]

I think the main problem is that many people are forgetting that the Pain Scale is 100% subjective.

It's human nature to apply our personal interpretation of what a 2, 5 or 10 pain level is and when the patients doesn't fit into our mold of how someone should be acting or what they should be saying with that stated level, sadly, many don't believe them.

I am always puzzled why so many Nurses really care if the patient wants a pain pill. Over the many years I have been practicing, I have seen Nurses wasting so much time with patients, squabbling and debating about their pain medication.

Who cares?

That's ridiculous. If we are simply dispensing medications because patients want them then we might as well give them a key to the pyxis and let them help themselves. The reason we don't do that is NOT just because of overdose, it's because like all medications, analgesics have a slew of other unintended effects, many of them unhelpful.

In this milleu of "client-centered care" we might hesitate to practice "paternalism", but we are really not benefiting patients if we are not providing them with judgement and guidance.

If I have a patient who is a nurse struggling with bone mets, I'm going to give her the full menu of palliation options and she can tell me exactly what she wants and when she wants it. If I have a 16-year old patient with cholecystitis who is chatting with a friend in the room with no diaphoresis or physical signs of stress telling me she has 10/10 pain and wants medication for that, I'm going to inquire further. I wouldn't say this person is drug-seeker, but more likely she isn't communicating her discomfort well and it's to her benefit that I find out what she is really feeling rather than shoving hydromorph in her vein.

That's common sense.

[LadyFree28, BSN, LPN, RN]

In this milleu of "client-centered care" we might hesitate to practice "paternalism", but we are really not benefiting patients if we are not providing them with judgement and guidance.

I would tread lightly on "paternalistic"...

When I am in the pt realm, with chronic health issues, I KNOW what's best for my pain relief; I don't need JUDGEMENT; I need the nurse-pt relationship to be built on enough trust that I can be comfortable, not someone preaching to me that what I have is "enough" when I have breakthrough pain and need something else...

I had to enlighten a nurse with this same attitude after a traumatic incident; I came out of surgery and had migraines after that; no, morphine wasn't going to touch it, but the Dilaudid sure did; and when needed, the Toradol did the trick as well.

[dudette10, MSN, RN]

Please everone, remember that the pain scale mentioned here is asking the PATIENT to compare this pain with the greatest they have ever felt in the past. If this current pain is the greatest then it is a 10. It might seem like a 5 to you, but that was not the question. We ask, "on a scale of 0 to 10, with 10 being the worst pain you have ever felt, how do your rate your pain now?". The scale is highly subjective, but nurses like objective statements. The real point is, no matter what the number, it only serves to help you evaluate whether or not your intervention is working. If the number goes down after an intervention, then it is working. The number itself has no real meaning - it is only a scale and not an absolute description. Don't relate the number to your own experiences, just the patient's

Excellent response. I'd also like to add that the subjectivity of it makes how you present reassessment questions important. I've had patients say their pain is better, but then give me the same pain rating as before. I've learned to say instead, "Your pain before I gave you [insert pain med name here] about an hour ago was an 8/10. What is it now?"

[I love my cat!]

That's ridiculous. If we are simply dispensing medications because patients want them then we might as well give them a key to the pyxis and let them help themselves. The reason we don't do that is NOT just because of overdose, it's because like all medications, analgesics have a slew of other unintended effects, many of them unhelpful.

In this milleu of "client-centered care" we might hesitate to practice "paternalism", but we are really not benefiting patients if we are not providing them with judgement and guidance.

If I have a patient who is a nurse struggling with bone mets, I'm going to give her the full menu of palliation options and she can tell me exactly what she wants and when she wants it. If I have a 16-year old patient with cholecystitis who is chatting with a friend in the room with no diaphoresis or physical signs of stress telling me she has 10/10 pain and wants medication for that, I'm going to inquire further. I wouldn't say this person is drug-seeker, but more likely she isn't communicating her discomfort well and it's to her benefit that I find out what she is really feeling rather than shoving hydromorph in her vein.

That's common sense.

You're right! Everything you just said is common sense and everything I wrote was ridiculous.

But, I am sticking to what I said before. I believe the patient and if they have a MD order for pain meds and they need them, they are going to get them. I don't have time to squabble and fight with a patient over a 5 mg vicodin.

[suanna]

As we all know, pain is the 5th VS- assessed with every interaction, as important as pulse or BP. Considering how important this is, as a part of promoting good patient understanding and patient centered education, I'm going to start my rounds by dropping a goodly dollop of Potassium Chloride IV solution mixed with a little alcohol from a swab into my patients open eye. I can then say "That was a 9 and1/2 on the 1-10 pain scale- what number would you give your pain now" and feel sure that we are using the same units to measure thier pain.

Seriously- I never use the 1-10 scale. It's useless. I prefer a behavior based pain assessment tool. I don't know if I've ever had a "10" on the 1-10 scale myself. Having my SI joints injected is a possibility- mostly because I didn't know how much worse it was going to get or how long it was going to last. I had alveloar osteitis after a tooth extraction that the oral surgeon felt poking a sharp stick with betadine on it, every day, onto the raw exposed nerves was the most effective treatment.(no topical first).- That was pretty close to a 10 in my book.

[caughtbuckinoff]

I don't know. I have a great ability to forget pain shortly after it happens.

I got kicked in the knee by a horse. Separated my knee cap. It hurt A LOT, but it was super sharp, super fast, and that screaming pain ended in a minute or two. Still hurt for a long time while it healed but compared to the initial kick, it was nothing.

I cut the ends of two of my fingers off. That part didn't hurt, too sharp a knife. Taking the bandaid the ER nurse put on my finger (dry bandaid, mind you) hurt really badly. You know, kind of felt like a flaying. Again, really sharp, really fast.

Broke my nose twice. Doesn't hurt as much as I expected it would.

I would imagine childbirth could put anything I've ever experienced to shame though.

I work on an orthopedic floor. Some of those traumatic injuries, OUCH.

[applesxoranges, BSN, RN]

The best way to ask a pain scale seems to include a "10 is if you were shot or stabbed." I personally never added that bit on it but wow, the people who he triaged went from 10/10 to 3/10 or so on. Our crowd is a little rough around the edges.

[suanna]

Please don't misunderstand my previous post to indicate I don't believe or treat my patients "10 out of 10" pain when they ask for it. I just translate the "my pain is a 10" to " My pain is bad and I'm afraid of it getting worse- I don't want to give you, my nurse, any excuse not to treat it to the fullest amount you can- so my pain is as bad as it needs to be for you to medicate me!"

[Anna Flaxis, BSN, RN]

Sometimes you have to judge whether someone's 10/10 pain is *really* 10/10 pain. Ever do triage in a busy ED? Is the person complaining of 10/10 pain while texting and eating potato chips who you would *really* give your last bed to?

Anyway, I've given birth twice with no pain meds. I'd rate those experiences my 10/10 pain.

[ComeTogether, LPN]

I've been in 10/10, but only for moments, directly after an injury. (dislocated my knee while turning) shortly thereafter it became a 6/10. I've experienced 8/10 back pain, but only while moving....etc.

I've also had several different types of pain. Oral pain, IMO, is just the worst. I can't tolerate it nearly as well as I can tolerate post surgical pain. IMO, pain is extremely subjective and everyone has a different threshold of tolerance. I had to bring my husband to the ER for pain relief during a migraine episode, he was vomiting the entire way, etc. I've never seen him like that, it was so scary. I knew there wasn't anything they could do other than offer pain relief, but I wanted him to have it so he could simply rest. I am so glad the Dr's and Nurses took his 8/10 at face value. They gave him dilaudid, which I wasn't expecting, but was so grateful to see him get some relief. That being said, he was complaining how bad a paper cut on his tongue hurt while I was recovering from having my gums cauterized..... ha!

So yeah, I think pain is different for each person. I've had patients flat out tell me (when asking pain number for the nurse) "I'm saying 6 so I get xxx drug instead of tramadol" I've also had to beg a double amputee to ask for pain relief when he needs it. *shrugs* So many things factor into it, I can't imagine not assuming it is what they say it is, not that anyone is saying they do that. All that matters is that's how it feels to them.