pain management

  1. How do you guys carry out effective pain management? They tell us in school that a pt is in pain when they say they are in pain. Now sometimes I find it difficult to believe someone when they say they are hurting on a scale of 10/10 and are talking on the phone and laughing and after administering the medication, they remind you that they will see you again in four hours when the next one is due. Now I give it just because it is ordered that way but I have a problem with it sometimes. What do you guys think?
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    About tobias fonge

    Joined: Sep '01; Posts: 9


  3. by   sharann
    You learned correctly in school. Pain is what the pt says it is, when they say it is, whether or not you or I agree. While it may be difficult to believe a pt who is talking or laughing etc... about being in pain, it is not for us to judge. We cannot physically or scientifically measure pain (even thouh it is the 5th vs). Our task is to document it. Hhaven't you ever seen a person writhing in distress, high BP and pulse,sweaty...and the say the have "a little discomfort" ?
    I would rather medicate a pt who doesn't "need" it than not medicate one who does because I took it upon myself to decide I know whats best. I also suggest you research some of Margo Mcaffery's articles on pain myths and management. She is truly amazing!
    Hope this helps,
  4. by   P_RN
    Sharann said it all.

    Here is another discussion re: pain meds
    Last edit by P_RN on Sep 14, '01
  5. by   NRSKarenRN
    Concur withSharann 100%. Also, be sure everyone on the unit uses the same pain scale each time with your client for consistency sake. I use the Wong face scale with numbers underneath 0-5 scale in home well with cognitively impaired persons and older clients.
  6. by   night owl

    I too have difficulty SOMETIMES with some who say they are in pain especially #10 pain, but I've learned that it's better to medicate than not to and I always document their behavior before and after their medication. It's usually the ones who ARE addicted that have the biggest mouths and are the nastiest about receiving any dose, but who am I to judge? You can always give him the old "BRICK" theory to explain what a #10 pain actually feels like, and I'm sure he will have a rapid change in pain level...Only kidding of course...
  7. by   frustratedRN
    dont even worry about it. its true what they taught you in school.
    just give them the medication as it is ordered when they ask for it.
    next time this happens to you...and it will...just ask yourself one question.....
    why do i care?

    you have an order for it. the doc most likely knows whats up. he doesnt care....why should you?

    this used to annoy me too but i have changed my attitude.
    even if they are drug seeking and where i work that would be a good what? they arent hurting anyone but themselves...and well you if its ordered frequently.

    sometimes i think we should just automatically medicate everyone. it would make our jobs a lot
  8. by   Jen911
    What they taught you in school is correct...pain is what the patient reports. We have to remember that every patient responds differently to pain, especially those who honestly have chronic pain. We're always gonna have the drug-seekers, that's something that can't be changed..but just remember, like someone else already said, they're only hurting themselves.

    I can speak on this from personal recent experience. I have a history of migraines, and have learned to deal with them. Lately, my migraines have changed, and no longer respond to my normal medication regimine. Well, finally the other day, I'd had enough, I couldn't handle the pain any longer, was dehydrated from the vomitting and diahrea the goes with it, and had to go to the ER where I work. Since I've always been taught to "buck up and deal with the pain," you wouldn't be able to tell my true pain level by just looking at me. Yes, I've been able to hide my pain quite well, and can still function with a moderately high pain level. Since my PCP had been trying to manage my pain on an outatient basis with vicodin, it took quite a large dose of demerol (100mg) and dilaudid (2mg) via IV to get my pain to a tolerable level. I still went home with my pain (my choice, I REALLY don't like narcotics) but at least it was at a level where I could manage it. Did it look like I was drug-seeking? Probably. Was I? No, I just wanted to be comfortable. Now, 4 days later, my headache is finally almost gone, and I'm almost back to my normal self. I'm one of those people who can still function and carry on a conversation with a pain rating of 7/10, even did my own EKG (LOL). I'm probably the nightmare patient who you think just wants more drugs for fun, but that's not the case. When I followed up with my PCP yesterday, I told her no more narcotics. And no, I'm not having any withdrawal symptoms, I just don't like that kind of stuff. Makes me loopy and I can't think straight. Probably the same reason I don't drink, either. I still have my 3/4 full bottle of Vicodin on my desk which will probably last me another year or so. Hmm..a burglar would love to hit my desk.

    Anywho..I'm not trying to say everyone who says they have pain actually DOES have pain. I'm just trying to reinforce that some patients who don't appear to have pain, but give you a high pain rating can actually be truthful.

    Not trying to bash anyone, honest!

    Have a safe weekend.
  9. by   CEN35
    Everybodys pain tolerance is diffferent. What one could consider the worst pain in the world, another might consider a 4 or 5 on a 1-10 pain scale.

    Subjective information is important. However if there is any doubt to whether they are in obviously more or less pain, you must document any objective information.

    Things have to correlate, common sense prevails. Here are some examples.

    case #1 - Pt: the pain is terrible.....I need something it's a 10/10.
    Objective info: You see this patient crying and restless, sweating, pulse 120, resps at 24-36......crying and I chart all that? Not usually......but she clearly needs more pain meds, for releif.

    case #2 - Patient: The pain is a 3/10 scale.
    Objective info: You see crying, maoning, increased pulse and respirations with some diaphoresis, and they are pale. Clearly this needs to be documented, and get an order for pain medication, or give it if you have an order already. Then re-evaluate after a period of time.

    case #3 - Pt: the pain is a 10/10........or as we hear so often on a 1 - 10 scale how bad is the pain? They say "12". Always quote the number they tell you.
    Objective info: The patient is talking to their friend at the bedside, occasionally laughing and smiling. No crying, no moaning, skin color is good, pulse at 62, resps at 14. Most likely they don't need pain meds at this time. the doctor and/or (in the future JCAHO) or her attorney may want to know why they were not informed, or why nothing was done for the pain? Documenting your objective info........will save your butt! This person clearly is not a 10 or 12, or whatever they claim the pain to be.

    Just a few tips........and .....if it's not documented, it didn't happen, or wasn't observed. The last thing anybody wants to hear (because it wasn't charted), "Well I don't know......but if they didn't get anything I am sure their was a good reason for it.

    Last edit by CEN35 on Sep 14, '01
  10. by   P_RN
    Frustrated, I hope what you said was facetious. If not it seems that you are on the way to burnout.

    Who cares? I care, your patient cares......When it is ordered by the MD, we must assume that there is a reason. Some people honestly feel that they are having more pain that there ever has been=10.

    Who are we to say they are not.

  11. by   frustratedRN dead serious.

    what im saying is this.....

    mr jones has a diagnosis of pancreatitis...we all agree this can be very painful.

    your SUBJECTIVE opinion is that mr jones might have that but hes not in as much pain as he says...he just likes to get high.
    why does that bother you?

    even if YOUR subjective opinion is correct....why do you care that he is using that medication just to get high?
    is it hurting you or other patients?
    what really is the consequence of that?

    i LOVE the docs solution changing the route. ive seen that work in drug seekers all the time.

    i stopped wondering what the patients intention is. if they want drugs to get high and they are ordered them....i give them.
    if they have pain and they want drugs and they are ordered....i give them.

    i care about the patient...i dont care about the intent.