Rate Your Pain

[jadelpn]

There's all sorts of pain. There's physical, emotional or a combination of both (and probably a lot more descriptive words that can be used). The most difficult part of pain for a nurse is to put aside some of their own thoughts, and focus on patients as a whole.

Pain control is complex. So one doesn't have to go it alone. Yes, there are "drug seeker, push it fast, give me more" kinds of patients. Those are the patients who need a few more disciplines involved than a nurse with a vial. And one should not hesitate to use them, especially when it becomes apparent that your interventions are not working.

So how does a nurse do all this with a "straight face"? Like a number of things in nursing, a nurse needs to have the ability to leave out judgement. Which is difficult when on the one hand we have to educate patients on care, on the other do it without a tone that suggests distaste.

We need to remember that for the patient the pain is real. And the loss of control real. And there is real fear. This is the patient's perception, for some their reality. If pain has the ability to raise one's RR, one's blood pressure, would it also make sense that it is a real symptom that requires intervention?

I have noticed that, especially in a rehab setting, that there's a huge push for pre-medicating. For a patient to receive a PRN prior to the pain "getting out of control". Using key words like "out of control" can backfire. Then you have a patient that is fearful, edgy and in constant anticipation for the other shoe to drop. And that does nothing to help a patient advance in function.

Then you have the "well, patient x was chatting and laughing and rated the pain at a 10. SERIOUSLY????". Again, needs more disciplines involved than you can provide, however, don't be so quick to judge pain on what the patient is doing just to not feel the anxiety that uncontrolled pain or perceived and/or real withdrawal can give.

Take the personality out of the equation, and follow the orders for control of pain. If you are thinking that multiple mg of dilaudid pushed every hour is excessive, then you need to speak to the MD about the plan.

Some patients do not realize there's viable options. There are patients who do realize there's viable options but choose not to take them. It is when we take the judgement out of the equation, do what we can to give a patient access to services that they may or may not take us up on, then can we be mindful of a paients needs.

Such as those in acute pain are mindful of the need to not let the pain get "too bad", chronic pain suffers are intimately aware of this idea, and both need to be medicated per order when indicated. If a patient is over-medicated, a nurse needs to respond to that. And if a patient is under-medicated the same holds true.

JHACO is very clear on the needs of a patient and the right of a patient to receive control of pain. This is when a personal judgement needs to be pushed to the side, and a nursing process be put into play. We should never be in a position to assume that all patients at the end of the day want to be medicated into oblivion, nor every patient who experiences pain and asks to be medicated are seeking some sort of high. We are not feeding addicitons. An addict is an addict. We are contolling pain.

[cadawasp]

I am going to weigh in on both sides. I am a hospice nurse that now works in the office due to chronic pain secondary to spinal stenosis, so I have been on both sides of this issue. As a hospice nurse I frequently needed to work with a report of "a little, not too bad, to the worst ever" I always believed my patients and sometimes needed to convince them to take the pain meds. One thing that was not mentioned was the use of adjunctive medicines such as neurontin or Lyrica for nerve pain, Cymbalta or Elivil for nerve pain, NSAIDs or steroids for bone pain. The use of these in addition to the opioids or even alone can help with pain. This is one of the reasons that knowing where the pain is and a description of the pain needs to be asked to help find the type of pain and how to medicate the pain.

Now as a chronic pain patient. I have taught classes with a pain level of 10, no one else to teach the class and able to "fake comfort". People who knew me could tell but not a group that did not. I have been taking either neurontin or Lyrica (moving from one to the other and back) for about 10 years now. My pain doctor added Cymbalta at some point for both nerve pain and depression. During this time I have been using Vicodin ER for breakthrough pain. I have also had three surgeries on my back during this time and have used a PCA pump post surgery of dilaudid. I did find myself unable to just stop the Vicodin after the surgery recuperation and needed to decrease it so I could return to prn use.

We need to look at many aspects of our patient's to understand their pain needs the cause of the pain, type of pain, what has worked in the past and what has not to name just some of what we need to know. Realistically that is hard to do with the time constraints in the hospital but knowing severity, cause, and description can help to see that our patient's are cared for in the best way possible.