Has pain scale contributed to opiate problem?

[Emergent, RN]

I work in the ER, therefore encounter many people with opiate problems. A lot of them, frankly, are unsophisticated people with low levels of education. We use the pain scale because we are required to. Many of these folks have been working the system for years, and are conditioned, like Pavlov's dog, to give a number that will give a result they need. We play along because we are required to put a number in.

I think the whole system is mostly highly inaccurate and subjective. A 10 often means how much they want the drug. The pain scale has contributed to our national sense of entitlement to be pain free through drugs.

I do find the pain scale useful with cardiac pain, but by and large, for the opiate seeking population, it contributes to the nationwide drug problem we are facing.

[meanmaryjean, DNP, RN]

Agreed! The underlying problem, as you touched on, is the unrealistic expectation that everyone should be pain-free 100% of the time*. It is simply not possible.

See also *pain is (always and without question) what the patient says it is.

[KatieMI, BSN, MSN, RN]

Pain scale is, essentially, a screen test. A simple, quick, low-cost intervention to sort out anyone who DO NOT need anything further to be done. Such tests, by the mechanics of their working, are prone to producing falce-positives. This is the law of math, no way around it.

So, yeah, pain scale use as a DEFINITIVE test for intervention did contribute to problem, to the same degree as intro of "sepsis scale" did for unnecessary ICU admissions, overhydration, appearance of new species of MDR bacteria, etc.

Unfortunately, as prompt usage of pain scale diminishes nurses's need to actively employ their critical thinking and clinical assessment skills while bumping "customer satisfaction" scores, the initiative should come eventually from above. But you might try to document things like "states 10/10 low back pain, appears comfortable, no other symptoms (in details), ambulates, vitals stable, demands Dilaudid IV". At least, it will help providers in the future to identify "quiet seekers". But then 90% of them master next level of "10/10 chest pain, allergic on ASA and everything else but Dilaudid" within next 6 months or so.

[rearviewmirror, BSN, RN]

OOOHHHH she didn't say it!! Emergent, other nurses don't like what us ER nurses say about that kind of foolishness! just kidding. As we (well not me anymore) are frontlines, our exposure to pain seekers is exponentially high compared to floors and units that get the "weeded out" numbers that can by all means be very pain seeking.

I think the whole system from top had very poor management on pain management, and it's interwebbed from those who make the policies, satisfaction scores, HCAPS, reimbursement rates, fact that business people run patient care, to addictive behaviors and us enabling them for that behavior.

I frankly think all ERs should ban use of heavy duty narcotics especially dilaudid, demerol, fentanyl and such until either the physician absolutely has very reasonable rational for use prior to confirmation via radiology or only use after such confirmation is made. No dilaudid just becase they are "rocking back and forth" and dry-heaving and obvious frequent flyer! Of course, that doesn't help with scores, so, yeah let's just keep em high

[Davey Do]

I also document the FACES scale.

Most 10's are 4-6's. Some are even 2-3's.

This prevents calls from the Pharmacist asking, "Do you think you should ask the Doctor for a stronger pain reliever?"

[blondy2061h, MSN, RN]

I hate the pain scale. You've got the patients grimacing and jumping a mile high when you touch them who are tachy with quick shallow respirations telling you they're "uncomfortable" and rating their "discomfort" (because it's not really pain) at a 3 on one end, and the Twitter updatter, munching on Cheetos, laughing with her boyfriend in tow with rock solid vitals eating her excruciating pain at a 12 on the other end.

[ScrappytheCoco]

Several of the hospitals I work for have a place to document the patient's behavior next to their stated pain level. One even asks for the nurse's "total pain impression."

[Emergent, RN]

I personally think if you are a 10, you are screaming in agony and unable to do much else.

I will tell people, "0 is no pain, and a 10 is like I'm sawing your arm off without anesthesia", and they'll have the barefaced audacity to still say a ten.

I just put the number in the computer and move on...

[BittyBabyGrower, MSN, RN]

I am so glad I work with babies!

[mustanglover]

Pain killer seekers clog up the waiting rooms, and forces those who truly need care to wait longer for treatment. In stead of being given pain killers they should be getting psych consults. When they ask for a certain pain killer, and you tell them the hospital ran out of it but you got plenty of ibuprofen, they usually get up and leave pissed off.

I had a man once claiming his leg hurt so bad, the pain was a 10, he couldn't even walk on his leg. I told him he could have ibuprofen, and it would be some time for a doctor to view his charts before he would even be considered for the drug he requested. After I told him that, he was able to walk on the leg that hurt so bad and then told me he would just go to the other hospital in town. That other hospital was informed about his planed visit.

I have even requested psych consults for patients who's pain was so bad they could not get out of bed, nothing medically could explain the pain. After they were informed a psych consult was requested, they were healed, able to get out of bed and no longer in pain. Another patient that claimed he could not get out of bed and would pee all over the bed, was informed that the doctor ordered a Foley catheter to help with the incontinence, that was the fastest I had ever seen a person run out of the hospital still in a gown.

[CanadianAbroad]

Unsophisticated and low level of education? My god is this a generalization. Here is the thing, instead of passing judgment on these individuals, how about taking addiction courses to learn how to help these patients? Most of the time, a great deal of these individuals have no where else to go; especially in inner city hospitals. They are not seeking these meds due to being a junkie. Most of the time, they are in pain. They are masking other symptoms and are using as coping mechanisms. Yes they clog the ER, but they need help. Get some empathy and put yourself in their shoes. I used to be like you, until I had an injury and a chronic pain condition. It was hell, but I eventually pushed through it and am back to work. Am I a junkie if I go to the ER because I cannot manage my pain properly? I work in part of the ER, and I can tell you that our pain seekers are of all classes and education levels. There was no need to even mention that in the first place, and it comes off very ignorant. I am not sure if you intended this or not. Here is some advice from someone who has been in their shoes. Ask the pain level, look at their facial reactions and ask them to describe the pain. Most pain specialists go by the description of the pain, and not the number. I used to attend a pain clinic for years, and my experience has made me understand just how easy it is to get dependent on a drug and even when you do not intend to. I do highly suggest addiction courses online. McMaster University in Hamilton has an excellent program. I do think it will help in the ER, and then help stop patients from being transferred to Clinical Decision Units to investigate their pain.

[Emergent, RN]

I had a serious injury last year, with 8 severed nerves, 5 severed tendons, and a very, very painful recovery. I have lingering limitations and pain.

Yes, I understand pain.