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.
I don't know if pain scale contributes to opioid problem, some people are in real pain.
But I have my suspicions about writing / telling patients when their next pain med is due. I say that because what I have noticed is when you tell people its do...even though they are in pain they will remember the exact time pain meds are due. It's something I will not want to practice. If they are on multiple pain meds I would give them options and if they ask for the opioid before it's due I will just have to tell them that is not an option right now. I know - I can hear people tell me good luck with that
I share your suspicions. We're supposed to write the time for the next available prn on the pt's white board. Some pt's get angry if we're even a few minutes late with their prn. And yet there are enough pt's for whom it is helpful to know when that next dose is coming and they're able to hang in there with that knowledge. I've even had some who would rather just deal with the pain and find it more tolerable knowing that relief is available if it gets to be too much.
I have a family member who has chronic pain. She injured her back in a fall and has had at least a couple of surgeries. Years later, she still goes to physical therapy to maintain her range of motion and strength. And yes, she has a script for norco that she takes on her bad days. She also takes ibuprofen and deals with the pain the best she can if she's going to be out driving. She's probably the ideal chronic pain patient. And yet, because of the people who abuse the meds, she gets all sorts of grief when she goes to fill a script. I know addiction is a serious and real problem but it makes me angry that their behaviors have made life difficult for the legitamate chronic pain sufferer.
Specializes in ER - trauma/cardiac/burns. IV start spec.
This thread is listed as "Has pain scale contributed to the opiate problem" but after reading all the posts it has devolved into something else. It has become a battle ground over addiction vs pain management. Here is my two cents worth after a life from both sides.
Medicine is based on numbers. Tests that quantify producing numbers for doctors to use to combat the disease process but pain cannot be measured. Pain is different in every person in such a way that my 1 - 10 is not like your 1 - 10 scale. I have seen patients having an MI state their pain was a 1 while in the next room another MI patient is crying that their pain is a 10. Some patients are just more stoic than others.
I have seen patients state their pain as a 2 or 3 and all their vital signs indicate otherwise and I have seen patients claim a 12 while laughing, texting or chatting and eating/drinking with a room full of family. You cannot quantify pain on a standard scale but when the complaint is only pain with no other medical complaints we need to use observation.
My experience has been the use of the complaint of migraines as the number 1 reason for requesting pain meds. I too once lived with migraines prior to my nursing career. In fact the facility I worked in was the one I went to for several years with intractable migraines. I became the de facto RN sent to rooms with migraine-ers to access the patient. With the advent of big pharma advertising every medication invented for something giving the description of "symptoms" for all to hear and the internet for detailed explanations of every symptom of the selected illness. This has lead those seeking pain meds to regurgitate the lists when they enter the ER. I have been amused by patients listing photophobia as one of their symptoms while sitting in a fully lit room while sitting up talking with family. It would be easy to say that these people are less educated (low knowledge) but that is not always true. While I was in nursing school I was suffering "migraines" constantly, I was sent to the ER for medication but my usual drug cocktail did not relieve the pain I knew something else was wrong. It took me losing the gripe in my right hand before my doctor would order and MRI discovering herniated disks with impingement on the nerves in my neck which in turn lead to neck surgery. My doctor and the ER was beginning to peg me as a drug seeker. Drug seeking has existed since we began restricting, classifying, drugs. Drug seeking predates the pain scale.
Pain management drugs have also contributed to the addiction problem with many drugs being pitched as non addictive when in reality the companies suspected or knew that the drug carried the risk of addiction but the money and the market shares outweighed the risk to the company. Oxycontin was pitched as a 12 hour pain control with a low risk of addiction despite the companies own research that the medication did not last more that about 8 hours. When patients continued to complain about break through pain the companies solution continue the 12 hour dosing just raise the dosage and keep raising the dosage until patients reached the max creating addicts along the way. Now you have patients in pain on legal pain meds without pain control for several hours before remediation time plus the bodies desire for the next "fix".
There is so much more to "blame" than the pathetic attempt to quantify pain in the ER/hospital doctors and nurses need to use their skills to sort through the fact from the fiction, big pharma needs to come clean before they drop new meds and addiction needs to treated as the disease it is not as a "problem" of self control. Perhaps it is time as well to stop the television advertising of every medication invented, just keep it in print.
Specializes in Gastroenterology; and Primary Care.
One can have chronic pain of a 10/10 and show no outward signs as one's body has adapted to the pain to function. I myself have chronic pain and I have pain of 10/10 a few times a month and my body definitely reacts differently than it did when my original injury happened! WHen I was picked up by EMS my blood pressure was 220/150's and tachnicaridc due to the severe pain. Now my blood pressure is WNL limits. I thank God my body has adapted to my pain as I wold stroke out if my BP was high like my acute pain. I have never in my life before my injury took narcotic, etc (except childbirth LOL) but I was immediately treated like a junkie 1 week after getting DC's from the hospital! My surgery was two weeks after my discharge and I felt horrible on the meds but I had to have them or the pain was just unbearable. After surgery was a long recovery...I to this day I do use many methods to treat my pain, as narcotics do not work for chronic pain! It's like taking an ASA! We need to educate these chronic pain people on other methods and meds that work (TENS, Massage Therapy, Invertor (great for my back injury), etc....Is that not our jobs as nurses to educate? Ok that was my two cents!
That's about what I tell people when they rate their pain. I love when someone says 10 and is sitting quietly, no grimace, no outward signs of pain, vitals stable/baseline. I want to say to them "Have you ever had a kidney stone ripping it's way down your ureter? What about as it passes from your bladder through your urethra feeling like a piece of glass cutting it's way out from the inside?That's a 10. This calmness you display is not a 10. At least get with the program if you think you are a 10." But of course, we can't!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
That one made me laugh out loud!
I was in the PT clinic a few months ago, working on exercises for my chronic hand pain (side effect of chemotherapy, so I'm truly blessed to be alive to complain about it) when a woman a couple of chairs over started screaming, kicking her heels, flailing her arms -- looking for all the world like a 2 year old throwing a tantrum. The problem? The old GP who had been feeding her drug habit for years had died; the new doctor wouldn't prescribe her Oxycontin 120 mg. every four hours "like I bin taking for years for my turrible pain." Instead, he wanted a PT evaluation and consult.
I was able to hear (everyone in the BUILDING could surely hear) the woman's response to the questions in the history. No, there was no injury. Her back had hurt her for YEARS. What difference did it make what caused it, it hurt! No, she couldn't clean her house, cook, shop for groceries, etc. because of the terrible pain. In tact, the pain was so bad she only got out of bed three times a MONTH -- to go get her disability benefits check, to go to her doctor to get another prescription for her pain pills, and to pick up the pills at the pharmacy. Otherwise, the pain was too terrible for her to leave her bed. When the PT suggested some exercises that could help with her pain and mobility issues, the drama increased. "I don't NEED to EXERCISES! I'm in PAIN! I need my MEDICATION!" All the while flinging herself back and forth and flopping about. (She had an amazing amount of mobility for someone who couldn't get out of bed more than three times a month.)
I wonder what effect a psych consult would have had on that display of status dramaticus!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I think the pain scale is a blessing for those patients who are in legitimate pain, doctors to write clear narcotic orders and for us to administer those narcotics. BUT..... For addicts the current pain scale or any other one that they would come up with is useless (unless they have legitimate physical pain.)
Researchers are working on methods to truly assess pain and treat it. It might be a long time until it gets to be used in hospitals but it WILL happen and that will help everyone.
The 1-10 pain scale doesn't really work. Most folks (those in legitimate pain who are actually trying to cooperate) can't quantify their pain on a scale from 1-10. The Faces scale actually works better, as does the behavior pain scale for those ICU patients who honestly expect (probably because some MD told them so) that their cardiac surgery won't hurt at all. Folks who just want to feel nothing are going to tell you their pain is 100/10 just to get the shot, while folks in legitimate pain will thoughtfully tell you their pain is a 3 or a 4 (while unable to work their incentive spirometer because it hurts so damned bad).
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I did not put anyone in their place. I stated there has to be a better way. It just gets old getting patients transferred to our section, without meds and feeling as if they are being judged. At some point, the system needs to be changed. I've been in the other side and fully understand how difficult it is for them when they run out of options for their meds. Nurses are getting jaded with the current system, and patients are over using narcotics.
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.
I beg to differ with you, CanadianAbroad. That was a definite "more compassionate than thou" post.
The 1-10 pain scale doesn't really work. Most folks (those in legitimate pain who are actually trying to cooperate) can't quantify their pain on a scale from 1-10. The Faces scale actually works better, as does the behavior pain scale for those ICU patients who honestly expect (probably because some MD told them so) that their cardiac surgery won't hurt at all. Folks who just want to feel nothing are going to tell you their pain is 100/10 just to get the shot, while folks in legitimate pain will thoughtfully tell you their pain is a 3 or a 4 (while unable to work their incentive spirometer because it hurts so damned bad).
I can't agree strongly enough. All too often, when I ask a patient to rate their pain on a scale of 0-10, they stare at me with a puzzled look. I do my best to explain, but they still struggle with it. Heck, when I've been the one in pain, I've struggled with it. When you're truly hurting, the kind of analysis needed to come up with a number is nearly impossible for many people.
The pain scale is only one part of the pain assessment. It isn't contributing to the drug problem at all.
Even the tired adage "Pain is what the patient says it is" isn't harmful in any way. Along with that adage is "The treatment is NOT always what the patient says it should be."
I've been watching this thread and debating whether or not I should comment. I admittedly am not always objective when it comes to these type posts. When I see posts of this nature, part of me wants to jump in because as a person who suffers from chronic pain I often feel that some healthcare providers misunderstand my pain and judge me the second they find out I'm a chronic pain patient. Yet the nurse part of me totally gets how frustrating it is to deal with patients who have drug-seeking behaviors. It can be exhausting and frustrating as hell. So here of some of my thoughts.
The biggest issue with the pain scale is that an objective measurement (0-10) is being used to measure a subjective experience (pain). It simply doesn't work. And it never will. I personally have a difficult time quantifying my pain on a 0-10 scale. I have Reflex Sympathetic Dystrophy (RSD), a neuro-inflammatory disease that causes severe pain. For the past 10 years I have been in constant pain. If you asked me when I was first diagnosed, I would have said my pain was a 10. The worst pain you can imagine. Well, I couldn't imagine anything worse. Now, I would consider that same pain a 3 or 4 because unfortunately, I've since learned that my pain can get a whole lot worse. So does that mean that I was overstating my pain when I was first diagnosed? (By the way, I no longer rate my pain as a 10, because I now know it can always be worse.)
To look at me most people would never be able to guess I'm in pain. I'm pretty good at hiding it. I function fairly normally at a pain level most people can't imagine because I don't have any other choice. (Unless I want to be on really high dose opioids. Been there done that. It didn't help my pain. Just made me not care about it, or anything else!) I live at a 5-6 on a good day. Bad days, well those days I don't function. I know it sounds like I'm exaggerating. I wish I was, but I'm not. My husband actually tells me I minimize my pain when I talk to my doctors. He tells me I'm too stoic. I don't know how to be any other way. It's how I cope. But I know it makes me unbelievable by many healthcare providers' standards. I don't look like I'm in pain. I don't act like I'm in pain.
I don't know what the answer is. I wish I did. I don't know how you develop a system to effectively measure pain. I don't know how you address the opioid problem without penalizing legitimate pain patients.
I am not a young woman, I've encountered addiction more than once, both professionally, and in my personal life. I've seen addiction to things I would never have thought of as something a human being would possibly become addicted to as little as 20 years ago - not just substances. Respectfully, my personal experience with addiction is none of your business, but I will say during the peak of each user's addiction cycle self control was not part of the equation. And none of the people experiencing it purposefully got there by their own choosing. I am also a proponent for appropriate pain management, having both personal and professional experience with those suffering from chronic pain.
"Loss of control" and "powerless" are two words defining the same meaning. The very first step in Alcoholics Anonymous is:
We admitted we were powerless over alcohol [or insert whatever substance, or behavior here]—that our lives had become unmanageable
The statement in the First Step that the individual is "powerless" over the substance-abuse related behavior at issue refers to the lack of control over this compulsion, which persists despite any negative consequences that the person may endure as a result.
: compulsive physiological need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly: persistent compulsive use of a substance known by the user to be physically, psychologically, or socially harmful.
My comment was not said with conceit or superiority, or to judge (glass houses and all that) it is from personal first hand experience. I guess it just boils down to intent and meaning being misinterpreted on an internet chat site resulting in hurt feelings (see "Some Days" thread).
Your response is hot tempered and poised for firing, purposefully adding insult to injure. You achieved exactly what set out to accomplish: in your view I hurt you (without intent), you hurt me right back (willfully). I'm not sure where you are in your 12 step program, but I'm guessing anger is still something yet to be worked on.
Regardless, I injured you without intention. I realize now my statement could be construed two ways - one of those as thoughtless - and I genuinely apologize for what you clearly view as a slap in the face, and for hurting your feelings. This is not said with snark, or smugness - I am truly sorry for hurting you 1sttime. You don't know me, therefore owe me nothing. I don't expect forgiveness from you, but I sincerely feel remorse for causing you more pain than you've already endured. I'd like the opportunity at some point to make amends to you, and anyone else unintentionally hurt by me, if possible. Please know if I could take back the hurt you felt that I would do so in a heartbeat.
Having the strength to stand up and fight an addiction head on makes you someone very much in control. I wish you well in your recovery.
I enjoyed this. Well thought out, mature, and very well written. 1 million likes if I could.
Rexie
108 Posts
I share your suspicions. We're supposed to write the time for the next available prn on the pt's white board. Some pt's get angry if we're even a few minutes late with their prn. And yet there are enough pt's for whom it is helpful to know when that next dose is coming and they're able to hang in there with that knowledge. I've even had some who would rather just deal with the pain and find it more tolerable knowing that relief is available if it gets to be too much.
I have a family member who has chronic pain. She injured her back in a fall and has had at least a couple of surgeries. Years later, she still goes to physical therapy to maintain her range of motion and strength. And yes, she has a script for norco that she takes on her bad days. She also takes ibuprofen and deals with the pain the best she can if she's going to be out driving. She's probably the ideal chronic pain patient. And yet, because of the people who abuse the meds, she gets all sorts of grief when she goes to fill a script. I know addiction is a serious and real problem but it makes me angry that their behaviors have made life difficult for the legitamate chronic pain sufferer.