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 agree, Someone needs to rethink and reinvent the pain scale. There are physical indicators that should be included in the pain assessment. I also feel that there should be a variety of things that the nurse can chose from for pain and the degree of pain observed and stated. The doctors and hospital policy should reflect the various choices ordered at the outset upon admission. The narcotic pain med is not always the drug of choice and doctors and nurses should be aware of placing their license's on the line which should be part of the decision making process.
I see several problems with pain and pain management when it comes to the "system" and for "drug seekers". First let me say that not all people that need frequent pain medication are "drug seekers" and they often get labeled that way, which is unfair. But the whole system is doing an injustice to the patients.
First, it started back in the 80s when JACHO came out with the notion that pain was the fifth vital sign and had to be addressed. That's when the pain scales came into play. I worked in pediatrics at that time, so I can't even count the time I'd pull out the smiley face scale for the patient/family to decide pain on the patient. Once pain was identified JACHO said we needed to document interventions for pain management and effectiveness. This was scrutinized by management, in fear they would be sited by JACHO.
Second, I grew up in WV where coal mines are a way of life. Pain medication started to be given out to coal miners liberally because they worked in cold, damp, cramped spaces all day long and their joints hurt constantly. I can identify with that pain. However, once the pain medication starts, it's difficult to come off the medication. Then not only did the coal miners become "addicted" but their families were also now experimenting with these drugs, and it became a whole family issue that everyone needed to seek drugs just to not get sick. I read several articles about how several pharmacies were shut down a couple years ago because they had lines of cars backed up at their drive through window. What they were doing was handing out pain medication to these folks, and then shipping the order to a physician across the street that would write the order for the pain medication to cover what the pharmacy had already dispensed. It became a lucrative business for the pharmacy and the doctor. And, of course, you can imagine that everyone an their uncle was very happy to be able to pop up at the drug store and buy pain medication The sad part of this story is that when these pharmacies and doctors got busted for their crooked work, it left all these people that were addicted to the pain medication very sick and in need of a fix. This brought about the rise of cooking crystal meth, and heroin. As a matter of fact, Over Memorial Day this year 12 people died in my home county from heroin overdose from a "bad batch" of heroin.
I no longer live in WV but I have family that do live there. I am so afraid for their safety now. Growing up WV was the safest place a girl could imagine. We never locked the doors of our home. Heck, we didn't even have house keys to lock the doors. Now, everything is locked, secured by alarms and cameras.
Lastly, came the payment to hospitals and facilities based on customer satisfaction. This is probably one of the most ridiculous ideas that I could even imagine. If someone presents to the ER and complains of pain that is 12 on a scale of 1-10, then to satisfy the patient they get pain medication. There does not seem to be much room for nursing or physician judgement about the actual pain. If the patient presents bent over in pain, guarding their painful area, grimacing, clinching fists then I really do believe they are having pain. If the patient presents laughing, watching tv, talking on the phone and then when the nurse comes in they have excruciating pain it becomes more difficult to really believe that they are in pain. But because it is now our mission as health care providers to make the patient happy so we get great ratings and get paid more money. This has become a sad state of affairs for healthcare. I feel like it's allowing the patients call the shots and it keeps doctors and nurses from being able to practice as we should.
I've been a nurse for nearly 30 years and I've worked PICU, Adult Med Surg, Peds ER, LTC, Home Care, Gerontology, wound care, and just about everything except L&D. I enjoy all facets of nursing. I have been working hospice for the last 5 years. I've seen pain. Hospice nurses are charged with the task of pain and symptom management. When a patient tells me they hurt, I truly believe they hurt. But most of the time I also assess and document the physical things I see the patient display when they have pain. If a patient is non verbal we look for non verbal signs of pain like restlessness, grimacing, moaning, clinching fists, facial frowning, clinching face, unable to be consoled, guarding a particular place that may be painful. I feel these people have the right to be as pain free as they would like. Some do not want to be "sedated", some want to be comfortable. It is all in a patient journey. One of the difficult things I've dealt with is Hospice is drug diversion by family members. Yes, this exists. Who in their right mind would want to take granny's pain medication when she is dying? We do everything we can to keep the medications controlled. We use lock boxes, pill counting, limited supply at a time. Yet, about every 3-4 months we find a family that won't/can't comply and we end up having to discharge after breaking contracts and referring to APS, and most of the time they also ask us to report the incident to the sheriff's office.
So, YES, in a nutshell the whole country now has a huge drug problem. I think its epidemic. I know many people truly do have pain, and need pain control. But it's always those bad apples that seem to put a bad taste in my mouth and spoil the whole bunch.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I see several problems with pain and pain management when it comes to the "system" and for "drug seekers". First let me say that not all people that need frequent pain medication are "drug seekers" and they often get labeled that way, which is unfair. But the whole system is doing an injustice to the patients.
First, it started back in the 80s when JACHO came out with the notion that pain was the fifth vital sign and had to be addressed. That's when the pain scales came into play. I worked in pediatrics at that time, so I can't even count the time I'd pull out the smiley face scale for the patient/family to decide pain on the patient. Once pain was identified JACHO said we needed to document interventions for pain management and effectiveness. This was scrutinized by management, in fear they would be sited by JACHO.
Second, I grew up in WV where coal mines are a way of life. Pain medication started to be given out to coal miners liberally because they worked in cold, damp, cramped spaces all day long and their joints hurt constantly. I can identify with that pain. However, once the pain medication starts, it's difficult to come off the medication. Then not only did the coal miners become "addicted" but their families were also now experimenting with these drugs, and it became a whole family issue that everyone needed to seek drugs just to not get sick. I read several articles about how several pharmacies were shut down a couple years ago because they had lines of cars backed up at their drive through window. What they were doing was handing out pain medication to these folks, and then shipping the order to a physician across the street that would write the order for the pain medication to cover what the pharmacy had already dispensed. It became a lucrative business for the pharmacy and the doctor. And, of course, you can imagine that everyone an their uncle was very happy to be able to pop up at the drug store and buy pain medication The sad part of this story is that when these pharmacies and doctors got busted for their crooked work, it left all these people that were addicted to the pain medication very sick and in need of a fix. This brought about the rise of cooking crystal meth, and heroin. As a matter of fact, Over Memorial Day this year 12 people died in my home county from heroin overdose from a "bad batch" of heroin.
I no longer live in WV but I have family that do live there. I am so afraid for their safety now. Growing up WV was the safest place a girl could imagine. We never locked the doors of our home. Heck, we didn't even have house keys to lock the doors. Now, everything is locked, secured by alarms and cameras.
Lastly, came the payment to hospitals and facilities based on customer satisfaction. This is probably one of the most ridiculous ideas that I could even imagine. If someone presents to the ER and complains of pain that is 12 on a scale of 1-10, then to satisfy the patient they get pain medication. There does not seem to be much room for nursing or physician judgement about the actual pain. If the patient presents bent over in pain, guarding their painful area, grimacing, clinching fists then I really do believe they are having pain. If the patient presents laughing, watching tv, talking on the phone and then when the nurse comes in they have excruciating pain it becomes more difficult to really believe that they are in pain. But because it is now our mission as health care providers to make the patient happy so we get great ratings and get paid more money. This has become a sad state of affairs for healthcare. I feel like it's allowing the patients call the shots and it keeps doctors and nurses from being able to practice as we should.
I've been a nurse for nearly 30 years and I've worked PICU, Adult Med Surg, Peds ER, LTC, Home Care, Gerontology, wound care, and just about everything except L&D. I enjoy all facets of nursing. I have been working hospice for the last 5 years. I've seen pain. Hospice nurses are charged with the task of pain and symptom management. When a patient tells me they hurt, I truly believe they hurt. But most of the time I also assess and document the physical things I see the patient display when they have pain. If a patient is non verbal we look for non verbal signs of pain like restlessness, grimacing, moaning, clinching fists, facial frowning, clinching face, unable to be consoled, guarding a particular place that may be painful. I feel these people have the right to be as pain free as they would like. Some do not want to be "sedated", some want to be comfortable. It is all in a patient journey. One of the difficult things I've dealt with is Hospice is drug diversion by family members. Yes, this exists. Who in their right mind would want to take granny's pain medication when she is dying? We do everything we can to keep the medications controlled. We use lock boxes, pill counting, limited supply at a time. Yet, about every 3-4 months we find a family that won't/can't comply and we end up having to discharge after breaking contracts and referring to APS, and most of the time they also ask us to report the incident to the sheriff's office.
So, YES, in a nutshell the whole country now has a huge drug problem. I think its epidemic. I know many people truly do have pain, and need pain control. But it's always those bad apples that seem to put a bad taste in my mouth and spoil the whole bunch.
Your post was very interesting, although I found it difficult in the extreme to read a solid wall of text. Paragraphs please!
Yes, somehow I have recovered without the 12 steps... I think it is a system that encourages one to be sick for life...
Well, I myself am personally an addict in recovery for more than 2 decades. The 12 Step Program was mandated by the SBON back then, so that is what I did.
Just an FYI to everyone, I originally didn't wish to divulge all this, but what the heck? Why not?
I'm not a smug holier than thou finger pointer too ignorant to understand the mechanics of addiction - I'm also a member of the club.
And incidentally, I was speaking about myself - I myself had little self control. And a pain scale sure didn't make me that way.
Bet ya didn't see that one coming.
I also realize that the way I worded original comment left a whole unsaid.
So there - all the blanks filled in for one and all.
I work in a rough neiborhood with very rough patients. Most of our pts are drug addicts with multiple infectious diseases. Ask them what their pain level is from the scale of one to ten and they tell you it's 20. Even the ones with common headache ask for morphine or Percocet and get very upset if you give them Tylenol. And in the end, most of them get the narcotic for a mild pain or discomfort. It seems administration likes that to keep the patients coming to us instead of going to another hospital. I always say we should turn one of the units into a rehab unit.
9 and 10 include objective measures for pain, and that is considered pretty offensive to some around here.
Whenever anybody implies that somebody eating, texting, and talking cant't be in 10/10 pain, they are chastised for being heartless and judgmental.
Oh, please ... oversimplify much? Pain, and the differences between chronic and acute pain, is a complex and widely misunderstood phenomenon. There are NO cookbook answers. If pointing that out offends you, I don't know what to tell you.
I've come to the conclusion that the 0-10 pain scale is just plain stupid. I was with my uncle at a doctor's appointment today and when they asked if he had any pain, he stated that he has arthritis in his knee. And when then asked how he would rate it, he calmly stated 10/10. I know his knee is really bad shape but there is no way his pain was 10/10 at that time. Rather than educate him on the pain scale the nurse just wrote the number down and went on taking vital signs.
I really like the pain scale chart shown above. I think something like that would be very useful to our patients. Or maybe we can just ask if pain is mild, moderate, or severe. People understand that.
Of course we will still have the drug seekers who claim that their pain is 20/10 (and can they have some more graham crackers), but our "normal" patients would be better served by moving away from the 0-10 scale.
0-10 isn't just bad for the pain scale. We now have to ask our patients to rate fatigue on the same scale. As someone with lung disease, I've been asked to rate my shortness of breath on that scale as well and find it darned near impossible. If my SOB is a 10 you better not be asking me to rate it.
prunejuice&BPs
11 Posts
I agree, Someone needs to rethink and reinvent the pain scale. There are physical indicators that should be included in the pain assessment. I also feel that there should be a variety of things that the nurse can chose from for pain and the degree of pain observed and stated. The doctors and hospital policy should reflect the various choices ordered at the outset upon admission. The narcotic pain med is not always the drug of choice and doctors and nurses should be aware of placing their license's on the line which should be part of the decision making process.