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.
Specializes in Home Health, Mental/Behavioral Health.
And...?
I'm a Mensa member and the child of two loving parents, both with PhDs and healthy bank accounts. I only have two Master's degrees but I reckon that still qualifies as reasonably well educated. Does that make me a better class human being? I don't think so.
Emergent, I think that you know that you're one of the posters that I appreciate here on AN. But I must admit that I don't understand your line of thinking here.
I'm not sure why you added this information to your post but it's a well-known problem that some societal problems are overrepresented in lower socio-economic groups. Some phenomena may occur in disproportionately large numbers. Also keep in mind that a well-to-do addict has many more avenues of drug acquisition available to him or her. So it's not strange if you see mostly the poorer segment of addicts in an ER.
How long do you think the human body can keep that up? An hour? A week? A year? A decade?
Of course a "10" pain can look like you described. But it doesn't always. It's been mentioned so many times before. Many nurses seem woefully undereducated on the different presentation of acute and chronic pain.
Acute pain is brought on by a specific disease or injury. It serves a useful biologic purpose and is self-limited. It is associated with skeletal muscle spasm and sympatheticnervoussystemactivation.
Acute pain is accompanied by the changes in vital signs and symptoms that some nurses seem to think is theonly way that pain can present as.
Chronic pain is different. It serves no biological purpose and there isn't no identifiable end-point in sight. There are often both physiological and psychological mechanisms involved. The reasons for the body to activate the sympathetic nervous system and various cascades when acute injury occurs, are absent in chronic pain.
Because the physiological response is different it stands to reason that people will also react and behave differently depending on the nature of the pain. You literally can not stay awake for a month even if you are in agonizing pain. So yes, you can sleep despite experiencing severe pain.
Chronic pain sufferers need to be helped with a multi-modal, multidisciplinary approach. Their problems will not be solved in an ER setting.
Why are you making up your own scale? It's "0 is no pain, 10 is the worst pain imaginable". There's a reason it's phrased that way. Ten is not an absolute level of pain. (If such a level could actually be reliably measured). What a person thinks is a ten isn't constant through life. It will be affected by what that person has physically experienced and what coping skills they have and what kind of emotional state they are in.
Honestly, if a nurse asked me how my pain was and added a fanciful and graphic personal interpretation of a ten, I'd be annoyed and ask why s/he can't simply ask the question without the embellishment.
Also, aren't you setting up yourself for a good dose of frustration/annoyance when the patient still answers "10" after your Chainsaw Massacre description of "10-pain" when you seem to think it's not that high/severe? I don't know, but I sense some nurse eye-rolling here..
This is in my opinion a good article if anyone wants to learn a bit more about acute pain and how chronic pain develops.
This isn't an easy article to read, especially if this isn't an area which you have studied before. Still, there's knowledge in there that's good to possess.
This article is old but the quote I'm including is still valid today.
Poorly managed acute pain can lead to chronic pain. I think that pain and pain management is an important subject and one that we should all be proficient in.
Everytime I see a thread like this one pop up (and it does on a regular basis)
I get real frustrated.
Some random thoughts:
Even a drug addict can experience pain that needs to be and should be treated.
If I had still worked in the ER, I would rather medicate ten individuals whose primary motivation turned out to just be to get their next "fix" then not provide pain relief to one single person suffering from moderate/severe pain. I'd hate to let even one person suffer unnecessarily because of my prejudices, ignorance or "jadedness". It's as simple as that.
If someone feels like all that they're doing is to enable drug addicts it might be a good time to find a new job. You won't cure an addict in an acute care hospital but if this is a societal problem that you want to help improve/solve, nurses can do a whole lot of good in the rehab milieu. Use the frustration regarding the drug addiction problem that plagues society and do something helpful and productive.
Focus on having a meaningful and healthy life outside of work. That makes us much more prepared to deal with various stressors at work.
Realize and accept that none of us are going to change a person's behavior if they don't want to or can't change. People aren't perfect. They sometimes make very poor decisions for themselves. We can educate and support, but beyond that it's out of our control.
Specializes in Home Health, Mental/Behavioral Health.
The city I live in has, according to stats, has more PhDs per capita than any other place with comparable population size in the USA. The prescription opioid abuse epidemic is raging here just as well.
It is not just coping skills. It is over-stressful work schedules, it is working three jobs instead of one (it is not pertinent why - to feed the kids or to keep up with "everybody else"; latter thing being definitely more common locally); it is insurance which doesn't pay for PT but does for monthly visits to fill yet another script, it is $0 copay refills, it is 2 months wait time for root canal, 3 months for orthopedic surgeon and 6 for podiatrist while being in pain every day and still having to go for these three jobs, it is firm belief in existence of instant gratification of every wish, including momentary relief from every ill by taking some special pill. It is lack of planning in life, loss of understanding of what is important and what isn't and that some things are just what they are.
My kid was attempted to be put on opioids for quite an ordinary, absolutely uncomplicated trauma and when I refused I was treated as a bad mother. Teens are routinely given them so that they could not interrupt their exhaustive sports practices. I'd seen people with two PhDs and MBA coming in and demanding classic "something for pain" because some strain or sprain which MUST be 110% relieved tomorrow, 10:00 AM sharp because they have to play golf with some SVIP or fly across the globe. You may educate these people all you want - they have other prerogatives in life right now, and they will always have them, putting their health and common sense aside... till it too late, for them or for their loved ones.
Even such a radical change as single-payer insurance system will not do anything with the problem till people change the way they go about their lives. "Something is rotten in the state of Denmark".
Love this point of view. Very observant to the circumstances of the community and not just scolding someone as being a seeker. Although there is indeed an epidemic at hand. There are SO MANY contributing factors. The biggest one? I guess that is still up for debate
No, my thoughts are pain scales haven't caused addiction - people with little self control are the root of addiction.
There will always be pain in health care, which requires humane management. When I use a pain scale trying to get a feel for level of pain I give them verbal cues, such as, "If 0 was no pain at all, and 10 was being in a meat grinder, what level would your pain be?". Rarely do I get a 10/10 that I would doubt, but then again I'm not administering narcotics any more in my job - I do telephone triage now, so I help them decide what next to do (home care, appt in clinic, or ER/UC).
There has always been people who milk anything, which is unfortunate, because people who really are suffering many times keep right on suffering.
There are some really good studies on the brain and addiction that you should read. Self control has very little to do with it. One the switch is tripped anything can become addictive.
There are some really good studies on the brain and addiction that you should read. Self control has very little to do with it. One the switch is tripped anything can become addictive.
You have a valid point I'll give you that, but with all due respect (and I really do mean it respectfully) you know this - I mean really know this how? Have you ever been an addict? I have. I have also been in recovery for more than 2 decades.
I had very little self control while at the peak of my addiction cycle. No, that's a lie, I had absolutely no self control left at all. I knew the consequences, but I couldn't control my urges until intervention was held on my behalf. Best day of my life too.
I also have the self control to chose to keep myself clean now. I go 24 hours at a time to the next, one day at a time (not too huge an undertaking when you keep it small) with the bigger goal the rest of my life. It takes work. It's worth it.
I'm not merely misinformed, or as one person said "smug" - nor am I someone who looks down my nose at addiction: I'm a former member of the club too.
I know what it felt like to be completely out of control, and I also what it feels like to make the choice to take control now.
I will acknowledge that for others it may be different, however for me at least choosing to remain clean is very much about choosing to remain in control.
You have a valid point I'll give you that, but with all due respect (and I really do mean it respectfully) you know this - I mean really know this how? Have you ever been an addict? I have: I was an addict. I have also been in recovery for more than 2 decades. I had very little self control while at the peak of my addiction cycle … no, that's a lie, I had absolutely no self control left at all. I knew the consequences, but I couldn't control my urges until intervention was held on my behalf. Best day of my life too. I also have the self control to keep myself clean now. I go from 24 hours at a time to the next, one day at a time (not too huge an undertaking when you keep it small) with the bigger goal as the rest of my life. It takes work. It's worth it.
I'm not a misinformed person who looks down my nose at addicts - I'm a former member of the club too.
yes I do know from personal experience....once the switch is tripped you had little if any control...nor did I or many members of my family.
Before the chemical or psychological trigger, however, no one knows if they have it or not.
I congratulate you on your recovery.
I find it interesting that you consider yourself a former addict.
most of us realise it is a lifelong condition.
Behaviour modification and " self control" are tools used to keep myself from following that path. However the neuro chemical changes are still there and always will be there. I am never one to be self congratulatory on my ability to stay away from my triggers. I know that I am just as fallible as the next person at a meeting. It's a rare person who has never had a slip.
yes I do know from personal experience....once the switch is tripped you had little if any control...nor did I or many members of my family.
Before the chemical or psychological trigger, however, no one knows if they have it or not.
I congratulate you on your recovery.
I find it interesting that you consider yourself a former addict.
most of us realise it is a lifelong condition.
Behaviour modification and " self control" are tools used to keep myself from following that path. However the neuro chemical changes are still there and always will be there. I am never one to be self congratulatory on my ability to stay away from my triggers. I know that I am just as fallible as the next person at a meeting. It's a rare person who has never had a slip.
I formerly practiced as an addict. The SBON only mandated 3 years of recovery - I'm still working at it 22 years later. Everyone else in my nurse recovery meetings left when their time was up - I still go.
Not saying I'll never relapse (I don't have a crystal ball) but I haven't yet. Doesn't mean I won't dust myself off and start again either.
And it is a pleasure - and an honor - to meet another person doing the very same thing. I also congratulate you on your continued recovery.
I hate the pain scale. I hate that I have to document it with every set of vital sign. I have worked in countries where pain was habitually ignored and that is a terrible thing to see. But asking people to score their pain really isn't the answer. It's too subjective to be helpful.
BabyFood26
203 Posts
THANK YOU!!!!!!!