How do you all like the pain scale???

z's playa · Dec 18, 2004

Think long term, if someone has worked to very high doses of narcotics they have been on them chronically.
Depression
Anorexia/Malnutrition
Liver Damage
Addiction
Injury related to lack of painful stimuli.
etc. etc.

I was thinking more of the immediate side effects rather than long term damage.

Thunderwolf, MSN, RN · Dec 18, 2004

It is usually not very effective with folks who rate their pain as a #10 (and swear its a #10) as they just get off the phone to get up out of bed unassisted and walk unassisted in order to go outside for a smoke just before ordering that big dinner tray because "the food is great and I'm hungry" and smiling as you please. I know I'm exaggerating here, but you get my drift. For these types of patients, their reported level of pain makes it kind of meaningless. However, the rating scale is helpful in assessing post op pain and evaluating effectiveness of pain management. Some folks in chronic pain may never get below a #5. The importance here is making sure that their level of pain doesn't shoot up suddenly out of control because of being in pain at a chronic level (sort of use to the abuse) and haven't asked for the pain med in awhile, especially before/during/after a bout of activity. Folks in chronic pain and post op pain, in my experience, usually do better if "routinely" medicated instead of waiting for the pain to be reported at a #9. I honestly believe that it is easier to keep the patient more pain free if you achieve and maintain their steady state of reduced pain than to put out the fires and ride the roller coaster of pain by only medicating when it begins to hurt "bad"....Ooops, that is not a number, forgive me, let's say #7-10. In the long or short of it, the scales work well in the post op setting.

Thunderwolf, MSN, RN · Dec 18, 2004

It is usually not very effective with folks who rate their pain as a #10 (and swear its a #10) as they just get off the phone to get up out of bed unassisted and walk unassisted in order to go outside for a smoke just before ordering that big dinner tray because "the food is great and I'm hungry" and smiling as you please. I know I'm exaggerating here, but you get my drift. For these types of patients, their reported level of pain makes it kind of meaningless. However, the rating scale is helpful in assessing post op pain and evaluating effectiveness of pain management. Some folks in chronic pain may never get below a #5. The importance here is making sure that their level of pain doesn't shoot up suddenly out of control because of being in pain at a chronic level (sort of use to the abuse) and haven't asked for the pain med in awhile, especially before/during/after a bout of activity. Folks in chronic pain and post op pain, in my experience, usually do better if "routinely" medicated instead of waiting for the pain to be reported at a #9. I honestly believe that it is easier to keep the patient more pain free if you achieve and maintain their steady state of reduced pain than to put out the fires and ride the roller coaster of pain by only medicating when it begins to hurt "bad"....Ooops, that is not a number, forgive me, let's say #7-10. In the long or short of it, the scales work well in the post op setting.

SarasotaRN2b · Dec 18, 2004

I think that this is a great way to write it up. You are writing what the patient feels their pain is but also using your assessments as well.

In general, I use the pain scale. But sometimes I have a confused postop patient and I'll use the "Patient exhibits s/s of pain AEB facial grimacing, elevated BP, restlessness, or crying out."

For the suspected pain med abuser, I'll write, "Pt rates substernal chest pain at 10 out of 10, and states that Nitroglycerin 'doesn't do a thing, so give me Demerol.' Pt's vital signs are stable, EKG reflects NSR and no change to baseline EKG. Pt also offered Mylanta as Pt was earlier observed having Taco Bell food for supper, brought in by S.O. Pt refused Mylanta, stating 'I hate the taste of it and it doesn't do anything for me either, but I could use some Phenergan.'"

So I just kinda write what I see--whatever the heck it is.

SarasotaRN2b · Dec 18, 2004

I think that this is a great way to write it up. You are writing what the patient feels their pain is but also using your assessments as well.

In general, I use the pain scale. But sometimes I have a confused postop patient and I'll use the "Patient exhibits s/s of pain AEB facial grimacing, elevated BP, restlessness, or crying out."

For the suspected pain med abuser, I'll write, "Pt rates substernal chest pain at 10 out of 10, and states that Nitroglycerin 'doesn't do a thing, so give me Demerol.' Pt's vital signs are stable, EKG reflects NSR and no change to baseline EKG. Pt also offered Mylanta as Pt was earlier observed having Taco Bell food for supper, brought in by S.O. Pt refused Mylanta, stating 'I hate the taste of it and it doesn't do anything for me either, but I could use some Phenergan.'"

So I just kinda write what I see--whatever the heck it is.

oneLoneNurse · Dec 22, 2004

From the IT perspective I think the Pain Scale is a necessary evil. We need to capture what the patient is feeling prior to giving him/her medications to address the problem. Pain is very subjective, yet the Pain Scale is an attempt to make it Objective(poor though it may be, I can't think of anything better).

I personally admit to being a whas(sp?).

graysonret · Dec 22, 2004

Personally, I much prefer the 1-5 scale than the 1-10. Patients find it easier to use and I use it to get a "ballpark" figure anyway. I do remember, however, in documentation, to state that I used 1-5, so as not to cause any confusion.

purplemania, BSN, RN · Dec 22, 2004

The scales are there to help you assess the patient in objective terms and to determine if your interventions are effective. Why give morphine when Tylenol will do? Saying "I hurt" is so objective, and the nurse can be blamed for giving too much medication (sedation, constipation and other side effects) or not enough. So the scale helps you help your patient while giving you a tool to justify your interventions.

TiffyRN, BSN, PhD · Dec 22, 2004

I don't miss the 1-10 pain scale. I like the NIPS we use (neonatal infant pain scale). It is very easy (perhaps over simplistic) and completely based on the nurse's objective assessment. Not that I discount subjective input from patients (I was always very generous with pain meds) but I don't miss it.

I didn't have much respect for the 1-10 scale, most hospitals I worked at just wanted some number to plug into some worksheet so it looked good for JCAHO. I totally lost respect for it when I had a patient who was allegedly narcotic naive using 200-300mg of Demerol (yea I know, demerol is evil) every 4 hrs with a PCA claiming her pain never moved from a 9. She wound up with a diagnosis of IBS. It took her doctor sitting her down explaining that a "9" meant she couldn't function, brush her teeth or concentrate on a conversation. I'm not saying I agree with him but the patient started rating her pain lower, we worked through her symptoms, lessened them and she went home with her pain under control. Until she came to that understanding though everyone was frustrated. She stated when she went home her pain was well under control and at a tolerable level (though I don't off hand remember the exact number right now).

shell911rn · Dec 23, 2004

I think the 1-10 scale is too complicated. If a patient is not feeling well and in excruciating pain, to try and concentrate on an explanation of this scale is ridiculous and just pure torture to patients who are actually in pain. I go ahead and rate them at a 10 myself when they are this bad off (our 1-10 scale is linked up with the faces scale anyways which makes this easy to do) and medicate them as appropriate and then chart when the Pt.'s pain level is "tolerable" or "mild" or "moderate" or chart the patient's actual words such as "I feel much better" or "the pain is increasing" etc.

Michelle

Mistorri · Dec 23, 2004

I have problems with the pain scale much as I have seen everyone say on these posts. You have to tell a patient that a "10" on the pain scale is not only the most excruciating pain they have ever felt, but: they are in so much pain that they are thrashing on the bed, unable to think on anything except the pain, they would like a bullet in the brain to end it! That is a "10"! The nine is a little bit less, at least you can forego the bullet! The 8 is a pain that you want to scream about, but not so bad that you can't think of anything but the painl They have to understand that the higher the number, the less the patient will want to hear your voice or cooperate with anything you say because they are so wrapped up in the intensity of the pain that they can't deal with anything else but that pain. Like one post said: "They won't be eating taco's and chatting"! that is for sure! I know what a "10" is because I had a back surgery and after going back to the doctor's office for my first checkup the pain was like a very sharp throbbing in my spine. If anyone knows what an exposed nerve (like with a tooth) feels like when something touches it. EXTREMELY sharp pain, and throbbing, that is what it was like. That lasted 2 hours after the two pain shots I was given in the ER to stop the pain. It was out of control. That was when I wanted the BULLET! I begged for a bullet. So, I understand real pain. Not the chatting and eating taco stuff. When they tell me it is a "10", I dig into the explaination of just how bad a "10" is! LOL! God bless you all!

General E. Speaking, RN, RN · Dec 23, 2004

Do you use pathways? (Pneumonia, Chest pain, CHF) Our hospital has been cracking down on following these pathways for certain admission diagnosis. Apparently, it has to do w/ reimbursment from Medicare... Some of our docs are resistant. "I don't need a piece of paper to tell ME how to treat my pt, etc..." It is putting the nurses in an awkward position because we are expected to scrutinize the charts and then call the physician and remind them about certain labs, tests, meds the patients should be getting on Day 1, Day 2... Or the pathway is filled out half a$$ and some things are checked but other required things are omitted. Or some doctor's hand write most of the pathway orders out and we are expected to refer back and forth between the handwritten order and the pathway so that everything is done appropriately. Too much room for error IMO. I think the hospital should go after the doctor's to ensure these are carried out, not expect/require that the nurses continue to REMIND the same doctor's over and over on how to do their job.

I guess I am just angry because it always falls back on the nurse's shoulders. Housekeeping can't clean up puke off the floor- nursing has to wipe up the chunks so they can mop. Pharmacy isn't in the hospital 24 hrs per day so nursing is expected to run from pyxis to pyxis looking for all of our 0900 meds. The nurses aide is busy picking up dinner trays and can't stop to take someone to the bathroom so the nurse has to stop what she/he is doing to assist. I have been nursing a long time and realize the patient's needs are my primary responsibility, it just seems more and more "other stuff" is being dumped onto already tired shoulders.