Pain-How do we know??

Specialties Operating Room

Published

I work on a post op surgical unit. After two years, I still have not been able to put all of my biases aside about pain medications. I am usually a pt. advocate for pain relief immediatly after and 24 hours postop. I have problems with wearing my feelings on my sleeve and my patients ask me why I get mad at them if they are still requesting IV pain med every hour after two days. Ironically,oral pain meds I have no problem giving every 3-4 hours. My question is how does one get over this? I know it is a problem and it bothers me to know that I am like that. Any suggestions will be joyfully accepted.

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Sunshine,

You describe a very common "bias" in the health care field. There are several reasons behind these feelings, including:

1) our own family histories (is someone in our family chemically dependent?)

2) our culture (we have a drug "war" going on)

3) the biases of our instructors and colleagues

4) lack of formal training/education in pain and pain management

5) lack of an objective pain monitor (i.e., there is no "dynamap" or "thermometer" for pain readings. We have to rely on what the patient tells us, which can be a scary thing, especially if we "believe" patients will become addicted to intravenous medications.

Margo McCaffery, RN has an excellent book called: "PAIN, A Clinical Manual for Nursing Practice" (McAffery and Beebe). You can order the book through any book store or from Amazon.com (http://www.amazon.com/exec/obidos/ASIN/080163248X/midwestanesthesi/002-1046947-2636411)

Good luck!

------------------

Jack

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Do you have a "pain mgt. nurse" in your institution? Check that out. Also, the receptors that relay our temp and pain are the same pathways. Have you made sure your patients are warm? I mean really warm, core warm? Often pts are cold post-op. We have alot of talk where I work about it. We pre-warm our OR pts. and keep them under a bair hugger for the first 12-24 hrs. We find they use less meds and have less complaints. There is literature to back this up. Check it out!

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ps--also PCA pumps may be a good idea for you. If you have a bias and really don't want to give IV meds then let the pt. control that end of things. You may find that you are okay with things afterall.

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Specializes in jack of all trades, master of none.

As a nurse, & a patient who has suffered from chronic, severe pain for the past several years, I would recommend getting that book that was mentioned.... and pray, really pray, that you NEVER have to be that pt who is being cared for by a nurse who doesn't believe the extent of pain. It's horrifying when the person caring for you thinks you're a drug seeker. If we could only switch places for a few hours... I don't think you'd ever doubt again.

And, maybe try a different unit. That may help some.

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You can't possibly KNOW what pain a patient is feeling. Are there some who ask for IV meds just for the buzz? Probably. But most are probably asking for the meds because they truly have pain. Pain is highly subjective and the pain that you can tolerate might be unbearable to me.

I was taught that pain is what the patient says it is. Why ask them to rate their pain on a scale of 1 to 10 if you're unwilling to act on that rating and medicate them accordingly? No offense intended, but it's about the patient, not about you.

That said, I also like to suggest things to patients to minimize unnecessary meds eg relaxation techniques, etc.

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I have been thinking over this question of "How do we know?" Well, like any other pain we "can't see" you need to find a resource that will help you to drop your biases and learn to assess every individual pt. The majority of patients are not seekers--try to practice to the majority. It is always easy to fall into the trap of "oiling the squeaky wheel" the trick is in knowing what that "squeak" is from!!!

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