Questionable Pain - page 2
Hi. I know that we are supposed to take our patient's word for what there pain level is, but has anyone ever experienced questionable pain in a patient that even the doctor can find no known cause.... Read More
Nov 7, '03Occupation: RN-i (RETIRED) Specialty: ORTHOPAEDICS-CERTIFIED SINCE 89 ; From: US ; Joined: May '00; Posts: 14,479; Likes: 2,298Fgr8Out, excellent post. Pain is what the patient says it is. That says it all.
There are drug-seekers and then there are drug-seekers. Have you ever had so much pain you couldn't function? One of those functions is rational thinking. I have had pain so bad I couldn't remember to take or ask for an analgesic.
So far I have pretty much avoided most narcotics. I know that the day will come when I will ask, I hope someone as compassionate and fair will not deny it.
Nov 7, '03Joined: Dec '02; Posts: 41,761; Likes: 48,078Fgr8Out - agreed! Great post.
I would never give a placebo for the reasons you so aptly stated.
And it bothers me that a patient's pain is discounted.
Nov 7, '03Joined: Jul '00; Posts: 11,351; Likes: 387That is a really neat article Steph! I am with you all, I would rather err by giving an addict a drug than by denying anyone pain control. There is so much about the body that we can't understand yet that I think it is a little arrogant to discount someone's pain because a doctor hasn't been able to diagnose a reason for it yet.
Nov 7, '03Joined: Sep '03; Posts: 1,199; Likes: 1,525Just had a patient last night who after back surgery was having headaches, per the patient " they did a lumbar puncture and it came back negative but I was still getting the headache, I couldn't lift my head off the pillow without screaming. After the surgeon visited the patient tried to sit up and started screaming only then when the surgeon heard her from out in the hall did he come back in and said has your head been hurting that bad all along and she said yes. He took her for an exploration of her back and found a large leak in a hidden area. Once it was fixed after 3 days of complete flat bedrest she was fine. She stated she is sure the nurses and other doctors just thought she was wanting drugs"
Isn't that sad. I agree error on the side of giving drug seekers pain med instead of witholding from a patient who truely needs drugs.
Nov 21, '03Joined: Sep '03; Posts: 1,214; Likes: 63Firstly, as a nurse I would have never carried out an order to replace a pain medication with NS.
Secondly, as a practitioner I would never associate myself with a person who would write such an order.
You cannot say that pain is subjective to the person, and then turn around and say that you think this person is seeking. Things just don't work that way.
Finally, good work on mixing the phenergan in NS. Unless I am in an emergency situation, I never order straight phenergan. I've seen some very strange things with striaght IVP phenergan, even had to pace a guy from it when I was in BSN school.
Nov 22, '03Joined: Dec '02; Posts: 1,055; Likes: 14Just had a TAH. For me this was a very painful and unpleasant procedure. I had been very concerned before surgery dt the fact that I also have fibromyalgia, RLS and PLMD. I was afraid because of the reluctance to aggressivley treat pain my pain would not be well controlled. My reg MD was worried about this as well so not only did I talk to my gyn but so did he. I was assured that there were many options and that my pain would be well controlled. Over all it was not. Imediately after surgery I had pca of fentanyl worked some but not real well took pain from 9 to 7or 8 she added toradol which did help pain about 6 which was bearable. Problem was whenever I would fall asleep and not push the button enough I would wake up in horrid 9/10 pain. Called for nurse which I tried very hard never to do but could not handle the pain. It took a shot and her staying with me to push the button several more times to get it back under control. What I could not believe was that just 3 hrs later my IV infiltrated so they took away the pca not even 24 hrs after surgery and began po percocet which I had and my reg MD had told them I use on a reg basis for fibro pain(that is the drug my insur. co covers) Obviously this did not work and out of control we go again. I called the nurse again who was not very sympathetic needless to say in all honesty I laid there crying and writhing in pain for 2 hours talking off and on to DH on phone begging him to take me home as at this point I was ready to self medicate. Eventually he ended up calling gyno and getting me a shot which I continued to get that day and the next even though the nurses never failed to remind me that this was not the normal protocal. I was suppose to be released on Thurs or Fri but Wed night told my gyno I was a nurse and I know myself and I would do better at home. She consented and gave me instructions to return if pain not controlled(yea right) or if temp which was 99.3 increased to 100.5 to return to hosp (not). I do think I am doing better at home and my temp is running 99.5 to 100 but I had so much gentomyacin in hosp this should not be a prob. I see one of her associates mon to have staples removed. My reg Md now that I am home is letting me use the higher dose of percocet along with plain ibuprofen in between to keep pain tolerable. It is now a manageable 5 or 6 on my own here at home I will never trust another hospital ever again. For me it was a horrible experience. Believe me I am not a drug addict or abuser but sometimes I think it would be easier if I were.
Nov 22, '03Occupation: Registered Nurse Joined: Feb '03; Posts: 299; Likes: 24Pain is what you (the one experiencing) percieve it to be. Some have a tremendously low pain tolerance others are extremely high.
When I gave birth to my third child I showed up at admitting with back pain 0300 Explained at triage that I just couldn't get comfortable, I was unable to sit down. Upon exam RN says you should have been here hours ago.
Dilated at 10 head presenting. delivered transverse 45 minutes after being transfered to delivery even broke my tailbone. I didn't believe I was in that much pain and I certainly didn't think I was in labor. I only had this very uncomfortable back pain.
Yet if I stub my toe or bark my shin you'd think I had broken something into 100 pieces
Remember the pain is what it is percieved to be.
As for drug seekers they tend to have very low tolerance for anything.
Nov 25, '03Occupation: lpn Joined: Sep '03; Posts: 27Ditto, Ditto, just wanted to applaud you on pain control. If someone says I'm in pain, who are WE to say, YOU HAVE NO PAIN OR THEY'RE WATCHING THE CLOCK!! Sure, there may be a few that are watching the clock, but we've got to give them the benefit of doubt, when they say, IM IN PAIN PLEASE HELP ME, OR OTHER SIGNS SUCH AS GUARDING, FACIAL GRIMACING, FURROWED BROWS OR THEIR AFFECT!! PAIN IS A SERIOUS PROBLEM AND WE NEED TO REALLY INSERVICE OUR STAFF, PROFESSIONAL AND NONPROFESSIONAL, BECAUSE IMAGINE YOURSELF ON THE OTHER SIDE C/O OF PAIN!!! Lord, please help us to address this vast area of the unknown KNOWN AS PAIN!!!
Dec 3, '03Occupation: RN Joined: Jun '00; Posts: 261; Likes: 4I just took care of a 19 yr old woman that was having unexplained epigastric pain. This lady lossed 100lbs in the last 2 yrs. N/v. She was also a diabetic. Her pcp seems to think it was all in her head. He prescribed a placebo prior to giving pain medication. I called the surgeon that was consulted and more or less was told by him it was unethical but he was not going to dog another physician. The pcp came in the next day and wrote to dc the pain medication and I was all over him. I told him I wasn't going to lie to my pt and she was in real pain. So he still wrote for the placebo. In between pain times I told her that I was going to give her something and she had to be very honest with me aboout her pain I gave 3cc 0.9 ns and came back in 30 minutes and said your pain is still a 9 isn't it.? yeahh!!!! I can't believe a doctor would do this she had gastric emptying study done. After 90 minutes 88 % remained in her stomach. She was transferred to the cleveland clinic for a possible stomach pacemaker. I went to everyone I could think of and wrote the doctor up also.
Dec 3, '03Joined: May '03; Posts: 662; Likes: 12I can remember way back when, when it was much harder to get anything for pain as a patient.
I am thankful that today that most nurses and doctors understand that a patients comfort is very important.
I must have a very low threshold of pain myself. I am thankful for the times I was able to recieve pain meds to help with it. I do remember times when the pain meds were not enough and there wasn't anyone suggesting anything stronger than a Tylenol 3 w/Codeine. After having a uterine suspension I could have used something like Morphine, and I wasn't a frequent flyer or a seeker. Was glad that after I had my gallbladder removed I was given Morphine, it was a God-send...helped get me home and recovering in the bosom of my family. Something else I remember from when I had my gallbladder removed...I was having that pain in the shoulder area, and hurt when I breathed...nurse brought me an anti-spasmodic and that relieved the pain TREMENDOUSLY. I think I can thank the nurse for thinking of that instead of asking the doc to give me more morphine when that was not needed.
Migraines are another thing I suffer from. I have prescription meds I take for those, but sometimes that doesn't work...I wonder the couple of times I have gone to the ED if they thought I was a seeker.
I am hoping that as I become accustomed to dealing with patients on a daily basis when I become a nurse that I will be sympathetic to the ones who say they are in pain. It would be easy, I think, to label someone who comes in with pain frequently, wanting pain meds, as a seeker. I just hope that I will remain sympathetic myself.
Dec 9, '03Occupation: RN, surgical floor Joined: Jan '03; Posts: 203; Likes: 14I try to take the patients pain for what they say it is, I hear nurses often complaing about "clock watchers" and I have done so a time or two myself. I always medicate the patient for pain, and will call the doctor if the pain is uncontrolled...makes your day easier to treat the patients pain or you may have a patient who is in pain and mad...bad combination.
Dec 14, '03Occupation: Acute Medicine/ Palliatve Joined: Dec '02; Posts: 274; Likes: 4As stated by Mc Caffery in various literature "Pain is what ever the patient says it is and existes when he/she says it does"
I believe this to be true. Who are WE to judge because nurses hold the keys to the locked drawer.
Dec 14, '03Occupation: Operating Room Nurse Specialty: 5 yrs OR, ASU Pre-Op 2 yr. ER ; From: US ; Joined: Jun '03; Posts: 17,036; Likes: 1,006We have a frequent flyer who winds up on our floor every other month who always rates his pain at a 9 to get his oxycontin. His diagnosis is "intractable pain".
Ironically, he can't tell you WHERE he hurts though, he thrashes around and wimpers in pain when you're in the room, but if you pull the door closed, and leave a crack in it JUST enough to see in, he IMMEDIATELY calms down and is quiet, arms folded up behind his head in a relaxed manner.
You only have to tell him one time that he can only have the med every 6-8 hours when he arrives on our floor (depending on the doc's order. Tell him this at 8 pm, it's a 110% guarentee that at 4 am on the dot he will ring for his next dose. This has gone on for over 3 years now.
But, pain is whatever the pain says it is. Not saying i don't believe him but as soon as the he thinks the door's closed, he's a 180 degree oppposite of while you were standing there. Maybe his mentaliy is that he must act like that to be believed, i don't know.