Two Big Questions For Pain Experts

Specialties Pain

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If it's assumed that the patient's pain is ALWAYS what they say it there are two major questions that arise. The questions arise because they are real-life situations.

1. A patient has had surgery that isn't expected to be painful. The patient has had 4mg of Dilaudid for pain that is reported as 10. The patient has a goofy grin and says: "I'm going to say that my pain is a 10 because I like pain medicine." (This actually happened)

Do you continue to administer Dilaudid in this situation? Do you take his report of pain at face value? I was advised by my co-workers to send the fellow home and I did so.....He left smiling......Did we do the wrong thing?

2. A patient is close to being in a Dilaudid coma after receiving 10mg of Dilaudid. The patient appears very comfortable and, when awakened, rates his pain at 10. (This actually happened)

Do we have a pain emergency here? (I've seen many situations that are clearly pain emergencies but this one doesn't seem to be a pain emergency.) Can you in good conscience send the patient to the floor with a pain of 10 under these circumstances?

O.k.....I asked more than two questions but the other questions are tied to the main ones.

Realistic criteria for assessing and treating pain.

After all these posts I'm still not sure what you are suggesting as an alternative.

What EXACTLY are those criteria? I would very much appreciate it if you would list them.

In what way are the criteria that you propose better than patient's self-reported pain/pain scales?

My major concern when assessing pain is sensitivity, I like to identify as many true positives as possible. I believe that patient's self-report accomplishes that goal.

You seem to be more interested in specificity, indentifying the false positives (or true negatives).

Specializes in PACU.
OP- I don't understand why you've chosen nursing. You seem to only want to prove your patients wrong and find ways to avoid controlling their pain.

I don't want to do that at all.....Not even a little bit.

My concerns about our current pain policy have to do with two things: 1. Harm to patients. There are far too many people who have huge opioid habits due to overprescription.....It's a national, and personal tragedy.

2. Forcing idiocy on Nurses makes our jobs more difficult. Controlling pain is a divine calling......I take pain control very seriously. Forcing us to engage in nonsense when addressing pain makes it worse for us and for patients.

Specializes in PACU.
After all these posts I'm still not sure what you are suggesting as an alternative.

What EXACTLY are those criteria? I would very much appreciate it if you would list them.

In what way are the criteria that you propose better than patient's self-reported pain/pain scales?

My major concern when assessing pain is sensitivity, I like to identify as many true positives as possible. I believe that patient's self-report accomplishes that goal.

You seem to be more interested in specificity, indentifying the false positives (or true negatives).

I haven't devised a new system for pain control.......It would almost certainly be a complete waste of time as it would never be implemented.

If someone said to me: "We need your input on a new pain control model" I'd be very happy to propose specific changes.

You seem to be more interested in specificity, indentifying the false positives

I'm interested in controlling pain and I work really hard at it. Forcing us to use nonsensical criteria interferes with proper pain control.

Specializes in PACU.

I guess if I was OP, I would try to get out of direct patient care.

I need to get out of direct patient care for other reasons.....That's for another thread.

The reason I need to get out isn't because of pain control......Pain control is something that I really like doing overall.

I need to get out of direct patient care because I'm getting to old for it........The day-to-day work has gotten extremely complicated what with sweeping changes in computer charting.......I'm good with computers but the complexities of matching screen after screen after screen on the computer with taking care of sick people is are daunting.

Perhaps this is worth a separate thread?

Here's an example of the complexity I speak of: Our Hospital has been changing names about every two years for awhile now due to various mergings with other hospitals and "Healthcare Systems".

We now have a name for our Hospital that is so long, and boring, that virtually nobody who works for the hospital knows the name of the hospital......I've asked around.

Given that almost nobody, literally, knows the name of the hospital and we're being hit with insanely complicated new software programs for insanely complicated patient care there is a case to be made for things being too complicated for human beings to function properly.

Specializes in Hospice.
I haven't devised a new system for pain control.......It would almost certainly be a complete waste of time as it would never be implemented.

If someone said to me: "We need your input on a new pain control model" I'd be very happy to propose specific changes.

I'm interested in controlling pain and I work really hard at it. Forcing us to use nonsensical criteria interferes with proper pain control.

We've already asked what you would propose as alternatives, but have it your way: We need your input on a new pain control model ... what is your proposal?

Specializes in PACU.
but have it your way:

?????

I'm not going to spend weeks, (months? a year?) devising a system that isn't going to be used. That would be a colossal waste of time.

It would be like coming up with a budget plan for our nation knowing that it will never used.

Specializes in Hospice.
?????

I'm not going to spend weeks, (months? a year?) devising a system that isn't going to be used. That would be a colossal waste of time.

It would be like coming up with a budget plan for our nation knowing that it will never used.

Uh-huh!:rolleyes:

Over and out ...

Y'know, sometimes I really miss the old "beating a dead horse" emoticon ...

Specializes in PACU.
Uh-huh!:rolleyes:

You're saying that coming up with a new system for pain control wouldn't take awhile?.......Why are you being insulting here?

A new system for pain control would, in fact, take a long time to devise..........When presented with obvious facts you resort to insults.

Perhaps I could talk to someone with a more adult attitude? Someone who can accept extremely obvious facts?

Specializes in Hospice.
You're saying that coming up with a new system for pain control wouldn't take awhile?.......Why are you being insulting here?

A new system for pain control would, in fact, take a long time to devise..........When presented with obvious facts you resort to insults.

Perhaps I could talk to someone with a more adult attitude? Someone who can accept extremely obvious facts?

Oh, please ... this from the one who calls those who disagree "idiots" and "morons".

Specializes in PACU.
this from the one who calls those who disagree "idiots" and "morons".

It's perfectly acceptable to refer to those who go in for extreme idiocy that way.

Pretending that idiocy isn't idiocy is a crime against truth.

You do realize that devising a new pain system would be a major effort?.......You seem to have a problem with that unbelievably obvious fact.

I haven't devised a new system for pain control.......It would almost certainly be a complete waste of time as it would never be implemented.

If someone said to me: "We need your input on a new pain control model" I'd be very happy to propose specific changes.

I'm interested in controlling pain and I work really hard at it. Forcing us to use nonsensical criteria interferes with proper pain control.

Although I have to agree that the decomposition of the unfortunate carcass is in a pretty advanced stage I seem to be unable to resist the magnetic pull of this thread... :arghh: ;)

OP, what has you so convinced that a new and better way to assess pain wouldn't be welcomed by the medical/nursing community?

I'm not surprised that you can't present an alternative approach that stills ensures that pain isn't undertreated. You are not alone. No one else has either.

That is why we currently use self-reported pain. It's the best we have available to us.

You can call it nonsensical criteria and idiocy all you want, that doesn't change the fact that it's the best we have.

The best nurse manager I ever had used to say: I welcome your (as in all staff) complaints, just make sure that you offer some ideas or suggestions on how we can improve/change the situation.

I agree with that concept. Simply complaining isn't constructive and won't better or improve a situation.

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