Pain is NOT subjective

[SunnyAndrsn]

Today I got called into my DON's office, where our executive director--who is not a nurse--yelled at my for charting "Pt. states pain is an "8/10". I listed my interventions, what her response was, etc. ED told me that "If her pain was really that bad, we should be sending her to the hospital. You need to do a full assessment then to see if that corelates to what she's saying." I asked her if she was concerned about drug seeking....

This pt. is A&O x4, has an infection in her hip incision, AND has fibromyalgia, for which she takes methadone 5mg BID. "You need to use the faces scale then if the objective assessment does not agree with what she's saying."

And then what? Only give her 1 pain pill instead of the two that I did that reduced her pain to a "3/10"???? She had previously stated "7/10" and the day nurse gave her one vicodin and vistaril, she was asking for more within 3 hours...

What ever happened to pain is subjective?

And I wonder why I can't get anyone to believe me about MY pain issues.

[sewnew]

I know this is an old thread, but had to put in my 2 cents, for what its worth!

Unfortunately the signs that a "DrugSeeker" exhibits are pretty much the same as a pain patient that is not getting adequate relief. i.e. requesting additional dosages, "clock watching" and asking for next dosage early or right on time, telling staff what meds do and do not work for them...etc. etc.

Just something to think about...

K-

This is exactly why chronic pain patients often avoid going to the ER if at all possible...

[TallFNP]

Just want to add something to those who c/o fibromyalgia pain. Please get your vitamin D level checked. Low vitamin D levels can cause bone pain deep down and make your muscles ache as well. Probably not a cure, but ya never know.....might help.

Also, people who come into the ED in horrible pain are almost never actually talking. They're in the fetal position and breathing weird, sweating, pale, and all sorts of things. There are indeed objective signs, and we can't go just by subjective, just like we can't go just by objective; we need both.

Drug seekers are famous for being allergic to everything non-narcotic and wanting that drug that starts with a ....... just can never quite remember the name until you say it. Then, "that's it! That's the only thing that works."

No one should need narcotics for fibromyalgia. If you do, you need to go to a different provider who is better able to take care of your pain.

[Fairlythere, ASN, RN]

I agree that the drug seekers are ruining it for all of us. It is a shame that people abuse the system. I agree that some people really do have pain and suffer needlessly but others abuse the system. How can we help these drug seekers?

I agree drug seekers are difficult to deal with, however at a recent conference on Pain Management, Nancy Pasero, who wrote the Pain Management manual, reminded us that addicts have pain also. They ask for frequent meds because they generally take more when they are not hospitalized. It is not our job to detox them. It is not for us to worry they are going to be "addicted", they already are. Some "seekers" are actually experiencing "pseudo addiction" which if their pain was adequately managed, they would not be "seeking".

Also, on the subject of the pain scale, the tool needs to be properly explained to the patient. Many of my RNs walk into a room, ask for a "number" and leave. The patient may never report his number is less because he is afraid that his pain gets under control, he will be given less meds or not be monitored as well and his pain will return. Good trust between patient and RN working together will help. EVERY patient deserves pain control treatment, EVEN the "addicts". I do believe the docs do them a disservice sometimes by writing orders for standard PRN medications for them, like "dilaudid 1-3 mg q 4hrs iv". Of course the addict will ask for that on the dot every four hours. Scheduled meds, around the clock, using less opiates and more multi-modal approaches will treat them much better. Read Pasero's book, it is a real eye opener and helped me understand how I have poorly treated "repeat offenders" on my unit because I didnt want to deal with their "supposed pain". Who are WE to judge? We are supposed to advocate for our patients.

By the way, I am NOT saying we should willy-nilly give any old med to anyone. Of course monitoring for adverse effects, over sedation, and trying the least invasive or least narcotic med combinations possible are always front line in treatment. Im just saying we should work WITH the patients. I cannot tell you how often in a short period of time since that conference the trust and explaination of the pain scale approach has made a difference for my patients. :heartbeat

[ebear, BSN, RN]

So true, TallFNP! I kept having this deep down muscle pain for years. Providers wold roll their eyes and give muscle relaxants, etc. A smart FNP FINALLY did Vit D level. It came back at 15! After treatment, I feel like a different person. THANK GOD!!!!

[tewdles, RN]

I just love the folks who doubt the report of pain because that is not "their experience"...lol

To the poster who has never seen a man with fibromyalgia...just because you have not "seen" something does that mean it has not existed? Interesting...some people feel that way about the holocost...they didn't see it so it must be made up.

By the way, have you ever personally cared for a man with breast cancer? How about a child with Holt-Oram? If you have no experience with that does it mean that they are phony?

Please tell me that not all EDs are filled with such biased and ignorant nurses...

I am not sure where tenexe went to nursing school, but my school had a focus on patient advocacy. Our job is not to generate a medical diagnosis or to prescribe medications. We assess and report. MDs prescribe. We administer with prudence and the intent to improve the situation of the patient.

Nurses who get confused about their role in health care delivery can cause significant harm to patients who need good nursing care. The ED nurse is not charged with diagnosing addiction and is not authorized to make moral or social judgements about the patient.

[meeka720]

After working in a LTC/Rehab facility it is often easy to start to think that (with a specific few patients) there is no way their pain in that bad! And you do begin to think that they are all drug seekers.

However yesterday I was reminded that pain is real and it is subjective! I had a root canal done and toward the end of the procedure the anesthesia started to wear off and I could feel what the Dentist was doing. I left with a script for PCN and IBUP 800...which did not even touch the pain. With in 1 hour after the procedure I was in so much pain that I was rocking back and forth on my couch in tears, I was attempting to inflict pain to other areas of my body in hopes that the pain that was engrossing the whole right side of my head would somehow be forgotten. I thought about running outside down the street in the blistering cold and snow in hopes that I would somehow run away from the feeling. Luckily I was able to reach the dentist before he left for the day and he was able to call in a script for something a little stronger. 2 doses of IBUP 800 and 2 doses of vicodin later...the pain has subsided. Its still sore and the pain is tolerable. I am able to be at work with just the ibuprofen as the vicodin makes me feel groggy.

But after my experience, I wonder about people who are locked away in coping units...people who everyone deems crazy as they rock themselves back and forth, or inflict pain to various parts of their bodies. Maybe...just maybe they are in pain and don't know how to verbalize it...or worse no one believes them!

I'm am going to continue to practice the way I was taught...Pain is whatever the patient says it is!

[enchantmentdis, BSN, RN]

Why are us healthcare professionals (RNs and MDs) so afraid of getting "suckered" into giving pain meds to drug seekers? I understand all of the legalities of it, but I'd rather adequately medicate my patient. I am also adding my !!!!!!

:uhoh3:

Because it is such a pain in the butt having drug-seekers control your shift all day begging for narcotics q 2hrs, eating everything in site, and jabbering non-stop on their cell phones. They need to grow up and realize the nurse is caring for several patients at a time. They treat the hospital like a hotel. If a patient is in severe pain his behaviors will reflect that--the patient might not holler and cry, but might be quiet and moody. The nurse must ask lots of questions to really ascertain the true level of pain. Because of lawsuits ever increasing in popularity in the US, drug seekers are very keen to cry lawsuit if they don't get what they want. Thanks to our freaking politics. These bums only grow a brain when it is time to get a professional stripped of a job or a license.