Pain is a pain

[ladedah1]

Sometimes we nurses just need to vent about the problems that tend to reemerge in our everyday lives… problems that are potentiated by annoying policies and practices which are often applicable to a few, useful for some, and just plain ridiculous for those certain” individuals. You know the ones I'm talking about… those patients for whom pain is a 10/10 when they are balled up in tears and somehow still a 10/10 when they are laughing and talking on the telephone...

Just because someone can spout out a number, it doesn't necessarily mean that they have given the proper time or consideration to answer this one simple question accurately at all. But when we try to help them clarify, so your pain hasn't improved at all since I gave you that medication” (ehem… dilaudid) as we think to ourselves seeing how I just woke you up from your seemingly pleasant little nap.” And because there are meds still available... and the patient is still somehow A&Ox4… and they say, No, It's not any better”… here we come with some more meds (because, heaven forbid, someone is in pain” and we don't do anything about it)… so, once again, here we come an hour later to reassess… and still a 10/10...

If pain is what the patient says it is,” then exaggerating is what a nurse says it is… (On a scale of 0-10, with zero being appears accurate” and ten being not even close,” how would you rate this patient? -----where on earth is this question next to the pain scale?)

It's not that this topic hasn't been broached before, but it's an issue that never seems to go away – especially if you work in med-surg. Pain… sometimes it's just a royal pain in the…

Disclaimer: I am totally an advocate for ensuring adequate pain control for people who are in pain and need pain management. I believe I may have thought the word "seeking" a total of once (in an incredibly obvious situation) in my entire nursing career. I am just not an advocate for the 0-10 scoring scale on ALL patients... oriented does not always equate to honest and / or accurate self evaluation.

So what is it that bothers you all today? Any thoughts?

[Ruby Vee, BSN]

Pain is 100% subjective. The prudent nurse looks at the patient and their presenting symptoms.

My father had 10/10 pain. It was neurological pain that narcs could not cover. Took 80 mg of morphine/ hour to get him comfort.

Bottom line.. do whatever it takes to releive pain.

Pain may be 100% subjective, but as you said yourself, the prudent nurse also looks at the patient and their presenting signs.

I'm sorry for your father's pain. Neurological pain is very, very difficult to treat, and it's difficult because even though you can LOOK at your limb and see it isn't on fire or being sawed off, your pain receptors tell you something different. I'm sure you can agree, however, that isn't the norm.

As a CVICU nurse, I've encountered numerous patients in recent years who were told by their surgeons and anesthesiologists that they would experience NO post-op pain, even though their sternums had been sawed open and they were on the operating table with retractors holding the chest open for many hours. That's just not realistic. I have tried to educate and to reason with my patients -- but it doesn't always "take." Even, "I can take all of your pain away, but then you wouldn't breathe" doesn't seem to get through.

We cannot "do whatever it takes to relieve pain." Most patients (and I'm excluding terminal patients who are being made as comfortable as possible) need to breathe. Being on a ventilator until their surgical site is healed enough to preclude pain just isn't possible, reasonable or desirable. So we cannot take all pain away. We just can't. Patients will have to live with some pain.

[Ruby Vee, BSN]

An interesting aside.... my current hospital is taking high dose morphine and Dilaudid OUT of the our ER completely. They will not even be an option at that level of care. Will be interesting to see what that does to the ER visits seeking pain meds.

I'm really interested in how that will work out.

I'm not an ER nurse, but I've been in the ER, either for myself or a loved one several times in the past few years. I was shocked at the drama ER nurses have to put up with, even though I'm a regular reader of the ER nursing forum. Sitting in triage with chest pain, left arm pain, a toothache on the left side and shortness of breath (classic signs, right?) and people who are munching on chips, swilling Big Gulps and chatting on their cell phones step around the desk to demand "That D-drug" for their "horrible pain" and insist that they're on the verge of dying (at maximum volume). People who scream obscenities at the staff because they're greeted with skepticism that "somone stole all my medication" for the third time this week. Of course they don't need refills on the hypertension or diabetes meds; it's all about the pain meds.

I think anything that will reduce ER visits by drug seekers will in the long run benefit all of us.

[Nurse SMS, MSN, RN]

Pain may be 100% subjective, but as you said yourself, the prudent nurse also looks at the patient and their presenting signs.

I'm sorry for your father's pain. Neurological pain is very, very difficult to treat, and it's difficult because even though you can LOOK at your limb and see it isn't on fire or being sawed off, your pain receptors tell you something different. I'm sure you can agree, however, that isn't the norm.

As a CVICU nurse, I've encountered numerous patients in recent years who were told by their surgeons and anesthesiologists that they would experience NO post-op pain, even though their sternums had been sawed open and they were on the operating table with retractors holding the chest open for many hours. That's just not realistic. I have tried to educate and to reason with my patients -- but it doesn't always "take." Even, "I can take all of your pain away, but then you wouldn't breathe" doesn't seem to get through.

We cannot "do whatever it takes to relieve pain." Most patients (and I'm excluding terminal patients who are being made as comfortable as possible) need to breathe. Being on a ventilator until their surgical site is healed enough to preclude pain just isn't possible, reasonable or desirable. So we cannot take all pain away. We just can't. Patients will have to live with some pain.

Ever get 'am asking to be reintubated until the sternum healed? I had one!

[Ruby Vee, BSN]

Ever get 'am asking to be reintubated until the sternum healed? I had one!

I had one too. Whining 52 year old who wanted his Mommy at the bedside at all times. Poor old dear was in her 80 s and one night in our chairs nearly crippled her.

[OyWithThePoodles, RN]

I don't care for the 0-10 either, "zero being no pain and 10 being the worst pain you've ever had".

I used to rate migraine pain 8/10, or a bad ankle sprain 8/10, as those were about the worst pains I had had. Then came my second c-section where my BP was 220/118, HR 20, my head hurt so bad I was legitimately concerned that I might stroke out on the table and couldn't control the God-awful screams that came from my mouth. THAT was the worst pain of my life. A terrifying, is someone stabbing me, pain.

Now, after experiencing that pain, I rate my pain a little different. My broken ankle was a 6/10. It still hurt like ****, but nowhere near that c-section. It is certainly frustrating when a patient is rating a 10/10 for abdominal pain, horrible nauseated and needs Phenergan "not that Zofran stuff, it doesn't work for me", and then calls a family member to stop by McDonald's for them. You KNOW they are lying to get the drugs they want and it makes you want to flick them on the nose and say "Stop it!". But we don't get paid to write the orders. We carry them out.

I love my docs who will listen to me when I tell them about that abd pain/nausea patient sneaking in food. They cut off the narcs. And miraculously the patient gets all better and can be discharged. We had one doc who would let the patient know that if they were getting pain medicine they couldn't go out to smoke. If they did, they would be discharged. And he stuck to it...I miss him.

[TeeKay12]

I ask the patient what the worst pain they ever had, and how this pain compares. I started doing this after my nephew was in ED for RUQ pain, and stated his pain was a 4/10 to the question of "1 being none, and 10 being the worst you've ever felt". They almost sent him home, but his mom was talking to me and i quickly said "Tell them what his WORST pain WAS" Yeah - the barn suddenly collapsing while he was in the loft, and breaking both of his ankles. An US was completed, and he had an emergency lap appy.

I hate the pain scale. I'd actually much prefer scheduled pain meds at a reasonable dosage than trying to chase the "pain" each and every one of my patients has as soon as their alarms go off (night shift, they're setting their phones for q1, q2, etc.). Or the elderly woman who tells me all night she's fine, no pain, but then her son or daughter who is a nurse comes in and suddenly she's writhing in agony!