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Discussion

Pain scale is missing a key element

I don't like the question, "On a scale of 0 - 10 with ten being the worst pain you have ever experience..." The problem is that no one ever seems to ask what IS the worst pain the pt has ever experienced. I spent three hours in an ER with my ovary twisted and no pain killers because two different MDs insisted I was "just constipated" and over reacting because I was an adolescent. So if I say something is a 5 it means it is half way to that, and that's actually pretty bad. I wonder how it is possible to properly assess a pt.s pain level without knowing what ten actually means to them.

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I spent three hours in an ER with my ovary twisted and no pain killers because two different MDs insisted I was "just constipated" and over reacting because I was an adolescent.

I think that's awful! As a student, we're taught that "pain is what the patient says it is." Everyone has a different tolerance and who am I to judge what you feel?! Even if you were "just constipated" if you were in that much pain you should've been treated. My daughter has had 2 cases of fecal impaction and trust me, she was in pain! lol

You make a good point though. Another thing to think about.. I remember being in a lot of pain during labor, but my actual memory of it has faded so when I think about that experience, I don't automatically think of the pain. A couple years ago, I fell and hurt my tailbone. At that time, that was the worst pain that I could think of so my perception of pain changed over time.

Today in clinicals, I took care of a pt who rated her pain as a 6 1/2 because it "wasn't quite a 7." She was adorable.:heartbeat

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We don't use the scale of 10 we use none, mild, moderate or severe pain

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We don't use the scale of 10 we use none, mild, moderate or severe pain

Oh, that makes more sense. Every place should do that.

I think this kind of the point of a pain scale. Because a person's pain is whatever they are experiencing and is subjective, it can only be compared to the pain that they have experienced.

I say "the worst pain you can imagine experiencing", not necessarily "the worst pain you have ever experienced".

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Memories of pain fades also.

In my personal expererience anyway.

When I had my daughter I would have said that is the very worst pain I had experienced (I had never really been in pain at all just the odd sore throat)

When I dislocated my knee, at the time that was the very worst pain, although now I am not so sure.

Post knee surgery oh lord that was definately the worst pain, until the night after when I was discharged then that was the worst pain

It is difficult to be accurate when you are in pain. The nurses asked me if my pain was mild moderate or severe and I said moderate during labour, and after dislocation but severe for post op. Had I been asked to score on the 1 to 10 1 being no pain and 10 compared to the worst pain I had expereinced all of them would have been 10 at the time because at the time it is difficult to judge and compare, you just want pain relief.

Not sure if that ramble makes sense but it is not something I would have considered unless I had been on the other side

The 1 to 10 pain scale works. I use it to compare the person's current pain to previous reports. It is a lot easier than moderate but not quite as bad as an hour ago, but worse than yesterday. It takes some practice for the patient and an experienced nurse for it to work well. The patient should also be asked "what is an acceptable level of pain?" That also puts it more in perspective.

In the ED and often on my floor, circumstances make treating pain a lower priority. We can medicate you to an acceptable level, but risk lowering your B/P to a dangerous level. Respirations are also a concern and cardiac events and..... I think the misdiagnoses of constipation, rather than your perceived pain level had more to do with you not receiving narcotics. I hate pain and will do my best to bring as much relief as possible, but I choose to not make your condition worse in the process.

Like Tweety, I use " . . . and 10 being the worst pain you could ever imagine"

It also has the added benefit of making most patients think twice before saying 10. I mean, really, how many times have you said "As bad as things are it could be worse."

Honestly, when I was in the worst pain of my life I could scarcely have heard or comprehended the pain scale question (delivering dd, induction, pit doubled, in transition, probably dangerously close to hyperstim--- I was not "at home").

I've heard nurses saying (mainly to women) "0 is no pain, and 10 is childbirth"

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I say "the worst pain you can imagine experiencing", not necessarily "the worst pain you have ever experienced".

Ditto; I even say, now, "The worst possible pain you can imagine, like being dismembered in an automobile accident or something." I work in psych, and all of our clients are v. well "trained" regarding the pain scale. I've gotten so sick of people walking up to me, chatting pleasantly for a while about this and that, and then saying, "Oh, yeah, I've got a headache -- can you give me something for that?" -- and when I ask about the pain scale, 0-10, they say, v. pointedly, "It's a 10." Oh, come on!!! They're going to get the same Tylenol whether they say the headache is a 2 or a 10 -- but, in our setting, everything is always an 8, a 9, or a 10 ... (Memorably, I had one person tell me he had a papercut which was a "10." Now, I'll grant you, those papercuts do smart quite a bit, but ...) This kind of attitude, behavior, whatever it is, makes the whole process of using the pain scale pointless.

I have occasional, evil fantasies of, one day, when someone is telling me their headache is a "10" (after getting up from a lively, animated game of cards in the dayroom to come speak to me about it), pulling out a baseball bat, saying, "Oh, really? Then what would you rate this?", and knee-capping them with the baseball bat (just joking, of course!! ;)) Of course, this is v. different from working in an ED or med-surg setting, and we do also have clients that do have serious, chronic pain (and the occasional acute injury).

If the patient is open to it: I use a card that has Mankowski's printed on it and sometimes it helps. Doesn't always work - it seems that people are at the extreme ends of the spectrum - the lol who you know is in screaming pain but won't admit it or the person who is always at an 11.

Oh the lovely pain scale. I just love it when someone tells me there pain is horrible and it is an 8. Give them pain meds. Reassess them and then their pain is a 7 but is so much better. I have a hard time understanding how that can possibly be. So basically I chart there level went from an 8 to a 7 and it looks like I am not doing anything for their pain. So frustrating.

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