Pain scale is missing a key element

rn undisclosed name · Jun 27, 2008

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.

classicdame, MSN, EdD · Jun 27, 2008

There are websites, and at least one nursing organization, devoted to pain management. I have learned that pain is highly tied to memory and emotion. Fear of pain, or anxiety, increases it. One problem I have noticed in acute care areas is that whatever pain level is the worst you have experienced may fall way short of what the providers have seen. If we really empathize then we begin to feel that pain too, at least emotionally, so we tend to protect ourselves. Bottom line, it is what the patient says it is.

jessiern, BSN, RN · Jun 27, 2008

Off the subject, but I am amazed at how poorly our current pain-management meds work.

A headache of 11/10 is still an 11/10 30 minutes after demerol 75/phen. 12.5 IV.

At least it helps them sleep :)

*ac* · Jun 27, 2008

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.

When this happens to me, I chart the score but also I write a note that says,

Pt reports pain is "much better".

mcs1505 · Jun 27, 2008

When I was 19 I was in the ER for abd pain (which needed emergency surgery to fix 2 months later) and when I told the nurse it was a 9 she looked at me and said, very skeptically "A 9? Are you sure?"

?!?!?!?!?!

The doctor then told me I had strained a muscle because "see how you pull away when I press here? That tells me it's a muscle thing."

Um, hello? I pull away because it frickin' hurts!!

All that to say, I'm not a huge fan of the scale either, but I learned to never question my patients.

(Oh, and my family now drives 25 extra minutes to avoid that loony hospital)

RedhairedNurse, BSN, RN · Jun 27, 2008

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

Or hemorrhoid surgery, which I had a couple of years ago. Feels like a baby made of razor blades coming out; worse than labor pain to me. One just has to experience there own pain experiences. It does gripe me though when I hear someone say their pain is a 10 and they're sitting up in bed....no crying, nothing. I want to say.....go sh_t razor blades, then tell me what you pain scale is....... :twocents:

mcs1505 · Jun 27, 2008

It does gripe me though when I hear someone say their pain is a 10 and they're sitting up in bed....no crying, nothing. I want to say.....go sh_t razor blades, then tell me what you pain scale is.......

Believe it or not some people are actually very capable of disconnecting and not exhibiting what we think of as typical displays of pain. Certain cultures, especially, are very stoic and will not show weakness. And don't forget chronic pain patients.

You don't want a lawsuit on your hands when a patient almost dies bc you didn't take their pain seriously. Not everyone is a drug/attention seeker.

lvnandmomx3 · Jun 27, 2008

I ditto that everyones pain thresholds are very different. I tolerate pain pretty well I went through 72 hours of labor to result in an emergency c-sect and was walking walmart the next day after leaving the hosp.(2days after c-sec). But that is just me and realize not everyone else is that way. I would say my pain was 2 or so after c-sect and nurses looked at me like are you sure? Now lets talk when TOM is here thats a another story I'm like a 8-9 for the 1st 2days....lol almost makes me wish I had a baby every 10 month so TOM would not come......

I feel really bad when someone says a lower number for fear of thinking that they will be looked at as a drug seeker, when in actuality they are in horrible pain.

When working in the ER ( admitting ) we would have our drug seekers coming up complaining of a 10 for a headache, but have earphones blasting music in thier ears..... ummmmm I don't think so.

Wish there was a better way to determine pain.

queenjean · Jun 27, 2008

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.

Sorry, haven't read all the responses...

Just wanted to point out that another aspect of the pain scale is assessing their comfort level. You may say your pain, based on your previous experience, is 5, but if your nurse knows what your comfort level is, he/she also uses that to assess pain.

I noticed the same discrepancy you (OP) did, and so now when I assess my pts, I always ask if they are having any pain. If they say yes, I then always always follow up with "And what is an acceptable pain level for you?" That gives me more of a target to aim for with pain control, and I feel like I take their pain more seriously. I mean, when you have people who will tell you their pain is a 10/10, but they are walking around, laughing and chatting, going down to the cafeteria, it's hard to take seriously. But when you ascertain that their comfort level is 8 or 9/10; okay then, I can try to take your pain down a notch or two, and I feel I can actually help as well as understand their pain response a little better. Does that make sense? Going on too little sleep here.

mcs1505 · Jun 27, 2008

I then always always follow up with "And what is an acceptable pain level for you?"

I think that's great. I'd never heard that from anyone before (granted, I'm still just a student). I think that would help a lot.

talaxandra · Jun 27, 2008

I'd never thought of ten as the worst pain someone had already experienced, only as the worst they could imagine (making it hard for me to have 10/10 because, as others have said, it's always going to hurt more if I get belted over the head!).

I agree that it's a far from perfect way to assess pain - for a start, the exact same pain is experienced as more severe at night, if associated with nausea, or if it persists of a prolonged period of time. And, as so many others have already observed, some people say their ppercuts are 10/10. The flip side, of course, are those stoic souls who have a roaring peritonitis or massive MI and say "I'm not too bad, sister."

I suppose that's why the pain scale is a tool - one of the many things, including vital signs, history, patient description, affect and demeanor, we use to get the best picture of what the pain is like, whether or not it's a sign of something truly ominous, and how effective our interventions are.

mcs1505 · Jun 27, 2008

I'd never thought of ten as the worst pain someone had already experienced, only as the worst they could imagine (making it hard for me to have 10/10 because, as others have said, it's always going to hurt more if I get belted over the head!).

My dad got third degree burns on his hand one Thanksgiving (*rolls eyes at the memory of stupidity*) and he told the nurse in the ER "Well, it can't be a 10 can it? I mean, if it was a 10 I'd have taken a hacksaw to my hand and cut it off because that would have hurt less, right?"