Pain scale

typoagain · Feb 2, 2018

I have to say it depends on the situation.

I once had a patient who had pain meds ordered Q4 hours PRN for post-op pain. She would set an alarm to go off 3 hours after she got her medication and then you immediately start hitting the call button demanding her pain meds early. After 2 or 3 days the nurses went to the doctor with concerns about her abusing PRN meds. Especially since she never once said her pain was less than 10 out of 10, even two hours after being given the pain meds. She would literally wake up in the middle of the night because her alarm went off and start complaining her pain was 10 out of 10. But if we were in the room when the alarm went off we could reach over and shut it off before she woke up. And she would sleep until her next round of vital signs. One of the other nurses actually tried it. She slept nearly 7 hours.

The doctor said to just give the pain medications and let him know of any adverse reactions. He also wrote in an order for Narcan.

About 5:30 a.m. one morning she was on her call light demanding her pain meds. And so I pulled the meds and gave them to her, just like the doctor said to do. Then when I went around at 6:30 to check on her I found her sleeping. But I was unable to arouse her. So I got the charge nurse to come in who also could not arouse her. So she got her dose of Narcan.

Needless to say she was wide awake in seconds. And she was throwing a wall-eyed fit about how much she hurt.

You should have seen her face when I told her she could not have any more pain meds and why. I also explained that even if we gave her more medication it would not work until the Narcan was out of her system.

Fortunately it was the end of my shift and I didn't have to deal with her anymore. When I came back that night she was giving everyone hell. She kept on demanding pain meds. But much to her disgust the doctor had DC'd all narcotics. He discharged her the next day, without any narcotic pain meds. But she did get a referral to a pain specialist. He also informed her that she would need to find another physician.

sweet sunshine · Feb 2, 2018

I know JCACO wants pain meds given according to scale which is dumb and could be dangerous. 90 year old, post-op hip replacement never has taken opoids rates pain a "10". Order for sub-q dilaudid, 0.5 mg for pain level 1-3, 1mg for pain 4-6, 1.5mg for pain 7-10. No way in hell im giving 1.5mg as starting dose. But according to scale that's what I should give. Also, pain level might be a lower number in a pt. because you're giving pain meds regularly. It took us a while to get your pain under control and now that it's a 4 I can only give you 5mg, not 10mg. Pain will bump back up out of control.

Buckeye.nurse · Feb 3, 2018

We just started using the Defense and Veterans Pain Rating Scale at my hospital. We're still getting used to it, but so far it seems to be much more useful than the old 0-10 rating system. Here's a link...

Defense & Veterans Pain Rating Scale (DVPRS)

mmc51264, BSN, MSN, RN · Feb 3, 2018

If they are borderline and I know that the higher dose is going to make them feel better, I ask what number their pain is when they move. It may make the difference.

I have had discussions about this number system. If giving a pt 15 mg of oxy Q4H keeps their pain a 1-2/10, why do we wait until they are a 10/10 to give them what we know works? It's a slippery slope, but as an ortho nurse, they are on narcotics short term. Why not let them be comfortable? Sometimes the pain gets away from us and then we have to start the IV breakthrough, which is a harder cycle to break.

**canoehead, BSN, RN** · Feb 3, 2018

If the patient states a 4, and you need a 5 to give meds, just use the FLACC (nonverbal pain scale) and document that you assess their pain at 6/10. That will give a clear reason as to why you gave the med, and hopefully appease the chart auditors.