Pain is subjective?

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I have been a nurse for only one year and I am already questioning the idea/assumption that pain is subjective. I work in the LTC ward where we have subacute patients (including acute rehab and extended care) and hospice patients. I administer vicodin, morphine, oxycodone, tramadol, tylenol #3, etc. at least 8-10 per shift and I work an 8-hour shift. I do have patients that I know without a doubt are really in pain, but 75% of my patients ask for PRN pain medication right on the hour everytime it is due not knowing that I am outside their door and I can hear them laughing and/or carry on an entertaining conversation with another person. Yes, I do believe that pain can be subjective but how am I suppose to assess pain for my drug-seeking/addicted patients? I find it hard to believe that they are telling me that their pain level is 8/10 every single time. Lately, I have been feeling less like a nurse and more like a street drug pusher in a hospital setting. Can anyone relate to what I am saying? Do anybody have any article that suggests I can objectively assess pain?

In case your patient really experiencing pain, give the proper medication as ordered.

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Is the concept of giving a placebo ever used? For some reason this just seems really crazy to me, yet two people have made that comment thus far...so perhaps I am just neive.

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Specializes in Med surg, Critical Care, LTC.

I absolutely do not agree with placebo's. In fact, I cannot recall anytime in my career where the doctor ordered placebo's - that would be ethically and morally wrong, IMHO.

I have, however, given the suggestion to the patient - on more than one occasion, that this medication, __________, should do the trick. It works "wonders" on pain. Usually the medication is toradol, one percocet, or vicoden, even 800mg motrin. I have found that even the most "severe" pain can be controlled successfully with minor pain medication, in many cases, especially if you let the patient know that "this medication works great, you'll be feeling better in no time."

I had a patient recently, that I made a med error on, hear me out on this. He was a teenager who took a lacrosse ball to the face, and had broken his mandible in two places. I had a facial ice pack ready for him. When he came to me, with his jaw wired shut, he initially had no pain, but as anesthesia wore off, his pain rapidly increased.

I didn't want him to vomit, as his jaws were wired shut, so the first thing I gave him was an antiemetic. He had ordered "morphine 2mg IV, q5min, max dosage 12mg.

We carry Morphine in 2mg/ml AND 10mg/ml syringes. I grabbed what I thought was the 10mg/ml syringe, and began to give the morphine in 2mg increments as ordered.

After 8mg, along with the ice pack, and my telling the patient, "I've already given you 8mg Morphine, that's a good amount, how is your pain now?" He had gone from a 9/10 to 5/10. He reported that the 5/10 was "tolerable" for him. I didn't want to push too much Morphine, since he was in a "tolerable" level, I stopped there. I could see he felt a bit better, as he began talking to me about what happened, and his school and girlfriend.

After getting him to the floor and returing to the recovery room. The OR nurse and I counted Narc's. It was then that I noticed I had one more 10mg morphine than I should have and one less 2mg morphine. I immediately realized what happened. I had accidentally grabbed the 2mg/ml and had been giving him .02mg at a time for a total of .08mg instead of the 8mg I thought he had be given.

I wrote myself up, and notified the floor and supervisor - all of whom laughed and said stuff like "well, I guess we won't need a narcan gtt!" I felt terrible. Anyhow, what is even more amazing is that that tiny amount of morphine actually helped him! I told him it would help, he saw me repeately giving him the medication, and it helped.

Do I think that small amount of Morphine really did any good for a 200 lb teen with an atheletic metabolism? NO. But he trusted me, and believed it would help him as I told him it would. I didn't intentionally deceive him, I really thought I had given him 8mg morphine. So, inadvertantly, I had tested the placeabo effect - and in this case, it worked. But I NEVER would knowingly lie to a patient and say I was giving morphine but push saline just to test the placeaboe effect.

Thanks for listening to my long post.

Blessings.:yawn:

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Specializes in ER,ICU,L+D,OR.

Placebos or obecalps should never be ordered or used.

Pain is subjective. Everyone shows their pain differently. Accept what the patient tells you their pain level is. To do anything else is being judgmental and not therapeutic. Some people laugh to control pain. Some people talk on their cell phones to control pain. This is affective for them. I would rather deal with someone laughng about their pain, than someone cursing me because of their pain. Give them their meds.

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Specializes in Cardiac Telemetry, ED.
If you knew that the patient is only acting, you can do the placebo thing.

The use of placebo is unethical.

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hi.. i know i am just a novice nurse. i have just been working for 8 months. but maybe i cud give you a relevant idea. we, nurses, should also experiment and explore our fields. we know more about our patients than their physicians that's why we should assess them well. yeah, we all know that pain is subjective data. but there's a way to know if the patient really experiencing pain or just a mind thing. we can give placebo meds. it will show you what your patient really feels.

give placebo for c/o pain? that means you are using your patients as guinea pigs. be careful with your license, you just got it.

if your patient c/o pain, assess, medicate and document. you have nothing to loose by doing that. it is up to u to judge or not, u are human, but never withhold pain med. :no::no::no:

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Specializes in orthopaedics.

i believe what i am about to write has been stated ad nauseum but, here goes, everyone deals with pain differently.that being said, i have a high pain tolerence. when i am in pain (serious pain) i tend to be very quite. i try to work through it. i would not however be laughing ordering lunch and chatting on my cell phone.

there are those that are clock watchers, afraid to deal with any kind or form of pain. they fear if they miss a single dose they will be in pain they will not be able to handle so they try to head it off by getting meds whenever it is time

there are some that wait and wait, try to be stoic, then when the pain is so out of control they are mean crying etc, and want to know what took you so long to get there.

then there are those that just aren't in pain and like the buzz they get from the meds.

our job is so frustrating some times. when we really need to be with a patient sometimes we are stuck with the drama king or queen trying to get their 10/10 pain under control so they can continue entertaining in there room.:rolleyes:

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Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
Well, there where the sense of a nurse will take over.. Based on what i have experienced, those patients who exaggerated the pain were also the one who really don't feel the pain(not every patients). If you really had a good assessment, you will know when the patient is acting and when it is real. :D If you knew that the patient is only acting, you can do the placebo thing.

:banghead::banghead::banghead::banghead::banghead::banghead::banghead::banghead::banghead:

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My pharmacist was just talking about placebo pills today! He's old school...he'll be 68 this year.

Apparently they used to stock placebo pills at the first few pharmacies he worked at. They had several "look-alike" drugs, mostly diet pills, stimulants, and a few pain meds.

The docs in the town would call 'em up and order "Placebo 1" etc...

I guess they had to quit doing that some time in the late 70's or so.

While I (mostly) disagree with this practice, it is interesting that it actually worked for some people.

My issue with the pain management movement is the Pain Scale. I hate it. If we go by what the Face Chart says, NO ONE (no matter HOW you "deal" with pain) could possibly be able to hold on a normal conversation or eat food with 10/10 pain. Even small stimuli, like light, would be painful. However, pts regularly complain of 10/10. I don't doubt they are in pain. I doubt it's an actual 10, though. Most people in "extreme" pain (following objective signs, like movement, and vs) seem to fall in the 7/8 category.

But pts don't believe they will be treated most effectively if they give any number lower than 10. Like they are not going to get their q 6 hour Percocet (even though it is ordered as a scheduled dose...) if they say they are at a 6 or 7. 6 or 7 still hurts!

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Specializes in ICU, Paeds ICU, Correctional, Education.
Pain is always subjective. And is your observance of a patient's behavior objective or subjective...

Pain is a biological characteristic that enables us to keep away from danger. Without it, we may hurt ourselves so seriously without knowing it that we risk death. This tells us that pain is in fact an objective experience. There are many different types of pain receptors and pathways. Try putting your hand on a red hot object. How much say do you have in how long you keep it there? I reiterate, that the interpretation of pain by observers of pain behaviours is subjective. Pain as a stand alone biological phenomenon is objective.

I note the cat who purred throughout the delivery of the kittens.

Animal ethicists and veterinarians have researched animal pain behaviours and often they are quite different to how humans demonstrate pain. For example, rabbits yawn and demonstrate stretching behaviours as a response to painful stimuli. Most of us would not recognise that the rabbit was in pain unless it was doing what we do when we are in pain.

I think if we only see pain as subjective, this limits our capacity to understand it and treat it effectively. :nurse:

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Specializes in Med surg, Critical Care, LTC.

Just an FYI. I actually watched a show on cats 2 days ago. Scientists know that cat's purr when they are content - but they also noted cats purr when they are frightened or in pain. Therefore, purring, in and of itself, is not an indicator of a cat's comfort level.

:twocents:

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Specializes in telemetry, med-surg, home health, psych.

In regards to pain scale.....when I had a grapefruit sized ovarian cyst twisting I was in so much pain that I was vomiting.....THAT is a 10....

After my TAH, I was in so much pain after they removed the PC pump the next day, I literally cried out....THAT is a 10.....

I totally agree, when I assess pts. that are eating, talking and they tell me their pain is a 10, I too, have to think ??????....but I chart it and I administer the meds as ordered......that is what I am paid to do...I am not there to question their pain or their meds.....I absolutely understand those of us who get aggravated by med seekers, but ours is not to question why, ours is to do our jobs....if meds are ordered, then I give them....and yes, Placebos given years ago actually helped with pain....but I doubt they would help when someone is actually having a real 10 on the scale....I think those placebos were for mild pain and the issue of "mind over matter" would help to deal with that..

just my 0.2

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