Pain is subjective?

cherrybreeze, ADN, RN · Oct 3, 2008

I've read about 12 pages of this thread so far; I will finish it eventually. But I want to comment:

I have had endometriosis for 10 years, so dealing with severe pain is not new to me. I had a regular plan with my OBGYN for pain meds when I would get my periods, and over the years I worked my way up to Percocet. Tolerance is a thing to expect in my case. I got to the point that, I was having this bad pain DAILY rather than cyclical, and about a year and a half ago, I was in the ER two nights in a row with pain bad enough that I could not control it. I had no prescription pain medication to take, as my GYN was on vacation, and his partners were not comfortable prescribing on his behalf (I got the lecture too many times to count, when he was not available. It was very hard for me to deal with, and he was TOTALLY ok with the plan we had in place to deal with my pain...his partners would be LOOKING AT MY CHART and still refuse to prescribe). I would get, say, 12 pills at a time, once a month to once every 3 months, depending on what my BC was at the time and how often I menstruated. I had had two surgeries for the endo over the years; we did everything we could and this was the best option for me (until the pain progressed, which brings me back to my original point).

The ER docs were terrible...they would do an ultrasound, see nothing, and tell me that they could find nothing to cause me pain to treat. Endo does not show up on diagnostic tests, only with surgery...and I had documentation of having it, and being surgically treated for it. They'd medicate me, and send me home. They'd refer my to his partners, who like I said, wouldn't do anything in his absence. When this ER doc asked me what I normally took for pain, I said Percocet. They brought me some, which I was actually surprised about. I later read the dictation from that visit, which said "Patient asked for Percocet"....NOT exactly true. I was livid. This was in the ER of the hospital I work at, and a friend of mine that worked in another dept had stopped down to check on me. There was a note in the dictation that read, "Patient laughing and talking with friend, but still reporting severe pain" (so of COURSE I was lying to them about how I felt, right?). These two ER visits eventually led me to a urology consultation, a cystoscopy/hydrodistention, and a diagnosis of interstitial cystitis. No wonder I was in so much pain. I at least felt justified for going in the first place, but NEVER want to go to the ER for this pain again, knowing that no matter what, they think I'm seeking just because bad pain no longer causes me to writhe around and cry. I felt very judged and like I had no options for proper pain management at the time.

Point of my LONG story is....people deal with pain differently, you may not see the same outward signs from everyone in pain. But you can NOT judge whether it is there or not. If they say they hurt, TREAT THEM, and please do it respectfully.

Wishinonastar, BSN · Oct 3, 2008

:icon_hug:All I can offer is a hug.

GooeyRN, ADN, BSN, CNA, LPN, RN · Oct 4, 2008

I've read about 12 pages of this thread so far; I will finish it eventually. But I want to comment:
I have had endometriosis for 10 years, so dealing with severe pain is not new to me. I had a regular plan with my OBGYN for pain meds when I would get my periods, and over the years I worked my way up to Percocet. Tolerance is a thing to expect in my case. I got to the point that, I was having this bad pain DAILY rather than cyclical, and about a year and a half ago, I was in the ER two nights in a row with pain bad enough that I could not control it. I had no prescription pain medication to take, as my GYN was on vacation, and his partners were not comfortable prescribing on his behalf (I got the lecture too many times to count, when he was not available. It was very hard for me to deal with, and he was TOTALLY ok with the plan we had in place to deal with my pain...his partners would be LOOKING AT MY CHART and still refuse to prescribe). I would get, say, 12 pills at a time, once a month to once every 3 months, depending on what my BC was at the time and how often I menstruated. I had had two surgeries for the endo over the years; we did everything we could and this was the best option for me (until the pain progressed, which brings me back to my original point).
The ER docs were terrible...they would do an ultrasound, see nothing, and tell me that they could find nothing to cause me pain to treat. Endo does not show up on diagnostic tests, only with surgery...and I had documentation of having it, and being surgically treated for it. They'd medicate me, and send me home. They'd refer my to his partners, who like I said, wouldn't do anything in his absence. When this ER doc asked me what I normally took for pain, I said Percocet. They brought me some, which I was actually surprised about. I later read the dictation from that visit, which said "Patient asked for Percocet"....NOT exactly true. I was livid. This was in the ER of the hospital I work at, and a friend of mine that worked in another dept had stopped down to check on me. There was a note in the dictation that read, "Patient laughing and talking with friend, but still reporting severe pain" (so of COURSE I was lying to them about how I felt, right?). These two ER visits eventually led me to a urology consultation, a cystoscopy/hydrodistention, and a diagnosis of interstitial cystitis. No wonder I was in so much pain. I at least felt justified for going in the first place, but NEVER want to go to the ER for this pain again, knowing that no matter what, they think I'm seeking just because bad pain no longer causes me to writhe around and cry. I felt very judged and like I had no options for proper pain management at the time.
Point of my LONG story is....people deal with pain differently, you may not see the same outward signs from everyone in pain. But you can NOT judge whether it is there or not. If they say they hurt, TREAT THEM, and please do it respectfully.

That would suck... I am sorry that happened to you. :no:

cherrybreeze, ADN, RN · Oct 4, 2008

At the very least, if nothing else, it taught me SO much about dealing with patients in pain. I have taken it upon my self to learn a LOT about pain management, and I do my best to educate my colleagues when appropriate. Will you always have patients that come in that are seeking?...of course. But sometimes they're not, and you might be the ONE person that actually LISTENS to them, and cares for them appropriately. It can change their entire mindset/outlook.

icunurse42066 · Oct 4, 2008

UK_cats_rule...
After reading this thread for days, I am not sure that anyone said that there were not drug-seekers in healthcare. The point is, how well do you know the patient's full history? Does the patient have an addictive personality? You know, this can lead to seeking behaviors of many sorts. What about his full medical history? Does he have chronic pain? This certainly can effect his tolerance of medications. As nurses, we tell the patient to know their bodies and their health. Who better to know what does work, and what doesn't? Are you willing to try to give Toradol to a patient that has an allergy to prove that they really do have that allergy? After having worked in the ED for years, I acknoledge that there are drug seekers...Just like there are stoic people who infarct and do not complain. Maybe that is why I try not to question what they are telling me. But I agree, that we ought to give the same respect to the nurse who works beside us...I try not to queestion her judgment either.

Well, when the pt himself tells us that he "dropped his heroin and didn't get his fix" would be my first clue that he does not have a chronic pain issue. Now, I didn't say that everyone that comes to the ER for pain meds is drug seeking, but it has been my experience that more often than not that is the case, and I'm sorry that I tend to group a few of them in that category, but I do. Now, before some self righteous person out there takes that as me saying that I will withhold pain meds because I think they are seeking, let me say that I have NEVER withheld pain meds unless the pt's condition warrants it. If the MD orders it and the pt wants it and their V/S are stable, then I will give it. I've had family members want me to give their loved ones pain meds and the pt's resp be 6-8 per minute! I've also seen family members pushing PCA buttons every 10 minutes and I had to end up giving Narcan to counter act it. I just think that there are so many out there seeking that the ones that are truly in need of pain meds are being clumped into the same category because of them. And the last time I checked, this is America and I do have a right to my opinion. :twocents:

jackiesue94 · Oct 5, 2008

I have a long weekend off and am catching up with reading...I have to say I am astounded by the judgemental attitudes concerning pain and pain management! Did some of you miss that section in nursing school? In Michigan it is required c.e.u. to take a pain refresher course. "Pain is what the person says it is when it is." We assess the verbal and nonverbal indicators and dose appropriatly. Not with prejudice or attitude but with tlc. As a side note, when a person is in pain the stress hormones rise and the ability to heal is compromised. Also pain medication works better when it is given BEFORE the patient is in excrutiating pain. It's really too bad that so many nurses have such a poor grasp of this and think that all their patients are drug seekers. As long as I am on my soapbox it is important to remember the difference between addiction, tolerence and dependence. Phew. Maybe I should have stuck with my new John Sanford novel!

Emma Peel · Oct 5, 2008

Pain is simply a nervous signal. Suffering, the meaning we give pain, is subjective.
it may help your own equilibrium to reframe this type of behavior as a symptom of a medial issue rather than just the willful misbehaving of a bad child.
D

Sometimes it is hard to keep from feeling insulted or angry when I believe someone is trying to deceive me (lying about pain to get meds). The voice inside my head says "I can't believe s/he thinks I'm stupid enough to buy this BS..."

As a nurse I know that if patients are upset or angry, it is usually about their medical condition and not about me, and I don't take it personally. But it is a bit harder when I feel like they are playing games with me.

I force myself to remember that addiction is an illness with strong psychological and sometimes strong physical symptoms. I remember an old friend of mine and how much he suffered when he was trying to stay off drugs for the first time in many years. He couldn't sleep for weeks, he was depressed for months and he was clearly miserable. And this was AFTER the first two weeks of forced detox where he had constant stomach flu symptoms. I picture my patient trying to fend off that kind of sickness and try to understand why they would try ANYTHING to get the meds.

Remembering both the symptoms of addiction AND the symptoms of withdrawal helps me to remain objective and not get angry at apparent "drug-seekers".

Emma "Cold turkey sandwich" Peel

Iam46yearsold · Oct 5, 2008

Have they ever just tried giving a menu to those in pain. No one knows what works best except for the person in pain. With a menu, advertise, The Daily Special is Demerol with a side order of compazine.

nanacarol · Oct 6, 2008

Cherrybreeze, I have been there!! My hat is off to you. MY heart is bleeding because I know it will happen to others and it is NOT just or right. We take an oath that says we will "do no harm" but every day we sit in judgment of patients and their perception of pain we are doing harm. Until you walk in the shoes of your patient who reports pain you don't have a clue!!! Nanacarol

Babs0512 · Oct 6, 2008

I have to say something to all of you who believe everyone who says they are in severe pain. should be medicated, and we should believe what they say, no matter what. WHAAAAT do you mean????

Look, I'm a very liberal person with pain medication, but lets be real here. There are people, believe it or not, who just like the narc's, or who just want to experiment legally with drugs. I usually will believe nearly everyone who say's they are in pain. It's the degree of pain that I usually question.

Like in my previous post, if you can laugh with your friends while eating a Burger King value meal and dance the jig at the same time, well, I just won't believe your pain is 10/10!

We were educated to use our judgment, we can't go giving narcs out willy nilly and stop someone from breathing just because no matter what we give them their pain is always a 10/10. I have had many, many people who always say 10/10 or 20/10 when they can barely slurr their words out, with a HR of 49, resp rate of 12 and a BP of 92/59!! Oh, and you have to WAKE them to get them to rate their pain.

Again, I believe people have pain, but come on, we MUST use our judgement and parameters in order to treat a person safely.

Blessings

cherrybreeze, ADN, RN · Oct 6, 2008

I have to say something to all of you who believe everyone who says they are in severe pain. should be medicated, and we should believe what they say, no matter what. WHAAAAT do you mean????
Look, I'm a very liberal person with pain medication, but lets be real here. There are people, believe it or not, who just like the narc's, or who just want to experiment legally with drugs. I usually will believe nearly everyone who say's they are in pain. It's the degree of pain that I usually question.
Like in my previous post, if you can laugh with your friends while eating a Burger King value meal and dance the jig at the same time, well, I just won't believe your pain is 10/10!
We were educated to use our judgment, we can't go giving narcs out willy nilly and stop someone from breathing just because no matter what we give them their pain is always a 10/10. I have had many, many people who always say 10/10 or 20/10 when they can barely slurr their words out, with a HR of 49, resp rate of 12 and a BP of 92/59!! Oh, and you have to WAKE them to get them to rate their pain.
Again, I believe people have pain, but come on, we MUST use our judgement and parameters in order to treat a person safely.
Blessings

Of course you would not medicate someone whose VS or any other indicators reflect that more opioids would do them harm. I don't think anyone here would argue THAT.

I personally have NEVER said I have pain of a 10, because I believe it can ALWAYS be worse, no matter how bad it is. But what we are taught is, if they are in pain, THEY ARE! I've had post op patients who are in obvious pain but do not have the VS to support more meds, so I don't give them, and I regretfully explain to them why I cannot. Otherwise, you have to make the choice to believe them. You never know when YOU (all mighty powerful mind reader) might just be wrong. I won't take the chance.

nanacarol · Oct 6, 2008

I would refer you to Evidence Based research that asks that you take off your pain police hat and make a paradigm shift that insists that you are not equipped to make judgments in these situations. Your job and mine is to provide the best care we can to our patient in as non judgmental fashion as possible. You are NOT the Creator,you are merely a nurse with limited skills and assessment skills. In nursing school you were given limited instructions and limited information, get off the high horse of judgment (not you personally) just provide the patient what the dr. prescribes and what the patient needs or asks for as long as the dr. orders the drug. Stop being the pain police, PLEASE nanacarol