10/10 pain..venting!

[NYCRN16]

Earlier this week I had a patient that apparently comes into the ED frequently always with abd pain, they can never find anything wrong with him. He must have thought I was an easy target because I have never seen him before. (I only started on the unit in August) Chief complaint? Constipation x 2 days. Takes multiple narcotics, hx of abuse, ect. He is complaining that he has 10/10 pain, as he is sitting up calmly, and is asking for pain meds. I went to the doc and was like, this guy claims 10/10 pain, but look at him. So he goes and does the abd exam with no tenderness on palpation. I had 9 patients that night (some of them really sick) and his wife was harrassing me every minute for something, I was like (in front of the patient too) I have a lot of patients, many sicker than him, that I need to attend to right now, I cant get a pill/give him dilaudid/get him another blanket. The nice lady in bed 2 is about to be intubated and she needs my attention right now. Give me a minute please. He starts saying to me that he is very sick and dying and that I need to focus my attention to him mainly. Than he tells me that I need to order Klonopin for him NOW because he takes it at home and he missed his dose and if he doesnt take now it its "very dangerous". (The doc was getting the d/c papers as we were speaking). He than becomes mad when he finds out he was being d/c'd, he "demanded" to be admitted. Sorry, but a clear CT and x-ray is not going to buy you a day or two free drug stay!

Thank you all for listening to my vent!! I love this site, I can vent about this and you all have been there done that and understand!

[athomas91]

why thank you harry!! - i would love to see it come back - it was great for pain,anxiety,nausea, and psych pt's - wonderdrug!!

a little pain gives character.....lol!!! just kidding for those i just offended.

[LilgirlRN, ADN, RN]

You have to remember that the average reading level in the US is on the 8th grade level. I have patient's that can't understand the 0-10 scale. I show them the Wong scale and say show me the that's you. That, they can relate to. Our scale has two places to fill in, one is for how the pain is right now, the other is the pain when it's at it's worst. I always hate it when the person is sitting there NAD and says they are having 10/10 pain, VS are WNL etcetc. The only time I've had 10/10 pain was in labor and I was SCREAMING, I'll even say to my female patients zero is no pain, ten is labor pain. Maybe an epidural is confusing them, lol. If you have a real drug seeker, most will say they are allergic to ASA, that gets them out of toradol. Pain is very subjective, it's hard to determine someone elses pain for them. I've had people come in without pain that are almost dead because they ruptured their appendix a few days before, they have peritonitis and rate their pain at ZERO. There are always exceptions to the rule. I have to be careful of how I use my judgement, just when I think I have my patients labeled the right way, one of them will surprize me. Addicts and abusers get sick too. I love toradol, it works well for me as a patient without making me too dopey, but if does give me somewhat of a buzz. I love it for my patients with kidney stones, like others have said, put it in on top of narcotics and they potentiate each other so well. I've had patient's still rating their pain at 8 after tons of dilaudid, add 30 of toradol IV and boom, down to a 3 and they can sleep. :)

[nma24, LPN]

I think Lilgirl has a very good point. People have varying reactions to pain and just because they can appear stoic on the outside doesn't mean their pain is any less and their need for relief from it is any less than the person writhing around in bed with an obvious pained expression.

[LilgirlRN, ADN, RN]

Thanks nma :):)

[purplemania, BSN, RN]

Re: 1/10 scale. If I am in acute pain and relate it as a "10" it may be because it is is worst pain I have ever had. This does not mean it is the worst pain I COULD have. We can only relate to whatever we have experienced up to that point. Wish we had better ways of making more objective judgement about what someone else is experiencing, especially since psychological pain is as real as physical pain. Very frustrating to deal with manipulative patients, regardless of their request.

[LilgirlRN, ADN, RN]

Good point purple. I used to work with a doctor who said he couldn't relate to it at all (the scale). Said he'd never had any really bad pain. Pain means different things to different people. My son who was 18 at the time, had an open tib/fib fracture then a few weeks later had strep throat. He said the throat hurt worse than his crushed tibia and fibula. I've never had strep, so I absolutely CANNOT fathom the thought of a sore throat hurting worse than that!!!

[athomas91]

i like the post about a 10 being "if i pulled off your arm and beat you with it...." - sounds like a 10/10 to me.

[NYCRN16]

I agree that to some point pain is subjective, but you can't have 10/10 abd pain and not be tender at any point during palpation, be up walking to the bathroom with ease multiple times, and have normal v/s. There was a negative CT scan and X-ray to confirm that there was nothing wrong. You can look at a person and tell if they are having pain, even if its not the same degree of pain you would think it was, it is quite obvious like it was with this patient I had, that he was not having any pain at all. Would you be justified in giving repeat doses of narcotics just because he "says" he is having severe pain, and there is no evidence to back it up? What happens when you give him so much medication that something happens to him? That is your license. We have to use our nursing judgement, and in this case it was very clear that this man was drug seeking.

[athomas91]

imagine - amen!!

our ed has recently had a signifigant increase in complaints of both md's and rn's that we are not giving enough pain med - so our manager said "don't argue - just give them what they want and get them out of here" - i agree that is a quick fix - but what about the next 5 times they come back this wk......

[galenight, BSN, RN]

LOVE Toradol... use it personally 60mg IM for migraine.. only thing that even remotely helps. Also love it for my patients. If they are open to relief by any means, it works.. If they are dead set to get narcotics, it won't. I am not in love with the 1 - 10 pain scale, but since there is not a decent alternative, we're stuck with it. All we can do is make the best of it by combining that subjective data with objective data like facial grimacing, gaurding, and BP elevation (I know.. not definitively accurate measure of pain).

[athomas91]

i use the 1-10 scale (because we have to ) BUT i also document their behavior ie: laughing, eating a big mac, requesting beverages and of course a phone for long distance calls on our bill...... gotta love it.

[angelbear]

I just had a TAH/BSO followed one week post op by a surgical evac of rather large hematoma. My pain never went below an 8. Unfortunately I have fibromyalgia,PLMD,RLS and severe arthritis along with long history of migraines. Because of this I am terrified my pain will not be able to be controlled so I expressed this to my gyn. She never bothered to talk to my GP to gain better understanding of me and therefore WRONGFULLY labeled me a drug seeker. Guess what she was wrong and may now be facing a law suit for neglegence. Know why? Cause she did not believe my 8 was an 8 so she did not investigate its cause. Cause was a gauze 4x4 they had missed in my wound from hematoma evac. therefore it was left in there to rot. Massive infection. Can anyone spell negligence or IDIOT. I would rather error on the side of believing pain is what pt says it is. But then again I am a bonafide chronic pain sufferer so I can sympathize. JMHO