SocratesJohnson

I haven't contradicted myself.....That's patent nonsense. You lose all credibility by posting patent nonsense.

I'm plenty well educated. What makes you think that pointing out the fact that the patient's pain isn't always what they say is makes me uneducated? What makes you think that me pointing out the obvious fact that overprescription is an epidemic in this country and has caused serious harm makes me uneducated? Instead of making dishonest accusations against me why don't you address those two facts? Citing extremely important facts isn't a sign that someone is uneducated.

I'm not convinced of that at all. The fact that the current crop of "experts" have dominated pain control policies gives me little hope of sanity in pain control any time soon. It's not the best we have. It's caused an epidemic of overprescription......It's been a disaster! Opioid habits are out of control in this country. The best we have involves a realistic approach. Stating important truths is very constructive.....Being blind to important truths makes the situation worse.

It's perfectly acceptable to refer to those who go in for extreme idiocy that way. Pretending that idiocy isn't idiocy is a crime against truth. You do realize that devising a new pain system would be a major effort?.......You seem to have a problem with that unbelievably obvious fact.

You're saying that coming up with a new system for pain control wouldn't take awhile?.......Why are you being insulting here? A new system for pain control would, in fact, take a long time to devise..........When presented with obvious facts you resort to insults. Perhaps I could talk to someone with a more adult attitude? Someone who can accept extremely obvious facts?

????? I'm not going to spend weeks, (months? a year?) devising a system that isn't going to be used. That would be a colossal waste of time. It would be like coming up with a budget plan for our nation knowing that it will never used.

I need to get out of direct patient care for other reasons.....That's for another thread. The reason I need to get out isn't because of pain control......Pain control is something that I really like doing overall. I need to get out of direct patient care because I'm getting to old for it........The day-to-day work has gotten extremely complicated what with sweeping changes in computer charting.......I'm good with computers but the complexities of matching screen after screen after screen on the computer with taking care of sick people is are daunting. Perhaps this is worth a separate thread? Here's an example of the complexity I speak of: Our Hospital has been changing names about every two years for awhile now due to various mergings with other hospitals and "Healthcare Systems". We now have a name for our Hospital that is so long, and boring, that virtually nobody who works for the hospital knows the name of the hospital......I've asked around. Given that almost nobody, literally, knows the name of the hospital and we're being hit with insanely complicated new software programs for insanely complicated patient care there is a case to be made for things being too complicated for human beings to function properly.

I haven't devised a new system for pain control.......It would almost certainly be a complete waste of time as it would never be implemented. If someone said to me: "We need your input on a new pain control model" I'd be very happy to propose specific changes. I'm interested in controlling pain and I work really hard at it. Forcing us to use nonsensical criteria interferes with proper pain control.

I don't want to do that at all.....Not even a little bit. My concerns about our current pain policy have to do with two things: 1. Harm to patients. There are far too many people who have huge opioid habits due to overprescription.....It's a national, and personal tragedy. 2. Forcing idiocy on Nurses makes our jobs more difficult. Controlling pain is a divine calling......I take pain control very seriously. Forcing us to engage in nonsense when addressing pain makes it worse for us and for patients.

It isn't ALWAYS what the patient says it is. We know that with certainty. It's absurd to pretend that it's ALWAYS what the patient says it is.........If we assume that then we have to treat people who have had 10 mg of Dilaudid and are in a Dilaudid stupor as pain emergencies and virtually nobody does that. If you're saying that the patients report of pain is always accurate you are saying to blindly treat pain. One important factor to consider is that some people always report a pain of 10 in order to receive as much medicine as they can get.......That is reality and it is important to be aware of in some situations. Once again....We know, with absolute certainty, that some patients will lie about their pain in order to receive pain medication. That's my point. There are other examples of patients reports of pain being wildly inaccurate by the way. There are many patients who say that there pain is MUCH less after receiving significant amounts of pain medication but they still rate their pain as 10. Some patients just don't do well with a 1-10 rating scale......You can explain it until you're blue in the face and they still won't use the scale properly. Some patients aren't capable of nuanced self assessment......Either they hurt and their pain is 10 or they don't hurt at all and their pain is 0.........0 isn't always realistic after surgery. As you said....."It's not all black and white."

The fact is that there are patients who go in for extensive lying in order to receive pain medications and this includes lying about their pain level. There are, in fact, patients who never report pain less than a 10 as a strategy to receive more pain medication.......It's silly to ignore reality here. Of course surgeons have follow up appointments but they aren't big on referrals on outpatient surgery and they generally don't participate in long term pain prescriptions unless they are treating conditions over long periods of time. If a patient has a hernia or gallbladder surgery, for example, surgeons prescribe pain medicine for the recovery phase (a few days or a weeks worth) and then they are done......They don't generally get involved in long term pain management. Realistic criteria for assessing and treating pain.

If you're assuming that the patient's pain is ALWAYS what they say it is you are missing a whole lot in some cases......Reality is what you're missing. Patients are being greatly harmed by overprescription of opioids....People are dying from it. I don't practice in an ideal setting (PACU that deals mostly with outpatients) so it's unrealistic to think that we're going to get a thorough pain history in many cases and even if we did we're unlikely to do anything differently in many cases.....Post-op pain is much different than chronic pain usually. Anyhow the point is that some patients will say anything to get their hands on as much pain medicine as they can and careful assessment won't change their strategy at all. Surgeons aren't inclined to go in for that sort of thing especially with outpatient surgery......They don't want to follow up on anything besides surgery. Outpatient surgery isn't at all a good medium for helping the patient with anything besides issues pertaining to the surgery.......In a perfect world we would fix all sorts of things but the reality is we usually only deal with surgical implications.

Just to be clear.....That's not what I'm talking about. I agree with you that I'd rather be a drug dealer than not treat post-op pain. What I'm talking about are the patients who under no circumstances admit to a pain less than 10 because their goal is to receive as much pain medicine as possible. There have been many occasions in my career when I take over a patient and take the pain far more seriously than the previous Nurse did. We have, by all accounts, an epidemic of overprescription of opioids. My point is that this combined with an extremely unrealistic model for pain control causes problems in acute pain (and other) settings.

Anyone who "thinks" that: "the patient's pain is ALWAYS what they say it is" is, by definition, ignorant. It's extremely obvious that the patient's pain isn't always what they say it is. That's not at all true. I've said many times here that pain scales work quite well in most cases. Pain scales don't work at all in some cases though.....The "ALWAYS" bit makes for extreme stupidity. If you don't think that the pain is ALWAYS what the patient says it is then we agree. There are, in fact, some patients who have reports of pain on the pain scale that have nothing to do with their level of pain. Pretending that the pain scale ALWAYS works perfectly is idiotic and that is exactly what is being crammed down our throats.

I have seen that too.......I once ran down to a patient's room at top speed (in my younger days) due to a perfect V-Tach waveform, saw the patient brushing their teeth, and said "good morning". Back to the tool metaphor for a second. I have a Bass that I love to play. It gives me warm rich tones and is amazingly punchy as well when I want it to be. It's got a nice fast neck and feels really good in my hands. My bass is a tool that I have a great love for. If I was told to play a song using only minor 7th chords with high bell-like tone I wouldn't want to use my beloved bass......I'd want to borrow a guitar. The pain scale policy forces us to use the wrong tool in many cases.

Everyone has feelings about everything they are involved with but that's not the point. The point is that forcing us to use the pain scale on all patients is bad patient care. Assessing pain is too individualized for it to work on everyone. It is a tool. The thing is that in many cases we're being forced to use the wrong tool......We're being forced to use a hammer when a hammer won't work. I really like using the pain scale when it works......I have very warm feelings for the pain scale under certain circumstances. It's completely irrational to use the pain scale on many patients though and it doesn't make sense to force us to use irrational methods.

Subjective reports of pain are usually very good guidelines. In some cases the subjective report of pain is completely unreliable....There is no reason to think it's accurate and every reason to think it isn't in some cases. As a practical matter it's impossible to always use subjective reports of pain even after we receive them. In a perfect world assessing pain would be simpler than it is. You're right that assessing pain isn't an exact science. We're making educated guesses about how to treat pain. (most medicine is educated guesswork). Treating pain involves a lot of educated guesswork as well. I've seen really big guys almost stop breathing after very small doses of Fentanyl and sweet little old ladies receive huge amounts of opioids without batting an eye.

Of course it's being shoved down our throats. Very few nurses who do patient care think it's workable. There are many ways to assess pain but I'm not allowed to use them because the pain scale is is being shoved down my throat. My discussion is based on the reality of pain control. My feelings have little to do with it. I'm with you there......The pain scale is premised on the notion that reports of pain are objective when, in reality, they are subjective. I'm happy using objective assessments but I'm not happy being forced to pretend that a subjective report of pain is objective.

That shows a really amazing amount of contempt.....I'll try to respond in kind. I'm impressed that you treat your fellow Nurses with that much contempt.... I'm not the one who came up with the idiotic notion that: "the patient's pain is ALWAYS what they say it is". It's up to the morons who are shoving that notion down our throats to explain to us how to apply it. I'm far to smart to "think" that the patient's pain is ALWAYS what they say it is......That notion is one that only very stupid people go in for. Does that help?

That's "thinking" with blinders on. You expect more from medical people but you don't always get more. The vast majority of medical folks I've worked with have more sense than that.

That's horrible! I used to work at a hospital where we had three siblings coming in frequently for Sickle Cell. Sometimes all three would be in the hospital at the same time but not usually. They were in their 20s and they were really nice.......You know how you become fond of some patients?.....I really liked those three. Dilaudid is the drug for a Sickle Cell crisis......There is no question about that. You and I disagree on some aspects of pain management but I think you know that, in no way shape or form, am I advocating not treating severe pain aggressively. A pain emergency is a pain emergency.....It gets top priority.

I agree. Addiction has different dynamics in different people. Some people are 'wired' to be addicts.....As soon as they swallow their first Percocet they are addicted.....This is profoundly sad. Others slip into addiction over the course of years. They take pills to escape psychological pain and, over time, become addicted. I couldn't agree more...Nicely put! I strongly agree with you about that too. I remember well how extreme the pain of Sickle Cell can be......I've seen a few patients in crisis and the pain is extreme and very real......They are the prototype of patients in a pain emergency who need to be treated aggressively.

I'm looking for a few things. I'm curious about what others think of the pain scale especially experts. I think it's important to tell the truth about the pain scale so that everyone knows it's limitations and, perhaps, we'll stop having it shoved down our throats. I'm very interested in talking about over prescription of opioids in order to help get it stopped. People are being greatly harmed by what is going on. I think that the definition of addiction needs to be agreed upon and it needs to be a workable definition.......Making the definition of addiction meaningless to prevent addicts from feeling bad for being labeled is silly.....When discussing important issues it's important to speak the truth.

I love that stuff. It's really good at relieving pain in many cases.....Including mine when I had a kidney stone. It's what I said about the Dilaudid stupor is still true.....There are some patients who never report pain less than 10. We do. I've given it a couple of times.....It works really well in normal pain situations.

There is, of course, complete hogwash in the world of addiction in academia. http://www.medicalnewstoday.com/articles/232841.php In many cases outward actions are all we have to go on.......Intense brain investigation isn't practical for everyone who comes into the ER exhibiting drug seeking behavior. We, to a very large extent, treat what we see.