Questionable Pain

bethin · Dec 9, 2005

Someday, Nursing will accept that pain is whatever the individual experiencing pain says it is. Why do we persist in this need to control an issue that is out of our hands, namely a patient's report of pain? There is no way to measure pain through biomechanical means, no magic machine that pinpoints the exact site or severity of pain. Pain is completely subjective, yet there are those in Nursing who simply can't or won't accept the fact that we don't have the ability to say "Yes, here is proof you have or haven't pain" with any reliability.
Patient's with a history of drug use/abuse can certainly develop a tolerance to opioid narcotics which require that they receive a dose higher than that of an opioid naive patient. This does not mean that individual is making their pain up and even if they are, again, Nursing cannot accurately assess this. The best we can do is administer pain medication as ordered once we've assessed our patient to determine there is no respiratory depression, and continue to monitor and intervene if it becomes apparent that an individual is overmedicated. Patient's who are awake do not code from respiratory depression, especially not with the dosage of opioid generally ordered. This is not to say Nursing should be cavalier in administering narcotics. We need to realistically look at our patient's level of sedation in relationship to the amount of narcotics they've been receiving and, with our critical thinking skills, assess the effectiveness of their pain management and treat them accordingly.
As for the use of placebos, who does this benefit? Certainly not the patient, who should have every right to expect that they are being cared for in a professional manner. Placebos are deceptive at best and can be considered malpractice. Physician's should be discouraged from ordering placebos and Nursing should never substitute NSS for a narcotic to verify if a patient does indeed have pain. To do so is completely presumptuous.
People in pain may or may not display behaviors that we consider indicative of "being in pain." Coping mechanisms such as distraction or avoidance, may often mask a person's true pain level. I believe that if health care professionals expect someone in pain to act a certain way, some patient's learn to adopt those very behaviors. They become concerned that if they don't "look" as if they are having pain, their report of pain won't be believed and they won't receive the proper pain management. What exactly does that say about our practice?
So long as a patient has appropriate respirations and arouses easily, their report of pain should be believed and appropriate measures taken to alleviate it. Pain assessment, including sedation and respiration, should be ongoing to determine efficacy of the medications and ensure no undesirable effects are occurring.
Lastly, the use of adjuvants such as vistaril and phenergan should be discouraged. These products DO NOT enhance the analgesic effects of opioids and may actually contribute to over sedation and other side effects. Because the opposite has been reported for so long, (that phenergan and vistaril potentiate the effects of opioids) destroying this myth is ongoing.
The American Society of Pain Management Nurses has a website with research based information for Nurses to better care for their patient's in pain.
http://www.aspmn.org/index.htm

I know this is an old post but you said it sooo well what I've been trying to say for years. Everyone has different pain levels. I have twin nieces who are a year old. The youngest, Kennedy, when she gets sick she's whiny, crying, has to be held all the time. Emma, the oldest doesn't whine or cry and doesn't need to be held. Different people, different pain levels. We cannot look at a pt. and tell them that a migraine doesn't hurt that bad, because you've had one before. I think nurses should leave themselves out of it. No "my labor wasn't that bad", etc. We need to look at it objectively. Pt. states he's having pain, pain meds ordered, pain meds given. Why oh why is there such a stigma associated with pain meds? Please, someone enlighten me. Is this a recent thing or has this been going on for a while?

bethin · Dec 9, 2005

Just read your posts about these "pain patients". I work in a large hospital where we have a GI doc who specializes in Diabetic Gastroparesis. This is a disorder in which the gut is somewhat lazy or even paralyzed due to the long term effects of uncontrolled DM 1. My usual patient is a 30 something white female with uncontrolled diabetes, pain of 10, and vomiting. They all have g-tubes for feeds and get Dilaudid 2-4mg q3-4 hr with phenergan 25mg SIVP. They are also on Methadone, Cymbalta, and Reglan. Some are even on Marinol for nausea. They are admitted at least every 1-2 mos for 3-7 days at a time for uncontrolled pain/nausea. This a very interesting and sad disease. It is hard on the patient and the nurse. These patients lead very difficult lifes and are addicted to their pain meds. It is becoming increasingly common (gastroparesis) and there are even gastric pumps or pacemakers that can be implanted to stimulate digestion. Just some info I though would be interesting and useful.

Very interesting post. I have one question about it though. You make it sound like a very painful disorder. If you take pain meds only when you have pain is it still possible to become addicted? Recently, a nurse told me as long as I only take my pain medication when I'm in pain I won't become addicted. I have Crohn's and ulcerative colitis and I'm very, very, fearful of becoming dependent. I see those people where I work and I don't want to become one.