"My pain is about an eight and a half"

guest940422 · Oct 18, 2018

See....you HAVE a point of reference. Not as bad as the knee. Worse than a migraine, better than a hangnail.... I think that for a lot of us who don't have a reference, we struggle with the number. I started using the Whaley and Wong faces with my new job and I *think* it produces a better response. There's no way to quantify a face on a chart, though....

I tell patients 0 is sitting pretty on cloud nine, and 10 means I can punch you in the (insert location of pain) and it wont hurt any more than it does right now.

This is adopted from a knee jerk unprofessional reaction to a 16 year old who told me she had a score of 10/10 while checking her facebook (I was a new grad and you can get away with saying what you are thinking with teenagers).

I tend to get pretty appropriate answers from people with this strategy. If all else fails, use an objective pain scale. Since we went and got half the population addicted to opioids, pain is no longer defined as "whatever the patient says it is"

Pt reports pain score 10/10, FLACC score of 3, hr and bp at baseline, currently involved in non-health related conversation with visitor while playing video games, non-pharmacological interventions applied: distraction, decrease noxious stimuli, encouraged visitor interaction, positioning....

.... will reassess in ___ hours/min

allnurses Guide · Oct 18, 2018

The poster that is in my triage has faces, and numbers, and descriptions. 10 is "death imminent", 8-9 is "unbearable", then interferes with task, concentration, and on down.

I put what they say, because that is what we are supposed to do. Some folks just assign a number to the pt by comparing their expressions to the Faces scale, and when I go to follow up, after pain med for instance, they say some number higher that the previous nurse put in. So, it isn't better? oh yes, it worked well! It is down to this number, but no one ever asked me what it was before. ARGH.

I don't round up though. I think of it as, first down at the 80 yard line. If you only went to the 75 yard line, (it's 7.5!), you didn't get the first down. Why do I care? because we have a new opiod policy that goes 4-7, higher meds for 8-9, review after an hour and remedicate per the numbers. If no relief after that, we call the provider. Waiting to see how well it works.

brownbook · Oct 18, 2018

Pain is so relative .......I had two lady partsl deliveries. I know I had pain the first time but I wouldn't say it was awful. I knew why I was having pain and that it would end soon. The second delivery I used Lamaze (is that still used?) and it worked great.

I had a sore throat a few years ago. Well.....geez it it was "just" a sore throat, and I'd feel silly saying it was a 10 but it was!

To be gross I had horrible gas pains the other day. I had to use my Lamaze breathing techniques to be able to bear it. Again I knew it was just gas, and how could I say with a straight face that it was a 10 but it was!

I can easily imagine nurses rolling their eyes and telling other nurses....sheesh my patient has a sore throat, or gas, and says it's a 10.

JustAdmitToObs · Oct 19, 2018

I never understood how people could rate something a 10/10 pain until 4 months ago when I gave birth via vacuum to a posterior facing baby with a failed epidural. The handful of kidney stones I've passed were a paper cut in comparison. Had I been on top of a building I would have launched myself over the edge as I was incapable of rational thought.

The thoughts that go through my head now when someone says their abdominal pain is a 10/10 while drinking a Monster and eating cheetos......

Been there,done that, ASN, RN · Oct 19, 2018

I get it. You think they are a professional drug seeker. Perhaps they are a patient with long standing, chronic pain issues that are trying to be as precise as possible to get some relief.

Either way, does not matter. We medicate them.

I have to get on my pain relief soapbox again. I was with my father in many facilities Saw many doctors and nurses roll their eyes when I explained .... He had chronic nerve damage for years. Also had a brain enzyme that blocked morphine. At one point it took 80 mg/ morphine/ hour to relieve his pain. He suffered a lot.

Please don't be one of those nurses that thought we were either nuts, or drug seeking.

doodlebuttRN · Oct 19, 2018

Oh man Brian Regan makes me laugh so hard, he is ridiculously funny. Something about his delivery just tickles the hell outta me.

Edit: I was replying to clebak, somehow it didn't show up on this post. Sorry

CCU BSN RN · Oct 20, 2018

I describe just about everything at work on a 0-10 scale.

e.g. 'I'm going to be 6.3/10 cranky if you give me that admission', 'I'm 9.8/10 uncomfortable right now'

I'm on the autism spectrum, my brain is wired differently. Unless you specifically asked for a whole number between 0-10, your patient answered your question honestly and within the given parameters. You're being ridiculous. If they said 'my pain is the square root of 2' then I'd agree they're just being difficult. You have to at least have SOME compassion for the fact that our brains are all a little different from one another; that's what keeps life interesting.

Yes, just put whatever you want in the little box you have to fill out for charting. I 'have' to chart a 0-10 pain score a bunch of times a shift for intubated/sedated/braindead patients because it's a required field. Normally I wouldn't advocate for inaccurate charting, but unfortunately the geniuses who write code for charting software and the geniuses who provide bedside care are almost entirely separate groups of people. You have to make do with the limitations of your documentation software, which I'm assuming is what you're really upset about here.

BeenThere2012, ASN, RN · Oct 20, 2018

@4:32 "Say eight!"
One of my favorite comedy sketches

OMG! That was hilarious. Thanks, I needed a laugh!

cretin, ADN · Oct 20, 2018

I get a lot of people that tell me that their pain is over a 10. I ask if I were to kick them where it hurts, it wouldn't be any worse then? It never fails, they always say that would hurt more. I explain that the scale only goes to a 10. They look at me and say "Its a 12."

There is also the lovely response, "I have a really high pain tolerance, so my 5 is like someone else's 10." Ok then!

BeenThere2012, ASN, RN · Oct 21, 2018

Also, I must complain about our pain documentation requirements.
I'm in home health and we are required to document the following at each visit:
- the lowest the pain has been in the past 24 hours
- the highest the pain as been in past 24 hours
- the level of pain at that moment
- the quality of the pain
- the pain treatment utilized
- the effectiveness of said treatment
- our action if the treatment isn't adequate (we don't administer medications, fyi, the patients give their own)
Annnd, if a patient has a wound? we must document all of these for each individual wound in a separate area, as well as document how often the pain occurs to the wound.

oh my God! Have we all lost our minds? How far does this crap really have to go?

Penelope_Pitstop, BSN, RN · Oct 21, 2018

Oh man Brian Regan makes me laugh so hard, he is ridiculously funny. Something about his delivery just tickles the hell outta me.
Edit: I was replying to clebak, somehow it didn't show up on this post. Sorry

I have seen him live four times. If he comes to your area, he is well worth the ticket price.

AlwaysLearning247, BSN · Oct 21, 2018

I hear this all the time! I usually just round up. I always wondered why patients feel the need to go up by half a point. My favorite is when you say "rate your pain 0-10, 0 being none and 10 being the worst" they'll be in bed on their phone and shout out "40". :nono: