The language of pain

squeakykitty

I felt shame over this for years because even my own family had the attitude of "Don't bother me with your pain", "Don't embarrass me by expressing it/what will people think" type of stoicism.

Then I went through CNA training and the first half of LVN school, and read what the textbooks had to say about pain. The first thing I learned was that different people and cultures have different attitudes about pain and express it differently. Even within the same culture, people will express their pain differently. The second thing I learned was people should not be judged on how they express their pain, and that people with chronic pain can look and act normal, and have normal vital signs. The shame I had lifted, when I realized there was nothing wrong with expressing my pain, but I was angered and disgusted at the judgmental attitudes of the people I have known.

A year before the CNA class, I woke up to abdominal pain that gradually grew worse as the day progressed. I went to the doctor to have it checked out, just in case it was appendicitis. It turned out to be a ruptured ovarian cyst. The pain was high, about an 8 on the 10 scale. No one at the doctor's office had me rate the pain on the pain scale, and the doctor told me to take ibuprofen for the pain, instead of writing a prescription for a painkiller. The ibuprofen didn't even touch the pain. I didn't call back and tell them that because, at the time I was uninformed and thought that ibuprofen was all that they would recommend and all I would get, and they wouldn't prescribe anything stronger. I did know about codeine, since my dentist prescribed it after I had impacted wisdom teeth removed. It really helped the pain. When I took pharmacology, I learned about other types of painkillers, and wondered why didn't the doctor try something else, even if it was Toradol? Why didn't I just call back and tell them the ibuprofen is not helping? Would they have told me "That's all we can suggest? Would they have thought of me as a drug seeker? It kind of makes me wonder what would happen if I had a bone fracture. (Maybe I need to read my chart)

I took care of a resident with dementia when I was a CNA and this resident would swear during care. A few months before I got the job, I had clinicals in the same facility and had the same resident assigned to me, and this resident wasn't swearing then and I wondered why. I would hear other coworkers telling this resident "You shouldn't swear" and I think they were thinking it was a behavioral thing. One day I was giving this resident a shower and heard swear words when I touched a knee, so I asked "Is your knee hurting?". The resident said yes and I told the nurse. After that, the resident didn't swear so much because the pain was finally adequately treated. I don't know how long this person had to live with the pain, because the staff thought it was a behavioral issue.

I have heard of doctors being reluctant to give narcotics for terminal cancer pain. I never understood that, since if someone has terminal cancer, is in a lot of pain, and is going to die anyway, then becoming addicted would be the least of their problems. Or people with chronic pain are under medicated for this reason and their quality of life deteriorates. Also, people with dementia are under medicated because their pain isn't recognized. I've even heard of a few nurses reluctant to give legitimately prescribed narcotics, either trying to avoid giving them altogether, or making people wait for their pain medication, and this is wrong because people needlessly suffer.

In a sense, we are all drug seekers and clock watchers. After my impacted wisdom teeth were pulled, I was prescribed codeine with Tylenol, one tablet every 4 hours. During the night my jaw would hurt; and when I looked at the time, it would be 4 hours after the last dose. I didn't need to watch the clock, the 7/10 pain in my jaw did it for me. When we have a cold we go down to the store for OTC meds. We look at the directions for how often to take them and we look at the clock to see when the next dose can be taken.

I do believe that pain should be managed adequately for everyone, and no one in legitimate pain should be judged for how they cope with it or how they express it. I have never been in chronic pain-----yet. It could happen though, to any one of us at any time.

leslie :-D · Dec 6, 2007

i agree with you 100%, kitty.

working in hospice, one would think we are all experts at managing pain.

yet since i've started working nocs, i've seen sev'l pts with insomnia, restlessness and behavioral issues.

all the nsg notes state, "pt denies pain".

that was the extent of their assessment...."pt denies pain".

many of these pts are unable to communicate their needs, generally r/t some sort of neuro involvement.

as it turns out, some of the pts were horribly constipated (which is very uncomfortable), or in pathological pain.

unless the pt is sleeping all day, there are far more reasons on why one would stay awake at noc.

and giving a prn haldol, trazadone, just does not address the problem.

and then, there are those who do manage their pain stoically, for whatever reason.

well, it's up to the nurse to explore that "reason", and manage it appropriately.

to merely accept, "pt denies pain", is shabby at best.

it seems that md's and nurses, both need just as much education, as do some of our pts.

i'm glad you brought this subject up.

and thank you.

leslie

SuesquatchRN, BSN, RN · Dec 6, 2007

I'll throw anything I have at someone in pain. And I say that because I NEVER have enough.

leslie :-D · Dec 6, 2007

and mental, spiritual pain is just as important to remember.

i recall one pt who was receing sev'l hundred mgs of ms04/hr, and we kept upping it, r/t persistent screaming.

long story short: this man was in such mental anguish, r/t children he had abandoned many yrs before.

and he felt condemned to hell, after he died.

w/a little bit of work on our parts, he received a message from his oldest son, stating he and his brothers were all well and happy.

and that 'dad' was forgiven.

never heard another peep out of this pt.

and he died peacefully, within an hr after receiving this news.

so please, pain comes in all forms- ea just as worthy as the other.

leslie

nursemary9, BSN, RN · Dec 18, 2007

Thank you so much, Kitty

Pain is a subject near & dear to my heart.

There is nothing more important to me, at times, then getting my patients adequate pain control.

Being an Oncology nurse puts me in close proximety to many pt's in severe pain.

Our in-pt. unit also gets all of the Sicke-Cell pt's.

It's just so frustrating to see the MD's undermedicate these groups of patients, HOWEVER, it's even MORE frustrating too hear my fellow RN's label these people as "drug-seekers".

We need to keep educating both RN's & MD's in Pain Management.

We as nurses need to be Advocates for our patients.

Es536 · Dec 20, 2007

Yes pain management is VERY important but we must find out what is causing the pain and fix it, if we can. I have heard of many people who have been on pain killer and the docs seem to ignore the thing that is the CAUSE of all their pain. Just a thought concerning pain.. someone said to me the other day "Whatever the patient says it is, it is." I thought that was right on the bulls eye.

chisgirl · Dec 20, 2007

Thank you for saying what so many of us know. I've been at both ends.. as a nurse watching a patient dying of terminal, late-stage colon cancer, and as a patient in chronic, unrelenting back pain. The doctors are TERRIFIED to provide adequate pain medication. I too have heard, in the case of my colorectal cancer patient... "what if he becomes addicted?" The man died within a weed of admission and he was in agony the entire time.... WHY??? When the heck was he going to get addicted??? And in my own case, I feel that the doctor feels that he wil be charged with over-medicating, even though we can definitvely prove the severe arthrtitis of the spine as a result of a patient kicking me ages ago. If a doctor had to go through the pain... you know that their pain would be adequately dealt with. Thanks for letting me blow off steam...

shadchan · Dec 20, 2007

Oh gosh, I so definitely agree with you chisgirl. For years I've suffered from horrible dysmenorrhea (pale, sweating, shaking, vomiting, at times losing consciousness) and for a while I would take one of my mom's leftover painkillers from her own back surgery because that is the only thing that would touch it. When that stopped working I finally gave in and went to a gyn and asked him for something strong, all I needed was one pill a month when my cramps are worst, and he flat out said no and told me it's either anaprox 500mg or birth control, made me feel like a hypochondriac and insinuated I was just looking for a way to get my hands on narcotics (I hate taking medication), and generally had a pretty condescending attitude. I took the anaprox but it maybe alleviates 10% of the pain. But what can I do? I have been to three doctors including this gyn in the past year and I have to reiterate my complaints over and over before they even listen to me. It's so frustrating. I have come to the other two with requests numerous times and it just breezes over their heads.

chisgirl · Dec 21, 2007

Shadchan... without diagnosing....have you been investigated for fibroids?

jschut, BSN, RN · Dec 21, 2007

Kitty~

Wonderful post.

I have been counseled for giving too much PRN medication to my geri patients. If they hurt, they hurt, and I am not one to stand idly by and say, "Oh, they just do that..."

No. Not me. If my patients are in pain, you had better believe I am giving them something to help them rest easier (I work 6p-6a).

Thank you again for your insight.

shadchan · Dec 21, 2007

Chisgirl, I will shoot you a PM with more info so I don't drag this thread off topic, but yeah, it was mentioned to me at one point but none of the stuff done to me apparently showed any signs that that could be so.

LilgirlRN, ADN, RN · Jan 29, 2008

I have chronic pain, I have RA and ankylosing spondylitis. Nearly impossible to get a doctor to adequately treat my pain because they are afraid of addiction. To me it's like what does it matter? I'm going to have both of these conditions for the rest of my life.

The language of pain

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