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.

[nurseirma]

I feel like you do!!!! I work in the mental hospital with DD clients. We had one client that would get so angry that he would throw furniture or try to hit the staff. The charge nurse and I started watching that client closely for patterns to his anger. To make a long story short, he was in fact suffering from knee pain. I am not too sure now, but I think that he had osteoarthritis. In the end, the RN and I were able to communicate to the Dr's the client's need and once he got the pain meds he needed, he turned into an extremely wonderful client and was able to be placed into a community setting.

[crone57]

I consider myself a compassionate nurse who readily gave meds as needed and often offered them before the patient would ask. However, I see docs who do not give the amount of pain meds the patient needs, nurses who dont' want to get up from looking at a magazine to care for the pt. After having my own pain issues which is likely to become a chronic issue if I stay with traditional ways of treating pain ( which I won't), I have new understanding of pain, the need for rest, and most of all, the need for understanding and not judgement.