Two Big Questions For Pain Experts

Specialties Pain

Published

If it's assumed that the patient's pain is ALWAYS what they say it there are two major questions that arise. The questions arise because they are real-life situations.

1. A patient has had surgery that isn't expected to be painful. The patient has had 4mg of Dilaudid for pain that is reported as 10. The patient has a goofy grin and says: "I'm going to say that my pain is a 10 because I like pain medicine." (This actually happened)

Do you continue to administer Dilaudid in this situation? Do you take his report of pain at face value? I was advised by my co-workers to send the fellow home and I did so.....He left smiling......Did we do the wrong thing?

2. A patient is close to being in a Dilaudid coma after receiving 10mg of Dilaudid. The patient appears very comfortable and, when awakened, rates his pain at 10. (This actually happened)

Do we have a pain emergency here? (I've seen many situations that are clearly pain emergencies but this one doesn't seem to be a pain emergency.) Can you in good conscience send the patient to the floor with a pain of 10 under these circumstances?

O.k.....I asked more than two questions but the other questions are tied to the main ones.

Specializes in PACU.
More like you didn't realize that all your posts would show the new username, not just the ones posted after you changed it.

I knew that. I did it on purpose based on a suggestion.

I don't see how calling me a troll constitutes rational discourse.

My opinions are as valid as anyone's here. I'm well educated and I've had a lot of practical experience. I support my assertions with facts and all that.....I go in for extremely well reasoned discourse.

I might be wrong about something but that's no reason to call me a troll or make other nonsecical accusations.

I've seen a bit of bad reasoning on the parts of other posters but you don't see me calling them names or making nonsensical accusations against them.

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Specializes in Hospice.
I'm not suggesting anything of the sort.

The example of the patient who was smiling after 4 mg of Dilaudid and boldly stating: "I'm going to say my pain is a 10 because I like pain medicine" seems to me to be different than someone who is screaming in obviuos pain.........Do you see any difference?

Frankly, I don't believe your example - in 40 years of dealing with addicts in varying levels of pain and engaging in various strategies for getting high, I've never seen one who would tell the person giving out the meds that they are lying about their pain to get more drugs. Either you're confabulating or you were dealing with the dumbest junkie on the planet.

If it ever happened to me, I'd laugh and give 'em a motrin. The guy just told me his pain wasn't what he said it was ...

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Specializes in Hospice.
I knew that. I did it on purpose based on a suggestion.

I don't see how calling me a troll constitutes rational discourse.

My opinions are as valid as anyone's here. I'm well educated and I've had a lot of practical experience. I support my assertions with facts and all that.....I go in for extremely well reasoned discourse.

I might be wrong about something but that's no reason to call me a troll or make other nonsecical accusations.

I've seen a bit of bad reasoning on the parts of other posters but you don't see me calling them names or making nonsensical accusations against them.

You keep making these claims about experts yet you neither name the experts nor do you provide any examples of the assertion that the only valid assessment criterion for pain is the patient's self-report.

In the thread that was locked, you did not define addiction accurately nor did you show any understanding of the differences between addiction, tolerance and habituation.

So, no ... your opinions are not valid. Your disingenuous protestations that you just wanted an expert to tell you what more you could have done don't wash. You presented neither facts nor reasoned argument. You presented clinical situations that deliberately left out information any PACU nurse would know ... information that could have suggested a course of action other than continued dosing, which was obviously the answer you were looking for so you could then tell us all how ignorant we are. Then you got mad and accused us of a lack of integrity when the real experts on the board didn't fall for it.

You are not trying to have a discussion, you're picking a fight - the definition of trolling.

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Specializes in Hospice.

I am not a PACU nurse and I am not a "pain expert" by far, however, I do have a question? Why couldn't you just call the anesthesiologist and let him/her decide what the next step would be? I'm almost sure that if you still have patients in the PACU one would be available.

It was just a thought, and please remember if I am wrong, I am very sensitive. LOL :shy:7

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Specializes in Nephrology, Cardiology, ER, ICU.

Friendly staff reminder:

DEBATE THE TOPIC, NOT THE POSTER.

And to the OP: your arguments carry a lot more weight when you cite sources.

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Specializes in Emergency & Trauma/Adult ICU.
OK, you're the same JonJacobs who was trolling around here the other day ranting about addiction and pain management. Hint: Using the same picture and the same profile (less the hometown in Maryland) isn't much of a disguise. Not to mention the same writing style.

I'm starting to think you're not all you say you are (would a real PACU nurse not know how to spell Dilaudid?) , even though the MD Board of Nursing says you have a diploma and a current license. What's your beef, anyway?

Did you not suggest a change of user name?

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Specializes in Hospice.
Did you not suggest a change of user name?

Whatever happened to this?

6:08 pm by traumaRUs

Friendly staff reminder:

DEBATE THE TOPIC, NOT THE POSTER.

And to the OP: your arguments carry a lot more weight when you cite sources.

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Specializes in Oncology, Ortho/trauma,.

Okay back to the original question.

For the 1st pt. I would ask them to further describe their pain, Throbbing? Sharp? Dull? Constant? I would assess their resp. offer re positioning and ice or heat, then I would have the discussion about pain expectation and that they are being discharged and IV meds are not prescribed for their home so I would offer them their po pills and say we need to see if this is an effective way of reaching your pain management goal. If they still met the criteria (resp okay and they were alert and not falling asleep in the middle of a convo then I would give them the dilaudid as per ordered) PACU is not REHAB center. my job is to make sure that we manage their pain and offer resources.

2. I would do the same as with the first and call the dr. let them know the pain medication is obviously controlling their level of pain and they need to consider other drugs. If the doctor doesn't want to address it I would document and when giving report to the floor nurse let them know. Then I would transfer them (even though I am a floor nurse and I hate it when I get a pt that is 10/10 but if they told me they already tried to get some meds changed then I would work with it)

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Specializes in PCCN.

situation a-I'd probably give it, given that the person will be leaving eventually.I will also tell him this will delay his discharge, and in my mind, if he says this doesn't relieve his pain, then a call to the anesthesiologist will be in order for "unrelieved pain" . Yes knowing the pt grins and says what he said can make me boil inside, but let's face it . There is nothing we as nurses can do about the situation. It's called customer service, the pt always wins, whatever you want to call it.That description of the pain scale is whatever the pt says it is will not be going away. And yes , if there are complications, you know darn well you as the nurse will be blamed for them . No win situation.As another shift manager I have says"suck it up, buttercup".

Situation 2. I have actually had this happen to me.pt was able to keep resps to 10-and aroused with a decent shake. Even with that , say, as to reassess, pain was still 10/10, and pt would go back to sleep in a stupor. I did not give any further med. I reported it to the doc.pt did take at home pain meds for chronic pain. Mind you , this pt was on a stepdown floor, non- surgical. no new pain, just continuation of chronic- but suddenly got IV meds while in hospital- because she complained ( when she would b more alert) That got this person a consult from the pain management MD in hospital.

Both these situations are just another checkoff on the list of why nursing sucks, and is a no win job.

Reread title of op post. No I am not an expert on pain, so my opinion is just that- an opinion based on experience.

I am also glad that most of the docs I do work with, do NOT prescribe pain meds freely. I see in their notes- sq meds only, or po, or avoid IV .Pt needs referral to a pain doc if thats the case. I think , again, my opinion, that some people get in trouble with chronic pain meds from others than Pain management docs

lastly, op- why do you stay in nursing if this bothers you so much??????

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Specializes in PACU.
in 40 years of dealing with addicts in varying levels of pain and engaging in various strategies for getting high,

The patient was a jovial fellow who seemed to enjoy engaging in a certain amount of honesty.

If it ever happened to me, I'd laugh and give 'em a motrin. The guy just told me his pain wasn't what he said it was ...

That's a valid response. The thing is that you still have to chart his pain as a 10/10 which doesn't look good. That's an example how it's silly to call pain "the 5th vital sign" as it's not an objective finding like a heart rate is.

Pretending an extremely subjective finding is an objective finding makes no sense.

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Specializes in PACU.
In the thread that was locked, you did not define addiction accurately

I did. I defined it as physical and psychological dependence. That is the definition found in the OED.

your opinions are not valid.

Your basing that on the fact that I used the Oxford English Dictionary definition of "addiction". Your claim that I don't understand addiction is nonsense.

Why are you going in for idiotic attacks on me? What are you accomplishing by doing that?

You presented neither facts nor reasoned argument.

That's an outright lie. Why don't you show that I'm wrong instead of lying about me?

You are not trying to have a discussion,

That's rich.....You're posting blatant lies about me and accusing ME of not trying to have a discussion.

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Specializes in PACU.
I do have a question? Why couldn't you just call the anesthesiologist and let him/her decide what the next step would be?

An anesthesiologist had been consulted in both cases.

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