Pain Scale Dichotomy
Whiny 22 year old female on her period, c/o cramps, rates pain as a 10/10
= 1 mg Dilaudid IV.
Stoic 87 year female with broken hip after falling at home, rates pain as a 4/10
= 2 mg Morphine IV.
WTF?
Saturday, May 10, 2008
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21 comments:
I've been grading research papers written by freshmen.
My pain is a 12/10.
Can I get a prescription for 1 gallon of margaritas?
I once took care of a little old man with a broken hip s/p ORIF. Only prn pain meds were ultram 50mg and tylenol 325-650. You can't make this up.
Crankyprof: I just finished my grading. I vote for an Rx of margaritas for us both.
Pain scales in the ED are pretty worthless. I routinely get people with minor complaints as 10/10. I ask, so if I were to hit you over the head with a bat that wouldn't make you any more miserable? You have NO more room on the scale? It couldn't possibly get worse? I didn't think so. Note to public: tell the truth, 10/10 pain means you're almost unconscious and screaming agony... otherwise we think you're a moron when you say 10/10.
Whitecap nurse says:
Whiny 22 y.o. already narcotic dependent of course - will need good strong drugs to achieve discharge. I have had many LOLs do OK with small doses of MS (neener, neener JCAHO) and would definitely want to go slowly to avoid gorking her completely.
I rated un-medicated childbirth as 6/10 as he was crowning. I get annoyed at my husband when he rates his back pain as 10/10. (Fractured spine in May '07 after being rear-ended by a drunk driver, but still... he's talking to me, it's not a 10)
just for a lark next time you are asked to rate your pain on a scale of one to ten get it down to the third decimal place. specificity rules.
The pain scale should be a set of pictures, and the patient indicates one.
1 = bug bite
6 = stomach punch by Joe Louis
10 = unable to actually indicate one, as pain is too graet
The vast majority of old timers with fractured hips tell me there really isn't much pain as long as they're lying perfectly still (most will rate it at like a "2") which jumps up there (screaming/calling out) with any and all movement, so I just medicate based on the assumption that the patient isn't going to be able to lie perfectly still forever. It brings the pain from an "AAAAAAAAAAAAAAAAHHHHHHHHHHH!!!!!!!" to an "arr!" with movement.
As a hysteric born into a family of stoics, let me just point out that the experience of pain is incredibly subjective. Your ability to have mild discomfort from having a limb severed using a butter knife does not diminish, in any way, my extreme pain from a muscle strain.
Sondra, the experience of pain IS subjective, you're right. We don't mind that you have a lot of pain and we'll treat you for it. However, when rating your pain ask yourself: "does this muscle strain hurt so bad that it wouldn't hurt any MORE if I were having a limb severed with a butter knife?" If those two painful experience would be different for you then the muscle strain is not 10/10.
Yeah, pain is subjective. My husband broke his hip in the front yard and trying to move so he could sit in a chair and then move to his truck so I could drive him to the hospital b/c he wasn't going to let me call an ambo... you could say he's a mite stubborn, cause him to clamp down on a stick he was holding between his teeth.
I let him ooch across the ground for about 30 minutes, bringing him water and a pillow for his head...then I called 911 anyway.
When we got to the hospital... the x-ray showed his femur was about 1/16" from being in 2 pieces about 1/8" from the head. He rated his pain as 4/10.
Or when my Daddy was in the hospital with Stage 4,metastatic Renal Cell Carcinoma. Had tumors all up and down his spinal column,,,he rated his pain a 2/10.
So when my Mother self diagnoses herself with "spinal stenosis" complicated by arthritis and rates her pain as a 10/10 while she talk to me on the phone in calm voice...I'm somewhat skeptical.
I think many patients operate on the Squeaky Wheel theory. And unfortunately a lot of the time they're right.
Also more young'ins are totally receptive to some high-powered painkillers, while many old'ins think taking a tylenol might make them look like or turn into an addict.
Frustrating, but I like the quizzing about whether or not any mallet- or butter-knife-therapy could possibly worsen the pain.
I've never had 10/10. I HAVE had 9/10, and I truly thought that death might be more preferable (horrid Crohn's Disease Bowel Cramping, worse than childbirth!).
I can promise you and other medical professionals that I will never every tell you I have 10/10 pain.
In the case I actually do have it, I will be doing too much screaming and/or passing out to tell you about it, and I'm confident you'll get the idea without my explicit verbal direction.
The worst pain I ever experienced was when a nearby explosion cleared, and I was left with a roughly 2-3 foot piece of steel rebar sticking through my right shoulder. Imagine my surprise. It really didn't hurt at all....until one of the squad members decided to grab it and pull it out. And not all at once, like a band-aid mind you. He decided to pull a little, stop when I screamed, and asked if I was okay, then pull it some more.
I'd say 7-8 out of 10. If it ever did hit 10, it did it when I kept passing out.
I HATE being asked numerical scales for pain. I do NOT think in those terms. Ask me what it feels like and I can tell you. Do NOT ask me numbers!
Second, how on earth can someone be doing anything but writhing in pain and gibbering if they are at 9/10 or 10/10?
I thought it was funny when during my first childbirth experience they would ask me what my pain was. I told them, "I have no idea what a 10 is, so it's hard for me to say." I jumped the gun for an epidural though because everyone kept saying, "Don't wait until the pain is too unbearable that you can't stay still." Well, once that wore off and I was going through non-medicated childbirth, I realized what a 10 was. Or so I thought, until I had a gallbladder attack!!!! I am now very conservative with my pain scale!!! Childbirth...yeah, I'd take that over the gallbladder. But that's out now, so hopefully no more probs!!!
I always qualify my pain scale by saying "10/10 pain is like being set on fire or having an arm cut off". I also match what the patients tell me with non-verbal cues.
And when I used to work a post-op ortho floor, I had n number of old timers with broken hips who'd tell me "just give me some tylenol honey, I'll be ok".
I just use the faces scale on the triage form, and I go by the face they had on when they didn't think I was looking at them.
Dilaudid for period cramps? Ya gotta be kidding me. There are some people with cysts etc., but geesh.
Motrin and a heating pad for cramps, Dilaudid for compound fracture.
Newsflash: people have different body chemistries, that means, different tolerances to pain.
OTOH, some people are just whiny.
I am also convinced that experience plays a part. I used to have a low tolerance to pain. Now, I have a significantly higher tolerance to pain. Like if I cut/gash myself, I don't notice it until my son says "Dad! You're bleeding all over!"
The more painful experiences you have, the better your body becomes at managing pain. Oh yeah, the above gash happened a few years after my kidney stone.
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