Ah yes, the "on a scale of one to ten" pain question. I'm not sure how this came to be the standard approach for health care providers to deal with patient pain, but I've never noticed that they make any use this information -- we all still get the same old two-tylenol response. I do believe these types of questions are creeping throughout the health care system -- perhaps some misguided attempt at "empowering" patients to "demonstrate their situational awareness" and "participate in their care"? I recall after I had been in hospital several weeks, following 3 months of illness including diverticulitis, bowel obstruction, malnutrition, surgery, etc etc, another new doctor came bustling into my room for some unexplained reason and introduced himself to me by saying "tell me why you are here". I guess he was expecting I would prove to him that I was self-aware and mentally competent by launching into the umpteenth re-telling of my lengthy tale of woe. Frankly, by that time I was tired of talking about it. My response this time was somewhat crisp: "Don't you know already? Didn't you read my 2-inch-thick chart before you came in here?"
Here's my "honest pain report" story: 30 years ago, I had this appendix that was about to rupture (which it did in the OR in the middle of the removal process). Erring way too much on the side of caution, the ER staff decided to give me a barium enema to check things out. I was absolutely writhing. After I rated the pain as a 10+, they began reading me all the informed consent stuff about the surgery. I rolled a bloodshot eye up at them and snarled, "Just cut the sucker OUT!!"
I wrote and then deleted a whine about the DEA, Tramadol, and taking OTC painkillers like they're candy, but then decided I just don't give a flying airplane through a rolling donut.
"Just remember that your insurance plan only covers words like 'shoot' and 'darn' and 'heck.' If you want to use stronger language, you'll have to pay out of pocket. Do I make myself clear, motherfucker?"
As I recall, Bonnie, he seemed a little startled. Then he just mumbled something about how he understood how difficult it had been for me and soon after he left, never to be seen again. I still don't know why he came in. But this seemed to happen a lot during this hospitalization -- perhaps I was a somewhat interesting case, in a morbid sort of way, because I had been so very ill for three months that I lost 70 lbs and I had such bad mal-nutritional edema that I couldn't walk anymore, but they couldn't find any cancer or diabetes or IBS or Crohns or allergies or heart disease or high blood pressure or liver disfunction or kidney trouble or anything particularly serious -- except for an idiopathic narrowed area of the sigmoid colon and diverticulosis (neither are particularly unusual in a 65+ year old woman) diagnosed two years prior which hadn't caused problems before. When I asked my colorectal surgeon later on why this had happened to me, he just said there's a lot about the functioning of the intestinal system that they don't really understand very well yet.
Some years back in the ER I answered that question with "Well, I haven't thrown up or passed out yet, so call it an 8." The nurse informed me that throwing up and passing out came after 10, so I've taken to adding 2 to my initial number.
I don't actually remember them asking me a number when I went in with my gall bladder attack; probably because I'd been throwing up for about 6 hours at that point. "Why didn't you come in sooner?" "Because the kids had the stomach flu so it took a while to figure out this wasn't the same thing?"
"I was just walking down the street one day when I stubbed my toe on a loose paving stone, and next thing I knew I was a nationally syndicated talk radio host."
"A 10" she says calmly, sitting in the triage chair with normal obs. "A 10?" says triage nurse? "So 1 is no pain, and 10 is the absolute worst pain imaginable. Like you got run over by a bulldozer and your leg is crushed flat, then a shark bit off your other leg" "Ok, a 9 then" Makes me laugh when I'm not ending a 14h shift.
You need to google and read Hyperbole and a Half's "A Better Pain Scale". I read it and made sure it was packed in my hospital bag for having one of my kids. The nurses loved it and asked for a copy.
I had an intervention with my pain doctor after I included "alcohol" on a questionnaire about what works for my pain. Much hand-wringing about the dangers of drinking while taking narcotics. Finally I said, "Look, I drink about twice a year, if that, and I don't drink very much at any one time any more. What I do is distraction, rest, exercise, all that healthy stuff, plus meds, but you didn't ask me what I do, you asked me what works. And I don't know how it works for other people, but I was in pain for 30 years before I found a doctor who cared, and one thing I've learned is that a lot of alcohol doesn't lessen the pain any, but enough of it sure does lessen how much I care about the pain!"
I'm pretty sure I have an interesting reputation at the rehab hospital. In other news, it doesn't go over well with physical therapists when you tell them you will work your @$$ off to develop and maintain skills that are useful (including, in my case, walking with crutches 15 feet to the bathroom), but walking for the sake of walking when it's slow, painful, exhausting and dangerous is not and will never be a hobby of yours.
Tonsillitis, to me, never was a pain worse than 2 or 3 (but mine never came with a fever either, making many doctors disbelieve me). Easily treated with throat lozenges, warm tea, a couple of ibuprofens, lots of water and not talking. My peritonsillar abscess didn't hurt at all, my pain level was at a 1, a 2 max. However, I just couldn't open my mouth more than half an inch for a week before surgery. My anesthesiologist asked right before surgery if I didn't open it any further because of pain or because it physically wouldn't open any wider and I had to admit that I had no idea. As soon as the anesthesia set in, it magically opened all up which for him meant it was a pain reaction just that I was in no pain at all. After the tonsillectomy the pain was at a 5 or 6 for maybe a night, three days later I took a paracetamol when going to bed but my blood pressure spiked at a 170/100 (where it's usually around 130/82) which the nurse said was a pain reaction. I have no idea how to actually rate me period cramps because they hurt like hell (as in somebody shoving a knive into my uterus and twisting) but it only hurts for a minute or two and warmth and ibuprofen do the trick. Unfortunately, my body won't let me walk upright for at least a day, it doesn't actually hurt but I just don't seem to be able to streightn up.
I never want to experience a 9/10 pain. I will also happily accept any drug offered at childbirth. I have no idea how I react to real pain.
Pain DO make a fella kinda moody. I know, I'm an expert. That said, I normally rate my pain a 2-3 and I promise that is probably low. I know a 10. I've dislocated my knees repeatedly and passed 18 kidney stones, the last being 8mm in size.
What a wimp, whining and bitching does not start for me until the 10 range and even then you would be hard pressed to hear a whimper.
ReplyDeletePain range 4, take a Tylenol and quit your bitching.
Packer, that's why pts express their pain in the 8 - 10 range. If they are honest, and say "4," they know or fear their pain will be ignored.
ReplyDeleteA "4" still hurts/
An honest patient who has a sense of humor. I can appreciate that!
ReplyDeleteAh yes, the "on a scale of one to ten" pain question. I'm not sure how this came to be the standard approach for health care providers to deal with patient pain, but I've never noticed that they make any use this information -- we all still get the same old two-tylenol response.
ReplyDeleteI do believe these types of questions are creeping throughout the health care system -- perhaps some misguided attempt at "empowering" patients to "demonstrate their situational awareness" and "participate in their care"?
I recall after I had been in hospital several weeks, following 3 months of illness including diverticulitis, bowel obstruction, malnutrition, surgery, etc etc, another new doctor came bustling into my room for some unexplained reason and introduced himself to me by saying "tell me why you are here". I guess he was expecting I would prove to him that I was self-aware and mentally competent by launching into the umpteenth re-telling of my lengthy tale of woe. Frankly, by that time I was tired of talking about it. My response this time was somewhat crisp: "Don't you know already? Didn't you read my 2-inch-thick chart before you came in here?"
Here's my "honest pain report" story: 30 years ago, I had this appendix that was about to rupture (which it did in the OR in the middle of the removal process). Erring way too much on the side of caution, the ER staff decided to give me a barium enema to check things out. I was absolutely writhing. After I rated the pain as a 10+, they began reading me all the informed consent stuff about the surgery. I rolled a bloodshot eye up at them and snarled, "Just cut the sucker OUT!!"
ReplyDeleteI'm pretty sure I've answered like that.
ReplyDeleteI wrote and then deleted a whine about the DEA, Tramadol, and taking OTC painkillers like they're candy, but then decided I just don't give a flying airplane through a rolling donut.
Cathie - Perhaps that was how he figured out if he was in the right room! But don't keep me in suspense - how did he reply to your question?
ReplyDelete"The pain in my brain mainly makes me complain."
ReplyDelete"Just remember that your insurance plan only covers words like 'shoot' and 'darn' and 'heck.' If you want to use stronger language, you'll have to pay out of pocket. Do I make myself clear, motherfucker?"
ReplyDeleteNot to be confused with "a lot of wine."
ReplyDeleteAs I recall, Bonnie, he seemed a little startled. Then he just mumbled something about how he understood how difficult it had been for me and soon after he left, never to be seen again. I still don't know why he came in. But this seemed to happen a lot during this hospitalization -- perhaps I was a somewhat interesting case, in a morbid sort of way, because I had been so very ill for three months that I lost 70 lbs and I had such bad mal-nutritional edema that I couldn't walk anymore, but they couldn't find any cancer or diabetes or IBS or Crohns or allergies or heart disease or high blood pressure or liver disfunction or kidney trouble or anything particularly serious -- except for an idiopathic narrowed area of the sigmoid colon and diverticulosis (neither are particularly unusual in a 65+ year old woman) diagnosed two years prior which hadn't caused problems before. When I asked my colorectal surgeon later on why this had happened to me, he just said there's a lot about the functioning of the intestinal system that they don't really understand very well yet.
ReplyDeleteSome years back in the ER I answered that question with "Well, I haven't thrown up or passed out yet, so call it an 8." The nurse informed me that throwing up and passing out came after 10, so I've taken to adding 2 to my initial number.
ReplyDeleteI don't actually remember them asking me a number when I went in with my gall bladder attack; probably because I'd been throwing up for about 6 hours at that point. "Why didn't you come in sooner?" "Because the kids had the stomach flu so it took a while to figure out this wasn't the same thing?"
"I was just walking down the street one day when I stubbed my toe on a loose paving stone, and next thing I knew I was a nationally syndicated talk radio host."
ReplyDelete"A 10" she says calmly, sitting in the triage chair with normal obs.
ReplyDelete"A 10?" says triage nurse? "So 1 is no pain, and 10 is the absolute worst pain imaginable. Like you got run over by a bulldozer and your leg is crushed flat, then a shark bit off your other leg"
"Ok, a 9 then"
Makes me laugh when I'm not ending a 14h shift.
You need to google and read Hyperbole and a Half's "A Better Pain Scale". I read it and made sure it was packed in my hospital bag for having one of my kids. The nurses loved it and asked for a copy.
ReplyDeleteI love hyperbole and a Half!
ReplyDeleteI had an intervention with my pain doctor after I included "alcohol" on a questionnaire about what works for my pain. Much hand-wringing about the dangers of drinking while taking narcotics. Finally I said, "Look, I drink about twice a year, if that, and I don't drink very much at any one time any more. What I do is distraction, rest, exercise, all that healthy stuff, plus meds, but you didn't ask me what I do, you asked me what works. And I don't know how it works for other people, but I was in pain for 30 years before I found a doctor who cared, and one thing I've learned is that a lot of alcohol doesn't lessen the pain any, but enough of it sure does lessen how much I care about the pain!"
ReplyDeleteI'm pretty sure I have an interesting reputation at the rehab hospital. In other news, it doesn't go over well with physical therapists when you tell them you will work your @$$ off to develop and maintain skills that are useful (including, in my case, walking with crutches 15 feet to the bathroom), but walking for the sake of walking when it's slow, painful, exhausting and dangerous is not and will never be a hobby of yours.
Tonsillitis, to me, never was a pain worse than 2 or 3 (but mine never came with a fever either, making many doctors disbelieve me). Easily treated with throat lozenges, warm tea, a couple of ibuprofens, lots of water and not talking. My peritonsillar abscess didn't hurt at all, my pain level was at a 1, a 2 max. However, I just couldn't open my mouth more than half an inch for a week before surgery. My anesthesiologist asked right before surgery if I didn't open it any further because of pain or because it physically wouldn't open any wider and I had to admit that I had no idea. As soon as the anesthesia set in, it magically opened all up which for him meant it was a pain reaction just that I was in no pain at all. After the tonsillectomy the pain was at a 5 or 6 for maybe a night, three days later I took a paracetamol when going to bed but my blood pressure spiked at a 170/100 (where it's usually around 130/82) which the nurse said was a pain reaction. I have no idea how to actually rate me period cramps because they hurt like hell (as in somebody shoving a knive into my uterus and twisting) but it only hurts for a minute or two and warmth and ibuprofen do the trick. Unfortunately, my body won't let me walk upright for at least a day, it doesn't actually hurt but I just don't seem to be able to streightn up.
ReplyDeleteI never want to experience a 9/10 pain. I will also happily accept any drug offered at childbirth. I have no idea how I react to real pain.
Pain DO make a fella kinda moody. I know, I'm an expert. That said, I normally rate my pain a 2-3 and I promise that is probably low. I know a 10. I've dislocated my knees repeatedly and passed 18 kidney stones, the last being 8mm in size.
ReplyDelete