Pain Scale Absurdity
Two patients came into the ER by ambulance complaining of pain.
One was a young woman with another migraine, who "usually gets" Dilaudid 4-6 mg IV in addition to IV Reglan and Ativan. She was allergic to many other medications, but she had a full bottle of dilaudid 8 mg pills and some Actiq lollipops in her purse from two different pain specialists. Her usual medications also included Ambien 20 mg at bedtime and Xanax 2 mg every 6 hours. Although she complained of vomiting constantly for 3 days, her vital signs, physical exam, bloodwork, urinalysis, and imaging tests were all negative, and she never vomited in the ER. She spoke calmly and was in no apparent distress.
The other patient was an elderly lady who had fallen at home, fracturing her hip. She was taking a blood thinner, so her grotesquely angulated and deformed thigh was also markedly swollen. The fact that she had crawled down the stairs after her injury in order to call the ambulance probably contributed to the swelling and deformity somewhat. She trembled a bit as she asked for something to relieve her pain.
Guess whose pain was a 5/10 and whose was a 10/10?
JCAHO, your pain scale sucks about a 12 on a scale of 1 to 10.
Thanks to KevinMD for the link!
One was a young woman with another migraine, who "usually gets" Dilaudid 4-6 mg IV in addition to IV Reglan and Ativan. She was allergic to many other medications, but she had a full bottle of dilaudid 8 mg pills and some Actiq lollipops in her purse from two different pain specialists. Her usual medications also included Ambien 20 mg at bedtime and Xanax 2 mg every 6 hours. Although she complained of vomiting constantly for 3 days, her vital signs, physical exam, bloodwork, urinalysis, and imaging tests were all negative, and she never vomited in the ER. She spoke calmly and was in no apparent distress.
The other patient was an elderly lady who had fallen at home, fracturing her hip. She was taking a blood thinner, so her grotesquely angulated and deformed thigh was also markedly swollen. The fact that she had crawled down the stairs after her injury in order to call the ambulance probably contributed to the swelling and deformity somewhat. She trembled a bit as she asked for something to relieve her pain.
Guess whose pain was a 5/10 and whose was a 10/10?
JCAHO, your pain scale sucks about a 12 on a scale of 1 to 10.
Thanks to KevinMD for the link!
Labels: migraineurs, pain, patients
posted by scalpel at 12:14 AM
43 Comments:
No prizes I reckon on this one :-)
Along the same lines, today our ER was running an anxiety and drama special. I'm sort of known as the looney magnet, so guess who had all the screamers?
The QUIETEST patient I had was the dude with the hip fracture. His treatment for pain was a request to shut the door so he didn't have to hear the young lady with chronic back pain, a negative MRI and multiple ER visits to many hospitals recently scream next door. After I complied, he drifted off to sleep. (He'd had a couple Vikies at home from a previous surgery that he took too).
It also bears mentioning that placing a #22 IV with lidocaine to numb the skin prior caused back pain lady to scream so loudly (including her throwing her hands up onto her head) that a couple staff members came down to see what was up.
Deadpan: "I'm placing a #22 IV. Don't worry."
I had to come out and tell her that was inappropriate, and she needed to control her screaming. That was the last frickin' straw.
As a migrainuer, that first woman infuriates me. There is absolutely no reason to have all that pain medication and come to the ER specifically asking for more pain medication. Also, I have real problems with someone getting pain meds from multiple pain doctors. That is super shady.
I just had the same thing with a LOL that broke her ankle. She actually STRAIGHTENED it herself before coming and asked for NO pain medicine. She thought it was painful but she would "be okay" because she did not like pain meds. She did let us giver her some ketoralac. Nope, she was not diabetic either. She was sweet and tough. We joked afterwards that when she went to surgery she probably told the orthopods what to do and then just put the pins in herself...
As a migraineur, gotta say these drug seekers give us a bad name. When I present to hospital with a migraine, it's when my usual advil/tylenol OTC combo with gravol hasn't touched it and I just need something to make the puking stop...
When I finally get in, I am dead easy to treat. Can't imagine taking opioids on a migraine belly. *urk*
(Not trying to start a flame war or anything)
Just wondering, are you aware of any other method that a medical facility could use for a patient to share their pain scale with the staff?
I totally agree with the idea the current 1-10 is completely subjective, and able to be used fraudulently, but then again, any new method will be abused as well.
With drug-addicts, the pain scale is irrelevant. As long as they are awake, they are in pain, and there is no other endpoint to the amount of medications they will consume.
I'm working on a new pain scale.
As someone with an allergy to NSAID class meds, (Typical treatment of a chronic inflammatory syndrome for me has involved long-term RX's of high-dose, long acting NSAIDs, and I had an allergic reaction to one new med, and then, dammitol, the others I had used before), and as someone who REFUSES to ever use the pain scale because it is stupid and useless, I get ticked off by the Dr's who roll their eyes at patients who say they have allergies.
You'd rather let me suffer than be "conned".
I say it's high time to take the conning incentive away from addicts, which means letting addicts buy whatever they want. I don't care if they fall asleep and die, or develop a happy habit and just feel cheerful all the time.
Let me go to a physician for careful treatment of my pain, because I'm smart and prudent. But let the idiots of the world bypass the smart action and act for themselves.
That's right, OTC narcotics. Let the self-treatment begin. I want 1907 back.
Of course, I can't even treat myself for a cold anymore without a cheekswab and a passport.
I think the best pain scale starts with 10/10 being equivalent to burning alive. Working backwards from there is a bit easier than the other way around.
How about the faces pain scale which was designed for kids and those who cannot understand or communicate but works for just about anyone. Its pretty objective. I frequently use it and do not even ask the 1-10 scale or use both and put the number side by side referencing the scale used. Severe pain is debilitating and will result in some observeable findings. One stratagy that also works is I do not deliver any sedating medication on the walk in pain seeker who "got dropped off" and "has someone to come pick me up" until I can verify that they have a ride home. I have been burned to many times by those who after getting several narc shots lie and get in a car and drive. The reason it works is because if you require a driver present they are not as likely to hang out and milk you for the extra shots because someone is waiting on them who probably knows their game and does not have all day to hang out for their friends repeat fix.
OH but "pain is subjective". I hate Jake-ho
Sometimes, a calm, cooperative patient with chronic pain of some sort will say their pain is an 8/10. My follow-up question is, "What is your pain on a normal day?" Some will actually say 7 or 8/10. That "what is it on a normal day" is important to ask for a chronic paineur/drug seekeur. Puts their number into perspective.
That pain scales are crap is the big secret. I run a pain service at a children's hospital and have not found any of the pain scales to be of any help.
Pain scales might be of some use for research purposes because with an ordinal scale you can apply all the usual statistical tests and produce the allmighty p value. JCAHO and the suits like scales because they like simple metrics in the business world; set a metric, set a goal, achieve a goal.
The bogus party line goes 'pain is what the patient says it is'. The reality is pain is what the health care provider understands it to be. Pain is a mix of a pathophysiologic process, anxiety, coping skills and cultural expectations and behaviors; this just cannot be meaninfully captured and relayed between patient and provider in a single number.
"One was a young woman with another migraine, who "usually gets" Dilaudid 4-6 mg IV in addition to IV Reglan and Ativan. She was allergic to many other medications, but she had a full bottle of dilaudid 8 mg pills and some Actiq lollipops in her purse from two different pain specialists."
And what is the problem with her coming in to get medications that will stop the migraine she has? Obviously she didn't need "more" drugs, just a different type that work in combination to stop the migraine.
I'm sorry, but I have no patience for the nasty comments.
I had constant head plus migraines for over three years. I was on a fentanyl patch and popped morphine like tic tacs. I went to the ER once in all that time, thankfully I wasn't treated poorly.
I finally learned how to treat a whopper migraine at home: [5mg prednisone, Imitrex, Fioricet as one coctail, plus a rehydration solution of 8 T. sugar, 1 t. salt, 1 qt water w/ some orange juice]
And the whole "narcotics will make you an addict" doesn't even figure into the picture when you are truly in that much pain. I quit all pain meds within 1 month of surgery to remove the pituitary tumor that was causing the pain.
And worst of all, I hate it when people miss the point of a blog post and go apeshit with details of their experience to the contrary, yet here I go... i-yi.
I have lived with acute roto-scoliosis since I was 12 (now 51). I have lived with COPD (because of the scoliosis) since 1991. My pain rarely goes away. Yet I have to answer that stupid question every time I go to the doctor's office. I tell them that if 10 is passing-out pain, 9 is labor, then on a good day I run about 3. When my arthritis is acting up, that shoots up to about 6. Yet I only take pain medication when I can stay home. If I have to go to the store, I will wait until I return to the house before "doping up". My pain meds have worked just fine for me for many years now. If these people didn't take pain meds constantly, they wouldn't develop an immunity to it.
Hmmmm. The drug seeker/migraine discussion will never go away . . .
I have to say that I can't imagine going to the ED with a migraine. I have suffered from migraines since 1990, and I've tried numerous meds ranging from fioricet to inderal. Fioricet caused rebound headaches, and although inderal works well for prevention, I have found that learning what my triggers are and avoiding them works the best for me. I had to learn some serious coping skills for dealing with stress, but I digress . . .
I totally understand the pain issues(including nausea and vomiting) associated with migraines, but when I can reduce them to once or twice per year, some ibuprofen and a dark room is much better than a bright, noisy emergency department.
Medications seem like the easy answer at times, but they aren't always the best answer in the long run.
That's my humble opinion, but I'm just a patient . . . ;o)
You may have had a couple of migraines, tk, but you show your ignorance with your claim that you can't imagine going to the ED to be treated for a migraine. Have you ever had one that lasted for a week? A relentless, insanity inducing week? If you had, you would know that under those circumstances your life can be at risk and you absolutely should seek out medical treatment.
Furthermore, despite all my best efforts to learn my triggers and prevent these damned migraines, I have had three to four of them a week for the past four years. It isn't nearly as simple as you make it out to be. I've been on more than 20 preventative meds, and I'm still working to find one that actually helps me.
I'm so glad that I don't have to deal with patient's like that. Big thanks to our ER doc friends. But for the grace...
Ibuprofen, benadryl and sleep..! wake up post migraine feeling like Marry Poppins. Fortunately migraines are rare for me.
Diana--I understand that we are all different, but yes, I have had the week long, puking yellow stuff or dry heaving (sorry for the graphic description) because I can't eat migraines. I didn't say that I never sought medical attention (I spent several years under the care of a neurologist), I merely stated that I wouldn't go to the ED with a migraine.
Trust me, I am not ignorant when it comes to migraines . . . Docs don't tend to prescribe Inderal for infrequent migraine sufferers. :o/
I stand by my earlier statement. ;o)
I'm sick of migraine discussion. We all know which ones of you are faking/seeking/exaggerating and which ones just want some relief from an actual migraine, but it's anti-PC and bad customer service to tell you you're a big faker, so we are stuck treating.
pain scales hurt me. i agree with your new pain scale. to tell clinicians, who manage pain all the time, that they need to ask the patient to do the one to ten thing is insane. if you can't see someone is in pain AND get a pretty good idea about the severity of said pain based on your H&P then you are probably a pathologist.
Migraine drugseekers are actually far worse than the regular crazy homeless drugseeker flavor. Nobody cares if your frequent flying homeless dude on his 53rd visit of the year for questionable reasons doesn't get opioids. But god forbid you don't give Jane Soccer Mom the Dodge Caravan full of morphine she demands, or the entire press-ganey company will strike down upon thee with great vengeance and furious anger.
Diana,
Just a question,
If you had a migraine for over a week,why not go to the doctor that treats your migraines to get pain relief. It's not like the pain just all of a sudden crept up on you in the middle of the night and there was no where else to go but the ER, you have had this for a week, surely your doctor had hours at some point, plus it would let him know that apparently something is not working to keep your migraines at bay.
I've never claimed a 10/10 for a migraine (and I get 26+ per month, intractable), and I've never asked for Dialudad or the like (I want DHE and if you try giving me narcs first, I think you're an idiot). I tend to avoid ER's because of the skepticism I see displayed here. The one time I did go was because of a drug reaction to a migraine med, but that's a different story... My doctor will usually set me up with an IV in his office or in the Urgent Care clinic at his office. I consider myself to be extremely LUCKY though. Many doctors are not this accomodating or have the resources available to do this. My doctor happens to be a migraine specializing neurologist.
Chronic pain is just a fact of my life. I live at 3-4's (on Scalpel's new scale) every day at a minimum. When I'm asking for an IV, it's because I'm at a 5-6, and I've been there for a few weeks. I don't get narcs of any kind to treat migraines, just Imitrex injections (2x's/wk), so most of the time, it's just me dealing with the pain, on my own. I'd appreciate a little respect for the legit migraineurs. Life's a bitch.
Bohica, that's a good (and fair) question. When I called my doctor's office to describe the situation ask them what the heck to do, they said I should go to the ER.
Quoting Nurse K "Sometimes, a calm, cooperative patient with chronic pain of some sort will say their pain is an 8/10. My follow-up question is, "What is your pain on a normal day?" Some will actually say 7 or 8/10. That "what is it on a normal day" is important to ask for a chronic paineur/drug seekeur. Puts their number into perspective."
Thank you Nurse K. I think more docs/nurses should ask this question. I generally volunteer it myself. It helped this last visit I had to the ER to not be treated like an addict.
I have had migraines, so does my grandmother. She has tried all the drugs imaginable for treating them. She would get migraines about 5 x's a week. We were both prescribed Topamax to keep them at bay. It has been a HUGE help! She gets one major migraine in 3 months now, and me even less. Topamax was our miracle.
I understand that dark humor and the medical profession go hand in hand, so does becomming jaded. I am an RN with migraines and a host of other problems that cause chronic pain. As a result, I try not to complain. I had a terrible headache that I thought was a migraine for 4 days before I finally gave in and went to the ER. I had been on the floor, literally. I couldn't eat, I had to crawl to the bathroom. I thought the hot/cold flashes were just hormones. I sat, actually laid across two chairs, in the ER for 3 hours before I was seen. After an hour in the exam room I was finally given pain medication. Oh, also the spinal tap proved I had meningitis. I was in the hospital for 5 more days. I didn't holler or yell while I waited, I think I did cry a bit, but quietly. I rated my pain as an 8, because I have had much worse pain. I had an emergency C-Section with what was later called a "partial" spinal anesthesia. Yes, it hurts to have your guts ripped out, and no I didn't scream then. I was too worried about my baby who had his cord wrapped around his neck. Thankfully, once he was delivered I was given general anesthesia.
The point of all this is everyone has unique responses to pain, and some of them will not fit into neat categories of 1-10.
It's not surprising that this headline has so many comments. I personally find it to be one of the most frustrating things about being an R.N. My shift yesterday included caring for a 23 y/o with hx of Hep C and IVDA with back pain from a spinal abcess/OM (chronic for 9 months mind you) Now, for the record, yes, I do believe she had some pain, but when she's sitting in bed with compact in hand putting on lipstick, laughing at her boyfriens's jokes, with perfect vs's and proceeds to tell me she is in a "10/10" pain. It makes me nuts!!!!!! I often will repeat it back to them saying, "you are a 10/10? Are you sure?? 10/10 means you're pain could not POSSIBLY get any worse, it's the WORST PAIN IMAGINEABLE, you would still describe it as a 10/10?" and they still say YES! I then I have no choice but call the md and document her pain. It's a joke!! I worked 12 hrs. and she did not claim pain less then 10/10 all night despite the increases in the Dilaudid PCA. I think the headache she gave ME was worse then her pain!!
I vote they make a separate pain scale just for the drug seekers.
It should START at 10 and go to 20.. since God know they never claim less then 10 anyway!!
Maybe one for the stoic as well.. goes from only 1-5!
haha (sorry.. did feel good to vent at least!! lol)
What about the people who really do have pain....least you forget. My husband of 30 years has 7 herniated disc in his back from hard labor all his life. He has 3 bone spurs in his neck and a rare muscle disease. The man is in chronic pain daily to the point of suicide...suck it up and get over it; you all sound totally burned out on patients and life in general. Not everyone is a drug seeker--where is your compassion...consider changing jobs.
I am on this site by accident while looking at medication options for a migraine-like headache (not my usual migraine that responds nicely to immitrex) that I have had to some degree or another for well over 40 days. To tell you the truth, I don't know if I would rate my pain today the same as the exact same pain a month ago. It is getting old. My tolerance is changing, i think.
I am very satisfied with my doctor, but there are days when he just doesn't get back to me in a timely way. I called this morning and it is about 7 PM now. Due to neither of our faults, if the headache increases I might have the potential to end up in an ER at night on a weekday.
Thus, I come to several
points.
1) For those of you who work in ERs, do you have any idea how horrid a place that is to be while in pain?
I have a handful of examples, and will choose the most recent.
I had a PICC line for 7 months for chronic pancreatitis, had rigors and intermittent fever, and because they knew they had to admit me they cleared the ER of patients they could DC to home before attending to me. I use a power wheelchair and get migraine-like pain from holding my head up for longer than i have the strength. I get muscle pain from being confined to a limited range of positions. How absurd -- I arrived with pain at one level, was at a much higher level by the time i was finally seen, and after reading this site i bet I was probably labled by at least 1 person if not several as drug-seeking becuase my multiple sources of pain were exacerbated just by the process of waiting to be seen.
I can't think of a worse place to be than the ER when in pain.
2) I distract myself from pain by talking. Doctors who know me know know that I am wordier, giddier, or something like that as my pain mounts. What you are seeing may not be what you think.
3) I don't scream. It just isn't what I do. But I think the people who scream get seen faster. After reading this site i am reavaluating my behavior.
Maybe you could develop quiet sides and noisey sides, and take your pain scales from there.
4) Mid-migraine, or mid-pancreatitis episode, or mid-anything medical really, I have no tolerance for other people's children. [I don't really have much tolerance for public barfing either, mine or others. I wonder if my pain would be lessened if I didn't have to worry about the shared experience of public barfing.] I love children, and in my normal life can't think of anyone I love more to be around.
Sometimes the children accompanying adults are noisey because their own hunger has become painful,they don't know how to manage their anxiety or boredom, or don't have support of parents who are worried, in pain, too preoccupied or otherwise distracted to deal with their children. Although the ER isn't a restaurant and one would need to be careful about precedents, a box of Cheerios and a juicebox for the children, and perhaps a few crayons and some paper, might result in lower cost than that needed for increased medication and more contact time with medical staff for patients in pain.
Most of the time by the time I am finally seen people are compassionate but also seem burned out. Are people bored in ERs by patients who aren't near death from car accidents or stabbings? Do we need separate ERs for people with chronic medical illnesses.
Well, here you have it. Tonight's manner of dealing with pain is being angry at people who are impatient about dealing with people in pain. Full circle, or something.
Really, I am grateful and thank you. Please take this with a grain of salt and perhaps a few grains of dilaudid too.
I am on this site by accident while looking at medication options for a migraine-like headache (not my usual migraine that responds nicely to immitrex) that I have had to some degree or another for well over 40 days. To tell you the truth, I don't know if I would rate my pain today the same as the exact same pain a month ago. It is getting old. My tolerance is changing, i think.
I am very satisfied with my doctor, but there are days when he just doesn't get back to me in a timely way. I called this morning and it is about 7 PM now. Due to neither of our faults, if the headache increases I might have the potential to end up in an ER at night on a weekday.
Thus, I come to several
points.
1) For those of you who work in ERs, do you have any idea how horrid a place that is to be while in pain?
I have a handful of examples, and will choose the most recent.
I had a PICC line for 7 months for chronic pancreatitis, had rigors and intermittent fever, and because they knew they had to admit me they cleared the ER of patients they could DC to home before attending to me. I use a power wheelchair and get migraine-like pain from holding my head up for longer than I have the strength. I get muscle pain from being confined to a limited range of positions. How absurd -- I arrived with pain at one level, was at a much higher level by the time I was finally seen, and after reading this site I bet I was probably labled by at least 1 person if not several as drug-seeking becuase my multiple sources of pain were exacerbated just by the process of waiting to be seen.
I can't think of a worse place to be than the ER when in pain.
2) I distract myself from pain by talking. Doctors who know me know that I am wordier, less precise, giddier, or something like that as my pain mounts. What strangesr are seeing may not be what they think.
3) I don't scream. It just isn't what I do. But I think the people who scream get seen faster. After reading this site I am reavaluating my behavior for future similar situations.
Maybe you could develop quiet sides and noisey sides, and take your pain scales from there.
4) Mid-migraine, or mid-pancreatitis episode, or mid-anything medical really, I have no tolerance for other people's children. [I don't really have much tolerance for public barfing either, mine or others. I wonder if my pain would be lessened if I didn't have to worry about the shared experience of public barfing.] I love children, and in my normal life can't think of anyone I love more to be around.
Sometimes the children accompanying adults are noisey because their own hunger has become painful,they don't know how to manage their anxiety or boredom, or don't have support of parents who are worried, in pain, too preoccupied or otherwise distracted to deal with their children. Although the ER isn't a restaurant and one would need to be careful about precedents, a box of Cheerios and a juicebox for the children, and perhaps a few crayons and some paper, might result in lower cost than that needed for increased medication and more contact time with medical staff for patients in pain.
Most of the time by the time I am finally seen people are compassionate but also seem burned out. Are people bored in ERs by patients who aren't near death from car accidents or stabbings? Do we need separate ERs for people with chronic medical illnesses.
Well, here you have it. Tonight's manner of dealing with pain is being angry at people who are impatient about dealing with people in pain. Full circle, or something.
Really, I am grateful and thank you. Please take this with a grain of salt and perhaps a few grains of dilaudid too.
"Do we need separate ERs for people with chronic medical illnesses?"
Yeah, we could call it the "Non-Emergency Room."
Scalpel - ROFL!
Yes, you could do what I do - have a very good primary doctor and, if necessary, go to an URGENT care facility when you really feel you have to be seen right away.
No, we don't need separate ERs for chronic problems....that's called your doctor's office. Too many people go to ERs for chronic pain, taking up much-needed space for true emergencies. Many times, I've seen people with real heart attacks waiting for a spot in the ER while beds are occupied with the chronic back pain or chronic headache. An ER is nothing more than a stablizing unit. They stabilize the heart until you can get to a cardiologist, or they stabilize the broken bone until you can get to the orthopedic. The ER was NEVER intended to treat chronic problems. If you have had that vaginal itch for 3 months, it is NOT an emergency! Go to a doctor. Ran out of your pain pills? Go tell your doctor, and stop taking up valuble space in the ER. And, Pain is not considered an emergency, unless it is your heart or a disecting aneurism or something acute. And as far as the pain scale goes, it's only use is to evaluate any pain medicine you might have received. They ask what your pain # is, then they might give you a pain shot, then they come back 30-40 minutes later and again, ask what your pain # is. If it was a "10" and now it's an "8", that's how effective the medicine was. Most drug-seekers always have a "10" pain scale and you can give them the entire supply of narcotics and their pain scale will remain a "10" They think the higher the number, the better and more amount of drugs they'll get. We ER emplyees know who you are, and it is commonly known that "10" pain scale with allergies to motrin, toradol, nsaids, ,,etc. equals a drug-seeker. Fortuunately, they are starting to link all of the pharmacys, and those who bounce from er-er-dr-dr-er for nacotics are going to be arrested for narcotic shopping. The pharmacys are going to be required to notify the law for those getting narcs filled at different drug stores. It has aready happened in my community. Also, the ERs are starting to refuse to see patients for chronic problems unless they can pay for the visit. Chronic back pain, no money or insurance? you don't get seen. Everyone complains about the cost of medical care, but more than half the peaople seen in the ERs are Not emergencies, and Don't have insurance and Don't pay!!!! That's why the rest of the working-insured people are charged SOOOOO MUCH. The dead-beats need to start helping out. I have several fractures with disc problems in by back, I have heart disease, I have severe kidney diseae, I have had a stroke with carotid surgery, I am diabetic, I have severe high blood pressure, I ahve arthritis, I am in PAIN every day, but I still manage to work over 40 hours a week as an ER nurse. No, I don't go running in to the ER with every little ache or pain. Life is painful, take a tylenol and suck-it-up!!!!
I have 50 years being asked the stupid question and in the last 5 years I have started out answering their question by defining the scale 1 - 10 that makes sense to me. Brace your self starting with
10 - Unconscious or worse
9- Trashing or still but unable to respond to commands or instructions not aware of the real conditions around for many reasons: part of which is hearing and eye sight are significantly impaired by the pain.
8- Barely able to response to the environment eg., trying to move out of danger but minimal rationally thinking.
7- Active but poor thinking response to fixing the pain eg, cutting off crushed arm, suicide, begging for help, etc. This is a common limit for migraine headache.
6- Rational thinking and dialog while shaking/thrashing; or having poor motor functions.
5- Has lost the ability to accurately read or remember and execute instructions.
4- Can to light reading like medicine instructions and if cartoons the point of the cartoon is seldom understood.
3- Sustained concentration is not possible and movies usuallydo not make sense – entertainment is just noise.
2- Hurts enough to want immediate relief and all other normal functions are OK.
1- Hurts enough to want to determine the cause or causes the body to twitch.
Sadly, La Belle Bianca has a *migraine*, so it is Retired Educator here (we share a blog). In fact, La Belle's status as a migraineuse caused me to recall the outlandish comment thread that hijacked Scalpel's neat little post -- and I am going to pirate it, à mon tour, by shamelessly linking to it.
Oops. I also had an actual point to make. It happens. I think what folks are referencing when suggesting a bifurcation of EDs, one being a site for people with chronic pain -- is the hard to deal with occurence of ACUTE-on-CHRONIC pain. Like my actual points, it happens, and is extremely difficult to endure. Harder to endure? Medicos who don't understand the concept.
Here's something I posted on another blog, but it's relevant.
The painscale is absurd, I've talked about thi swith my brother, who's and army medic - he agrees.
I can moan to myself and literally bite a pillow all day,flat on the bed, moving by inches, but that's not like having ground glass under my eyelids- it's not torture, for God's sake. So I rate that a 7.
I can work. I'm grateful for hat. I don't like having the "kidney stone shuffle" at work, and having people looka t em like I'm retarded, and peeing blood.
But it's tolerable as I sit down, and am free to stand up and move around when I'm too sore.I rate my day to day pain as a 5, or six. It's relentless, and people are always telling me to smile. After 6 years of this, I still don't know what I'm supposed to tell doctors. My teeth are down to that of a 70 year old, my dentist says, from gritting them.
I have the misfortune to have a barely-studied illness where my kidneys bleed, and I get clots in my kidneys and urethra every fourth day or so, with steadily compounding pain as they build up.
My brother is a combat medical technician. He can't stand to see me writhing, but I've told him I don't want him to intervene, or bother people on my behalf.That's not his business. My wife is furious that I can't have sex with her half the week. When I get home from work, I take another painkiller, and lie down for an hour or so, until my bastard kidneys settle to a dull throb.
I take the minimum of morhpine (10mg oral) to get through my days, and my 60 hour weeks as a teacher. My doctor has to jump through endless hoops to cover his ass and write pain meds, and I carefully keep pain diaries, take anti nausea meds, and work my ass off, so that people who abuse narcotics can make my life more difficult. Thanks a lot.
When my doctor went on holiday, my stand-in physician refused to prescribe. I accepted his professional judgement and din't make a fuss. My wife turned up a week later, and howled that I hadn't had sleep. I took her back to the car and explained it's not up to us- doctors have their own pressures, and if they're even suspected of giving narcotics to abusers they lose their careers.
So I took paracetemol, and went to work. I didn't whine, I didn't doctor shop.
Finally, my doctor came back, and we went back on my 5-year l0mg every 4 hours.carefully prescribed plan.
So, screw the abusers, they make life more difficult for me. I just want pain relief, my job and my family. I don't want to trouble ERs while they are busy saving lives.
I figure I look like a drug fiend to 505 of the medical professionals who run into me. I don't know. I don't even care. I just want to live my life. I don't mind that I have constant pain. I could be far worse off - I could be really, sick, I could be unable to support my family.
But some days, I just want to scream and not worry.
I'm a long time sufferer of chronic pain (FMS) and find it absurd that doctors do not understand that I live most days ranging between 5 (a pain i can't ignore) - 7 (pain that inhibits my daily activities such as work, driving, and walking).
Bad days range from 7-9. (I have never given birth, so I will never claim to be a '10' - I reserve that number in respect to childbirth.)
I'm not irrational or rude when I'm in pain. I'm courteous and patient, try to be as emotionally stable as possible. I focus all of my energy on communicating my needs instead of having a emotional meltdown.
So, my pain is less valid than hers? I bet if I lived my life around a 1-2 pain level, a migrane
You're ignorant and you will be until you have to deal with a pain that isn't visible.
A truly professional and skilled doctor who is supposed 'understand' human bodies and pain, not mock them.
I wish you luck in your career. With your attitude, you'll need it.
"I think the best pain scale starts with 10/10 being equivalent to burning alive..."
That's CRPS. I developed CRPS immediately after wrist surgery; the surgeon denied doing any damage, but it's there. Never mind that, he decided that my pain wasn't real. Never mind the other clinical signs of CRPS with which I presented upon every visit to his office. Never mind that he mentioned CRPS was a possibility but dismissed it in favor of thinking I -- someone who had a record of tapering off pain meds within a few days postop, before those doctors even mentioned it to me -- an addict. I don't even drink alcohol. I'll spare you the whole story.
Once I was finally referred to a compassionate doctor, I was diagnosed with CRPS and given the pain meds I needed. Not nearly enough to touch the pain, but I no longer wanted to step in front of a speeding train to escape the worst pain that i imagined.
It's like being crushed, stabbed with hot knives, and burned alive, 24/7, the most intense pain. Being touched hurts, and hurts for hours. Frequently, it feels like lightning strikes, causing explosions of searing pain over the entire limb. (I have it in all four, plus torso -- so my entire body is burning continuously, with continual spikes of pain.) I've passed out due to this pain.
I don't behave as my pain is. If I did, I'd scare my dog and be labeled hysterical by people. I'd scream and wouldn't allow anyone to touch me, since even slight touch is painful (as is wind, clothing, etc.)
So, doctors, what IS the "right" way to behave when we have intolerable pain such as CRPS? If we behave like we're in as much pain as we're in, we're not believed. I've had unbearable pain downgraded to moderate in official Workers Comp reports simply because I was able to smile when I greeted the doctor. When I didn't smile previously, I was labeled depressed and that was the cause of my pain, not CRPS.
If we behave like we're holding it together -- an act that I've put on many times -- then we're in no distress and therefore no pain... never mind that our pulse rate is higher, our blood pressure is higher ... and that we may be just on the verge of wanting to die because we know our condition is incurable and the treatment options don't offer lasting relief. And some of you would minimize soul-crushing pain like this and deprive us of even enough pain relief to take the edge off.
BTW, CRPS doesn't appear on most tests. The McGill Pain Inventory places it above first-time untrained childbirth, amputation, arthritis, and other pain conditions. It's ranked as a 42 out of 50.
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