Re: Pain management
From: Henry Gregor (henrygregor@yahoo.com)
Wed Mar 29 09:27:03 2006
What it means is ten is the "worst pain possible", doesn't it? ... and one thing we've all seen, is that no matter what pain someone's experiencing at any moment, it can be made worse, unless of course they go under anesthesia or become comatose. Had a call recently re a patient who rode her motorcycle to the er, which then called me to report she had 9 out of 10 pain rating....perhaps because it wasn't a Harley? lol
Hank
"Garry E. Siegel, M.D." <garrys@mindspring.com> wrote:
The 0 to 10 scale seems meaningless and artificial to me.
I love it when a nurse dutifully calls and reports pain 6/10. I ask,
"what does that mean?" Another old dog can't be taught a new trick. . .
Anyway, Lynn, one thought--are you doing more through the scope (i.e.
more complex operations previously done by laparotomy) such that more
pain is commensurate with more surgery?
Garry
At Mon, 27 Mar 2006, Meenan, Anna, Kevin wrote:
>
>It has always cracked me up to see the poster on the wall in the
>labor room that says "Are you in pain?" Duh.
>
>Actually, there was some research done on cultural attitudes toward
>pain in childbirth and the need for pain relief in labor, involving a
>comparison between Dutch and American women, which was published
>several years ago in Birth, I think, though I could be mistaken about
>the source.
>
>Anna Meenan, MD
>
>>I agree with you but of course it's not a culture of "better" living
>>through pharmaceuticals, it's a culture of pushing more drugs, it
>>seems at times. As a nurse I understand that JCHAO has emphasized
>>the pain scale and pain relief and has dinged hospitals for not
>>adequately addressing pain management. The result is every hospital
>>I've worked in in the past few years requires RNs to assess pain,
>>using that 0/10 scale, on a regular basis (my present hospital
>>requires double charting on it Q 2hrs!!!!). The pts get tired of
>>being asked. I think it's counterproductive, esp. in labor and
>>birth, where the patients go up to 10 rather quickly ... and PP I
>>think it's obsessive and helps them focus on their pain more than
>>they should. My assessment of pain can be quite different from the
>>pt's, based on what I observe of them. My hospital also hands out
>>the 7.5mg Lortabs, not the 5mg we used to routinely give post op
>>joint replacements (pretty painful postop course) ... what's up with
>>that? The increase in epidurals can't be coincidental either. In
>>fact, the group of patients I've had who routinely are able to do
>>without pain meds or epidurals are those from outside the USA. Must
>>be different cultural attitudes towards pain, birth, &c that enable
>>them to cope -- it'd be interesting to see research on this.
>>
>>Suggestions on how to get rid of that pain scale, or on how to
>>better address this issue than by handing out more and stronger pain
>>meds?
>>
>>Grace RN
>>
>>Lynn Montgomery:
>>Now I have been been doing scopes for 18 years. Over that time, I have seen
>>a progressive increase in the requirement for post-operative pain
>>management, despite my procedures being exactly the same. In the recovery
>>room, patients are requiring much more immediate post-op pain medication. I
>>now discharge patients with Lortab 7.5 mg, #30 and quite routinely get
>>called on post-op day 3 or 4 for a refill - which I typically refuse.
>>
>>I place part of the blame on the hospital's use of its "Pain Scale", where
>>they counsel patients pre-operatively on gauging their pain on a scale from
>>1-10. They are taught that if "they" feel they are greater than a 4-5,
>>their pain is not adequately controlled. Nursing staff doesn't do their own
>>assessment any longer, but rather relies on the patient's own assessment of
>>their pain - hell when the recovery room nurses call to advise me of a
>>patient's post-operative pain, they don't even know the patients vitals.
>>
>>It seems that we have created a culture of better living through
>>pharmaceuticals and we are expected to provide the remedy.
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
