re: "Pain level as a vital sign"

quote:

---

I personally enjoy telling people that the scale only goes to 10 when they give a 15 for their pain when not in visible distress

---

When a patient like that comes my way, I make sure to chart in free-text, "Patient rates pain 10/10. Patient in no discernible distress. Currently using cell phone and eating cheetos"

I had a resection (cut out a couple feet of intestines) done for crohns which they gave me an epidural for.

The auto feeder worked great until the first night. Around 2 in the morning the "low" alarm went off on the feeder, the nurse came in and said it had a couple hours left.

Slowly I started sensing pain. Started clicking my self medicate button but pin kept coming stronger and stronger. The nurse was saying the machine was working but it felt like I was being sliced open. She finally called the on call doc (took around 20 minutes for him to show up who asked how bad the pain was. I was certainly at 10 but said 9 just so I didn't play the most serious card if I needed it in the future. I did tell them to get me a new fricking machine though. Worst pain I have ever had in my life.

That sucked. Thanks for reading.

quote:

---

You think they'd let you take them home in a jar if you asked? I mean, it is your's.

---

Was hoping for a balloon clown to make something interesting at the very least.

quote:

---

why so many of you have to go to the doctor for "pain" issues.

---

I did it for the fun of it.

"On a scale from 1-10, how bad is your p-"
"It's a ten."
"Do you think it might get worse?"
"Oh definitely."
"Soooo... currently not a ten?"

The dumbfounded looks you get are amazing.

I have a relatively strong pain threshold, but my three times passing a kidney stone sent me to the ER in cold sweats head to toe. At least a a good 8 or 9 in pain. It takes a Morphine or Dilaudid drip to make the pain go away.

And non-opioid Toradol/Ketorolac works better with my kidney and back's pain receptors than does say Percs..which a descending stone just laughs at and marches right on.

Don't like being on medications of any kind if possible.

quote:

---

Are you obligated to treat the pain as a 10? If I was a junky I'd be scared to say 10 because they'd think I was just looking for pills.

---

It's pretty easy to spot when people are looking for pills.

They way we operate in our ER is that if a patient is presenting with a clear as day diagnosis we can confirm (kidney stone, fracture, perforated ulcer as someone said in here, trauma after an accident, etc.), we treat the pain scale as more reliable.

If this is their 8th ER visit in 2 months with the same complaint and have had 4 CT scans, 8 sets of labs, and still no diagnosis, that's when we get suspicious.

BUT I will stress there's a difference from a "junkie" trying to get high, and someone who is just pain seeking. A junkie trying to get high has a different feel, their story is more fanciful, and it is easier to tell when they're lying to you. They're more nervous, or they're way too calm while they tell their story. A chronic pain syndrome is harder. They are screaming in pain, and you believe their pain is "real" a lot of the time, even if you know it is because they've numbed out their pain receptors from years of opioid use and now everything hurts. The pain is still real.

Also it is never really cut and dried like that, but that seems to be a theme in some patients.

We generally don't give either scenario opioid medication unless again we find something obvious/life threatening.

Now people will do INSANE stuff to get medications in the ER. ER physicians are being taught to shoulder most of the management, education, and basically shitstorm that goes with dealing with these patients. It's a large portion of lawsuits in the ER as well is that a doctor didn't treat my pain. Even though there are signs a lot of times that say "In general, ER doctors will not prescribe opioids for chronic pain", patients ignore it.

quote:

---

Are you obligated to treat the pain as a 10?

---

Only when some crotchety floor nurse pages you about it.

Well the doc still questioned me about it as if I was lying about the epidural machine not giving me a drip as though that thing gave me a high or something. I could have thrown something at him.

If I wasn't writhing in pain.

I am not a junkie. I do not take drugs for pleasure.

That's why I consume ungodly amounts of scotch.

Therefore, when I'm in pain, which has to be pretty fricking significant for me to notice and even more so for me to complain, I want the strongest drugs you got. And I want to take them for as long as the pain persists. If they give me a high, that's a bonus, but I don't care what they do as long as my discomfort goes away.

I shouldn't have to suffer while there are drugs I'm willing to pay for just because some other frick can't handle his shite.