"On a scale of 1-10 how much does it hurt?"
Over the next few posts I'm going to share some of my philosophies that have grown from surviving in Hospital, an institution that has some bad practices that hinder recovery. From the best intentions, systematising care with bureaucracy. Some hospitals have de-evolved in to a place where the default pattern of behaviour breaks the spirit of the positive agents of healing and the sick get needlessly sicker.
The experience of pain is a purely subjective. Medical types have the objective of 'getting the pain under control'. So some smart-alec came up with a robotic flow-charted method of dealing with. If you are in pain they ask you 'on a scale of one to ten how bad is your pain?' 1 being negligible 10 being intolerable and it is according to your response what effort is expended to relieve you of this pain.
Every surgical incision I have experienced is excruciatingly painful when not covered sufficiently with pain relief medication. I have come to the conclusion that the question is flawed. It implies that pain at some level is acceptable, a tolerable level of pain should not be the objective, the objective should be to relieve all pain.
The question should be 'Are you in pain?' If yes, administer relief. Ask the question again and keep repeating this question until the answer is 'no' then observe and ask at regular intervals. If the aim is to relieve pain, a response of 1, 2 or 5 is the equivalent of a 'yes' and should be treated.
The present system does not work, it is founded on a subliminal philosophy that some suffering is good for the soul. My hack for this stupid system is you modify your answer to 'the question' to '9' or '10'. Pain is unique to you, a number is no substitute to communicate your suffering. Its not brave to suffer, its stupid if it can be avoided. Meditation and other things can work, I've used TENS and meditation successfully , I am capable of tolerating pain and have spent time in the past suffering unnecessarily due to various condition that taught 'some pain is good'. Its not, its a waste of energy, that could be used towards healing. You must get pain under control and the fastest way in the West is with medication.
Convenience of the carer should not take precedence to needs of the patient.
It is my experience that the lower the score you give the less effort is made to reduce your pain to nothing. Low numbers of pain are 'acceptable' to some hospital staff and the experience of treating in not standardised so giving a 5 or 6 to one nurse may not be treated the same way as another nurse.
I have been in severe pain, visibly trembling, sweating and pale yet still asked 'on a scale of one to ten, how bad is your pain?'. Robotic procedures dehumanise people in to caring automatons obsessed with adjusting their responses to a 'pain-scale'.
Its possible the attending carer might have no idea of the history of your admission, no idea of the cause of the pain and only concerned about the added amount of inconvenience required to obtain the appropriate medication. Fight them. If all they have as reference to your internal condition is a number, give them one that will get you the response you need.
6 comments:
The reason they ask you to rate your pain is so the medical professional/nurse/doctor can determine what strength of pain medication to give you. If you had a headache and rated your pain as a '1' a simple aspirin would suffice. However, if your pain was a '10', giving you an aspirin and waiting 30-45 minutes to judge the effect before giving you another aspirin could be considered criminal. When I report a pain level of '10', I expect to receive a healthy dose of morphine. There are other medications and dosages that are appropriate for other levels on the pain scale.
Just as the patient rates his/her pain using the scale, they also get to determine what an acceptable level of pain is on the scale. This becomes their pain management goal. I've had people tell me that a '2' is acceptable or that a '5' is acceptable. I've asked people if they would like their pain to be even less than that, and they've told me that they would be happy with that. I guess when a person experiences prolonged pain at a high level, it's hard to imagine that your pain could be a '0'. Personally, my pain goal is '0', but I can't choose that for someone else.
We've spent decades with doctors deciding how much pain there 'should' be from a procedure. It's about time that the medical profession has decided to actually ask the patient how severe their experience of pain is.
Thank you Sue.
My post is made in a surgical context. I was offered oral paracetamol in the hours after my first surgery when the PCA was not effective. When I asked for this intravenously the nurse said she would have to wake the on call pharmacist to get him to dispense it, which she was not prepared to do!
Obviously some common sense has to be used given the context, i wouldn't expect Morphine having given a 10 for a root canal.
Setting a goal with the patient is susceptible to a white-coat trance, whereby the patient is hypnotised by the authority figure and is made to believe that some level of pain is acceptable. My argument is that the forgone conclusion should be to delete all pain, this is not about patient choice - that's a red herring.
Patient choice is not a red herring, that's total BS, patiet choice is what it is all about. Some of us want to achieve a balance between the amount of chemicals in our system and being comfortable, I do not want some doctor pumping me full of highly addictive opiates because he wants to eliminate all of my pain. I want some say in that, by them asking the question I get that option and that is exactly how it should be.
superman I think you have been watching too much Trainspotting. Using Morphine over a short period for surgical pain will not make you a smack head. The fact is that 'patient choice' is about shifting the burden of responsibility.
Patient choice is about placing the burden of responsibility exactly where it belongs. The doctors are responsible for treating my pain, but only I can determine how much relief from pain I need. The first paragraph of your next post illustrates this for me, only I should decide whether my pain is enough for me to be put into a drug induced stupor.
Thank you for contributing your point of view superman but you've missed the point of this article - its about hacking the pain scale in the immediate hours after surgery - not a headache.
Morphine is plumbed in to you whilst in theatre - you do not get a choice. In those crucial hours after theatre the levels need to be properly managed. If you have not discerned already - mine were not.
If you are *not* happy with the treatment you are receiving - hack the system.
In a stupor is exactly where I want to be after 7 hours of being sliced and diced on the operating table.
Brainwashed nurses fighting for an answer to 'on a scale of one to ten....' while you are crying in agony is not a moment that you want to be worrying about patient choice or bullshit questions, the tears and trembling should be enough for intelligent carers to make a decision and limit your suffering.
Winning an argument on some blog on the internet is very different to the severity of the moment. Of course if you are happy that your numbers match up to the the system then there's nothing to hack.
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