Saturday 14 February 2009

Survival Guide to Hospital: Hacking The Pain Scale


"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.