Providing appropriate analgaesia seems to me to be one of the greatest challenges we face. We have a variety of analgaesics at our disposal, which work in different ways, and, often synergistically, complementing each other.
Part of the problem is that the stronger painkillers have side effects that some people enjoy, and are habituating, thus addicting. Using opiate painkillers appropriately should minimise the chances of this... but:
I have it in mind that the quicker one gets control of someone's pain, the longer the effect lasts, and the less analgaesia they need in the future.
So: should we be giving more opiates not less?
Or do we have to accept some pain in our lives?
Showing posts with label Pain Scales. Show all posts
Showing posts with label Pain Scales. Show all posts
Tuesday, November 10, 2009
Wednesday, December 05, 2007
Maid Of The River
Now that Mo'vember has passed, I've slackened off a bit. Sorry. I continue to find it difficult to find stuff to blog about; some days I'm pretty much too lazy to sleep, if you can credit it.
Today has found me on just such a day. A day off, after a late; slept late, then mooched about. I did have good intentions to get some work done... I guess it'll have to keep.
So tonight finds me immersed in my favourite pastime - watching old episodes of ER. This one is one of my especial favourites. Its called Exodus, and features Carter stepping to the fore in the face of a major incident. A benzene spill, with contamination of the ER. High melodrama at its finest.
In real life, shit continues to flow downhill. I am forever fascinated by people's reactions to our enquiries about their pain. Most if not all, places use a 0 - 10 point scale. 0 is no pain, 10 the worst imaginable. Yet people insist on telling me their pain is '12', or '20'. Now I recognise that your pain may be bad, but when I offer you a scale that tops out at 'the worst imaginable', there is no point telling me it's worse than that. It's childish. It's like saying 'infinity plus one'. Particularly when you then flinch as I put a venflon in.
I'm thinking we should tell people the scale is "0 for no pain, 10 for worst imaginable, and more than 10 means you're making it up.". I was once confronted by an angry young woman, who had come back from the waiting room, to ask when she would seen for her headache. Her pain, she said, was '20 out of 10'. I was amazed that she was able to converse with pain twice as bad as, for example, being cut in half with a rusty lemon. Interestingly, it always seems to be these people who insist they have a very high pain threshold. Never the people with horrendous compound fractures sitting quietly. Why do they never feel the need to brag about their pain threshold?
Something else that seems to confuse people is the pointing out of inconsistencies in their stories. I recently saw a patient, whose final diagnosis appears to have been cholecystitis (inflammation of the gall bladder), who assured me she had a very high pain threshold. Despite this, she was unmanageable with pain, despite morphine and enough entonox to sedate an elephant. The pain, she insisted was markedly worse on movement. 'But you're moving all the time', I offered. 'Your breathing, in fact, is using all your abdominal muscles, and you're rolling all over the bed (I know what you're thinking, it's colic; and it was), so is it really worse on movement?'
Patient just looked blankly at me. I mean, I know we sometimes blind people with science, but...
Well, it could be worse. I could be mopping up benzene...
Today has found me on just such a day. A day off, after a late; slept late, then mooched about. I did have good intentions to get some work done... I guess it'll have to keep.
So tonight finds me immersed in my favourite pastime - watching old episodes of ER. This one is one of my especial favourites. Its called Exodus, and features Carter stepping to the fore in the face of a major incident. A benzene spill, with contamination of the ER. High melodrama at its finest.
In real life, shit continues to flow downhill. I am forever fascinated by people's reactions to our enquiries about their pain. Most if not all, places use a 0 - 10 point scale. 0 is no pain, 10 the worst imaginable. Yet people insist on telling me their pain is '12', or '20'. Now I recognise that your pain may be bad, but when I offer you a scale that tops out at 'the worst imaginable', there is no point telling me it's worse than that. It's childish. It's like saying 'infinity plus one'. Particularly when you then flinch as I put a venflon in.
I'm thinking we should tell people the scale is "0 for no pain, 10 for worst imaginable, and more than 10 means you're making it up.". I was once confronted by an angry young woman, who had come back from the waiting room, to ask when she would seen for her headache. Her pain, she said, was '20 out of 10'. I was amazed that she was able to converse with pain twice as bad as, for example, being cut in half with a rusty lemon. Interestingly, it always seems to be these people who insist they have a very high pain threshold. Never the people with horrendous compound fractures sitting quietly. Why do they never feel the need to brag about their pain threshold?
Something else that seems to confuse people is the pointing out of inconsistencies in their stories. I recently saw a patient, whose final diagnosis appears to have been cholecystitis (inflammation of the gall bladder), who assured me she had a very high pain threshold. Despite this, she was unmanageable with pain, despite morphine and enough entonox to sedate an elephant. The pain, she insisted was markedly worse on movement. 'But you're moving all the time', I offered. 'Your breathing, in fact, is using all your abdominal muscles, and you're rolling all over the bed (I know what you're thinking, it's colic; and it was), so is it really worse on movement?'
Patient just looked blankly at me. I mean, I know we sometimes blind people with science, but...
Well, it could be worse. I could be mopping up benzene...
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