What is your philosophy about pain?

[Ridryder 911]

Great posts Spock...

I just did a clinical presentation on pain management and the perception of health care workers. Basically, they studied the ratings patients gave and then the ratings triage nurses and in-house ER nurses gave. Remarkably, there were times that the nurse underrated the pain by as much as 48% of the time. This as well as on the 1- 10 scale, being up to 4 points off .... ( I can cite literature if you request...) The most closes were orthopedic injuries and the farthest away form being accurate were abdominal pain.

The most closest nurses to giving pain med.s were burn center nurses...

Short and simple, if our patient is in pain... give them med.'s .. if they are drug seeking treat accordingly.. notify physician for deviation or more appropriate orders. Use common sense... (wow ..new concept) We way under-medicate pain control... the tuff cowboy era is over...

R/r 911

[BlackSheep]

Interesting article-

Pain is a mysterious beast; it can feel very real even when there's no physical reason for it. Recently, scientists in Finland looked at how your brain handles psychologically induced pain.

What the researchers wanted to know: How does the brain light up in response to physical and psychological pain to the left hand?

What they did: The researchers used 14 young adults who scored high on a test that measures how susceptible people are to hypnosis; they also responded to pain suggestion. Before the imaging session, each person was hypnotized. Then they were positioned inside an MRI machine for functional MRI imaging, in which the machine "watches" your brain work. (It detects increased blood flow, which shows what parts of the brain are active.) Then they were subjected to psychological pain, which was induced by telling them the back of their left hand hurt, followed by physical pain, in which the researchers used a laser on the back of the left hand. The subjects had given permission for this before the experiment.

What they found: Both laser-induced pain and suggestion-induced pain lit up circuitry in the cerebrum that react to pain. But during the pain induced by lasers, the parts of those pain circuits that connect to the senses were more active. During the pain induced by suggestion, a part of the brain involved in the emotional aspects of pain was more active.

What the study means to you: Research like this could help explain the mysteries of pain, which can feel real even if there is not a physical stimulus. If these results hold up, this could even suggest a way to distinguish psychological pain from physical pain.

[paramedicmike]

Agreed. Analgesia early and often until they either get relief or I can't give any more.

Pain hurts! No sense in making someone suffer unnecessarily.

Spock, sorry to hear that ER nurse was such a witch. Unfortunately, I know several like that. They're all burnt out and have lost all perspective. I cringe every time I think about how many patients have had poor care at the hands of these people.

On the flip side, though, I know many more good, solid, caring nurses who provide excellent care. Just didn't want anyone to think I was into RN bashing...I'm not.

-be safe.

[TechMedic05]

Sidenote: BlackSheep - Your Avatar fits rather well here. I'm too big a fan of irony for my own good.

Sorry for the interruption.

Now back to your regularly unscheduled thread.

[Just Plain Ruff]

It's amazing but since I consult in the Emergency room field, I've been to about 25 emergency rooms all over the country and have taken patients to every ER in the KC MO area and I have seen some who with hold pain meds an awful lot and others who give meds out freely.

Case in point, I just rolled off a project in southern colorado and their ER gives Dilaudid out as first line pain meds.

A ER in New York City gives demerol and also toradol almost exclusively(this was in 2002 though not sure what they do now though).

It is amazing what pain can bring about - case in point - ED medical director having kidney stone pain, was given dilauded for the pain and after he was back on the job their pain admin guidelines changed.

I agree with the "My pain is my own and no one but myself owns the pain" We need to be a little more proactive on the administering pain meds.

I think if we were to experience the same delay in getting pain meds like our patients experience, I think we'd be a little more quick to get them relief.

[fire911medic]

Controlling pain early on actually may lead to shorter recovery times. This is due in fact to especially within cardiac situations, because if a patient's pain is well controlled, their breathing will slow, anxiety decreased, and oxygen demand decreased resulting in less cardiac damage. It's a great win situation. Also, if a patient is a burn patient or multiple injuries (ie multiple fx) or an isolated long bone (ie femur) I am going to provide pain relief to the extent that they are stable. Granted their injuries may be due to their own stupidity, but then again, who are we to judge? We have all done stupid things does that give us the right to say what you did was more stupid than me? I don't think so. Most patients requiring pain medication will have a long enough road facing them with rehab which will be filled with pain. Why make them suffer needlessly? Now as far as my drug seekers, well, we carry a wide variety of medications ranging from Toradol to Fentanyl. Also remember, just because a med is a narcotic does not mean it works better for pain control. Amazingly, toradol is an excellent pain reliever for kidney stones, better than alot of narcotics. It also works well for the drug seeking "back pain" people. There is legitimate back pain, don't get me wrong, but that is for the docs to sort out not me. My department has fairly lax protocols regarding our ability to use pain control, and I will never make a patient suffer needlessly, but I will also use the mildest pain control possible. There are other ideas besides meds to control pain, and some patients do better than others with this. Distraction is a great things, especially with kids. The only time I will be cautious with pain meds is 1. If I KNOW the patient is a drug seeker and even then I will still give it under certain circumstances listed above 2. the patient's condition is unstable and I cannot risk depressing them with a pain medication - I will encourage them to fight the pain to keep them alive, it may be uncomfortable, but it may be what keeps them alive and 3. there is a specific contraindication to giving it. That's just my opinion, but I think it's an appropriate assessment. The biggest thing to keep in mind is that pain is a subjective thing, and what is a 2 for me, may be a 6 to you, and you tend to use your own scale in judging how much pain medication to give based on your thoughts. For example, I might take a tylenol for a level 4 pain, where as you might require something stronger. Also, you must take into account the individual's pain tolerance may be different than yours and what is an acceptable level of pain for you, may not be for them. An interesting note that was made recently in a class I attended at U of L is that pediatric patients tend to receive less adequate pain control than other populations. Because they cannot express pain, it is more difficult to judge their pain level and the effectiveness of control. But I would assume the same would be so for the elderly population, except there is a tendency to "snow" elderly patients, actually overdosing them. Again, as I said, these are simply my observations and thoughts, take them for what they are worth. Best thing is to practice safely, advocate for the best interests of your patients within your protocols and it will not steer you wrong.

[mediccjh]

For the most part I can tell the seekers from the needers.

My philosophy is simple:

If you're having chest pain due to an MI or something not of your own origins, you get pain medication.

If you're having chest pain because you just smoked 2 rocks of crack, you can suffer.

[GAmedic1506]

We give Toradol for muscular pain, Fentanyl for fractures, Versed for sedation, and Morphine for mac-daddy pain (MI or Burns)

[AZCEP]

Morphine and Fentanyl? And to think, I have to be content with Morphine and baby ASA.

[GAmedic1506]

Fentanyl is a great drug for EMS pain management due to its short react time and short duration. They do not arrive at the ER unconscious -- but there pain is well managed during the 10-30 minutes you have them. I believe Nitrous to be the best, but the delivery system is expensive (compared to narcotics).