AIBU to think that HCPs are allergic to the word pain??

[OwlBeThere]

This is only semi-serious, but actually sometimes it’s really unhelpful and makes a situation worse.
Every time I see any kind of health care professional they will use words like ‘sore’ and ‘discomfort’ when what they mean is ‘painful’ and ‘it fucking hurts’.
I heard it when I had a hysterectomy, when I’ve had biopsies, when I had my wisdom teeth out, when I broke my femur(?!?). None of those things were uncomfortable they hurt like fuck and not acknowledging that either makes you think it’s not going to be so bad (ie lumbar puncture) or makes you feel like you’re causing a fuss about nothing (definitely bloody not with a snapped thigh bone or a raging infection in my hysterectomy scar).
So why does it happen? Do they imagine it helps people? Because it doesn’t.

I never said it was herculepoirot, but it certainly wasn’t a deliberate choice or the actions of someone in full control of all their faculties at the time. I was in stirrups, I had a cramp so bad in my calf there was child’s fish sized hole in my leg, I had been in labour for days and my baby was trying to be born through a passageway so swollen I couldn’t pee normally for s week after.
I said in my post I’m not proud of it. The doctor in question apologised for his mistake. I later when I had had an emergency section and stopped nearly dying apologised to him. So I think the implication that I’m some thug that goes round kicking people for fun is harsh and unfair and taken out of context of the situation. As I’ve now said repeatedly bashing the nhs and it’s work was not my intention.

I am not saying you are a thug. It’s just not excusable.

Trouble is that pain is so subjective and also variable. Many patients will say their pain is 10/10 whilst still functioning which is, when you’ve seen people in true, absolute agony, difficult to believe. It’s as if, if they say 6/7 they won’t be taken seriously.

Once I was sobbing with pain and my physio said it must be a 10/10 and without really thinking I said, ‘no, a 9, if it was 10id be almost dead.’ So, you see, subjective.

But, yes, you are right, HCPs rarely say, ‘Sorry, this is going to be agonising.’

I hate the pain scale question as pain is subjective. I had an induced labour with no pain relief and on another occasion stopped pain relief 24 hours after a csection and managed perfectly well, but a raging ear infection had me sobbing in A&E begging for help.

HCPs can't make all pain go away either. If you've had a midline laparotomy it is likely to be fucking painful. HCPs can still only do so much with pain relief. Too much and you will go into respiratory arrest. They can try to make the pain more bearable, that is all in some cases.
Again, cramping pain may be better relieved by buscopan rather than typical painkillers.

Also some people do seek opioids and try to play the system. Their baseline observations and body language will tell us a lot.

And please don't dismiss IV paracetamol. It is an excellent pain reliever, especially when used as an adjuvant.

Yeah, I woke up from my bariatric surgery in agonising pain, I could have screamed. I'd been told I could go back to work 3 days later.
I couldn't get myself out of bed three days later.
Thank God I had some cocodamol at home because the paracetemol I was discharged with were about as good as a chocolate teapot.

Jane’s description of the situation as being ‘purposely violent to a hcp’ implies that @herculepoirot2. That skews a desperate human being who can’t talk through pain wanting to be heard and helped into a deliberate act of violence. That day was the worst day of my life for many reasons, not least the actions of that doctor So it’s a little sensitive for me still even though it was long ago.
Anyway, I would like to delete this post. How do I request that?

I wasn't offered iv paracetamol just tablets when I'd already been on tramadol all day and it hadn't sorted the pain. I understand that some people do abuse the system. What I objected to was the assumption that I must be abusing the system as I didn't fit their standard profile.
I don't know why I didn't fit the profile but I wasn't trying to abuse the system or get admitted to get morphine injections. Firstly I'd no idea that morphine injections would be given to me on admission ( first time I'd been admitted to hospital ever) and I'd never has morphine injections before either so had no idea how I would feel on them.
I just know I didn't want to go home until the pain was under better control and politely but clearly kept saying this. An apology after the true situation had been diagnosed would have helped.

Totally agree. Had a lumbar puncture where the needle was scraping against my bone. It was incredibly painful and I could not stop myself screaming and moaning. It was bloody awful.

I did once have a procedure and asked the Dr if it would be worse because of my illness, he just said yes. It was.

@EducatingArti 🕵️‍♀️

@BlankTimes I get electric shock feelings in my limbs and have done for years. I have been investigated and told there was no cause - it was implied it was psychological. I don't believe it is as it happens both when life is good and I am content, and when life is tough. Nothing makes it vary. I have just learned to live with it.

I work in theatres and it’s actually incredibly helpful to us minimise pain.

If I’m assisting the anaesthetist with a regional block for example (like a spinal for a c section) we will always say you will feel a small scratch. Some people react to the pain you tell them they will feel psychologically (there is evidence of this) so it may seem like we are minimising but it’s best to keep things as calm as possible. We can always manage pain much easier if it starts as a slight twinge than going from a 0-10 straight away.

If you’ve ever had Surgery under a regional block, another thing you won’t ever have been aware off is that the surgeon will test the block with something sharp without letting you know but the anaesthetist will to check your reaction to the pain. If we can see you react to it we either wait a bit longer or we know the block isn’t working and so need to look at other options by that point.

So I apologise for all my colleagues if you do feel that way in the theatre Department but please be reassured we are doing it with your best interests at heart and with evidence based practice. We also look at all your physiological signs too and can check your responses to your pain signals (we do this while you are asleep too). And of course everyone is an individual with different responses and pain thresholds. I know mine is very high. When I had kidney stones I was pacing up and down the a&e dept cause I was bored, in between the vomiting (I scored it a 6 out of 10 I think even though it’s the worst pain I’ve had).

I had some brilliant HCPs last time I was in. I was grey and pacing and the triage spotted me and gave me morphine
When the MRI came back, the surgeon came in and looked at it and he said to me so kindly "I don't know how you are walking still. You must be in so much pain"
I cried because he was SO nice. Probably my "cut my leg off now" helped with the pain description...

The thing is, HPCs 'measure' pain by physical signs like pulse rate, and the person's behaviour, not just how the person rates their own pain.

This is why I nearly gave birth in the triage room because 'you're clearly not in active labour, let alone needing to push - you'd be shouting and screaming'. When someone finally examined me she shouted 'I can see the baby's head!' and they started running down the corridors with me on the bed. Turns out I wasn't lying or an idiot when I said I was in agony and needed to push, I was just a silent sobber rather than a screamer

Jane which do you think is the lesser evil: occasionally giving out 'too much' pain relief to those who are exaggerating their pain, but also making sure that those who are in genuine pain are treated effectively; or making sure that drug seekers and the exaggerators do not get pain relief/faster treatment, but a significant proportion of patients who are in real pain, but do not show textbook, signs suffer unnecessarily?

I would prefer the former scenario to be the outcome. Far better that, IMO, than leaving people to suffer unnecessarily, which is not only extremely cruel in the moment, but can contribute to/cause longer-term mental health issues such as anxiety, health anxiety (which may cause patients to avoid necessary treatment down the line), and even PTSD.

It sounds from your responses that you prefer the second scenario. Is that the case? If so, why?

And if not, how do you ensure you provide effective treatment to those who do not react typically to pain?

Very depressed by some of the comments from HCPs here.

I’m sure you get some patients who deliberately lie. The rest are suffering, in pain, used to being completely fobbed off by HCPs who don’t give a shit, distressed, frightened or any number of other things that might impact what they say to you.

I’ve had pain that’s made me vomit, lose consciousness and bleat like an animal - and I didn’t say it was 10/10 because I’ve had even more painful experiences in the past (like a near-amputation of my arm). So when I had cholecystitis and pancreatitis I wasn’t saying 10, I was saying 7 or 8. Was that a lie? Or is it only a lie when it’s the other way?

This isn’t even getting into the fact that women’s pain is taken less seriously, they’re given less pain relief and take longer to get it than men. Before my endometriosis diagnosis I was treated in an appalling way by HCPs more times than I can count. Maybe if they hadn’t assumed I was lying, they’d have done the test needed to diagnose me years earlier.

Rating your pain as 10/10 when you are sat in the waiting room scrolling through your phone and chatting/laughing with your mates is not going to get you a priority consultation. Same goes for " having difficulty breathing" when you actually have a blocked nose and have just come from the gym. Sorry. Slightly jaded after a Bank Holiday weekend in ED...

Yes agree. 10/10 with pain would be losing consciousness.

I'm a hcp and worryingly, I find that my colleagues don't seem to value giving pain relief as much as they should. I often come on shift to find people in pain and it is upsetting. I have set up pain assessment tools in their notes, but nobody uses them. The people I care for are paralysed and can't express themselves apart from making some sounds or looking distressed. I have tried to get them fixed up with a greater level of background pain control, but nobody is interested so these poor people are left suffering uncontrolled pain in the care of staff who can't be arsed to go into the controlled drug cupboard and nab a care assistant to act as a witness to administration of something stronger. I often awake at 4am worrying about these people and wondering how much longer I can cope. Pain relief should never be treated as an optional extra 😢

@Daveminion, yes that makes sense. Thank you for the reply. I remember having surgery on my vagina under local anaesthetic and it starting to wear off towards the end and being told by a nurse that it was better to grin and bear the ‘slight’ pain as to give more local at that stage would mean having to stop when the surgeon was almost done and would mean it would take longer. Which in theory is fine, but for me at the time with a scalpel in my vagina that ‘almost done’ felt like an age. But I didn’t feel able to say it was hurting so much as the way it was phrased by the nurse (a man, which I think is significant in that he has no idea what it feels like to have a vagina!) was it would be really inconvenient to get more pain relief.
That said that is my only complaint I’ve ever had in surgery. I find that the post op team have been great at making sure I’m ok whilst in their care.

I’m my notes giving birth it states that I was experiencing ‘tightenings’ but I was ‘comfortable’ in the bath. In reality was induced and had a rapid labour with a back to back baby. It felt like someone had broken all my bones and that they were repeatedly stamping on me. I told the midwife that I was in so much pain I felt like I was dying and repeatedly begged for any pain relief. She wouldn’t believe I was in labour at all and wouldn’t even give me gas and air. Less than 30 minutes later I was fully dilated and pushing.

My letter I had from the hospital upholding my complaint was states that there was no reason I was denied pain relief.

ineedaknittedhat that is appalling and, as Mum to two non verbal children, I find that if the patient can’t express that they’re suffering it’s much easier for some HCPs not to think about it. There’s absolutely no reason for those patients to be in pain, I’m not surprised you find it so upsetting.

I agree with the poster who said some patients lie about pain. Sometimes patients have never had an opiate until they're given 10ml IV morphine in A&E, they experience a complete relief of pain plus a warm fuzzy feeling of deep relaxation. When it wears off they naturally want more. If they are genuinely in severe pain they get more. But if the pain has improved so much they are relaxed, chatting on the phone or reading, with no physiological signs of severe pain like tense muscles, rapid pulse, rapid breathing, dilated pupils etc, they will be offered a milder painkiller like paracetamol. Even if they say the pain is 10/10!

Giving out opiates is risky: respiratory depression, urinary retention, addiction etc. Lots of patients who need regular opiate pain relief (eg after major surgery) have a hard time weaning off it, and keep asking for Oramorph long after the pain can be managed with NSAIDS.

Other people experience psychosomatic pain (psychological pain expressed physically) and genuinely feel their pain is a 10. Medications like amitriptyline and gabapentin are more effective than doling out opiates every 4 hours.

Then you get patients who are blatantly meds-seeking, eg asking for tramadol and morphine, saying they are allergic to codeine when there's no documentation of this, or ringing their buzzer every 4 hours at night for PRN morphine, yet when they think you're not watching they're sitting up in bed eating cake and gaming!

"yanbu
it's both patronising and minimising, especially towards women who seem to never be completely believed about pain levels.

whatever happened to 'pain is what the patient tells you'?"

This! In bucket loads!

I'm currently commenting on a "state of the Nhs" thread and I also started a thread of my own last year about the dismissive attitude of too many medics to patients - especially women!

I have endo, I've had migraines in the past, I have a physical disability that pain is a major symptom of, dd has a disability with pain as a major symptom...

We also both have problems with analgesics and anaesthetics (likely genetic - relatives have had similar issues) in that they mostly don't bloody work on us! To the point I come out of GA very quickly and require more to keep me under than I'm supposed to get based on weight calculations. Plus I'm allergic to a wide range of analgesics.

Many, many times we have been told we're making unnecessary fuss, exaggerating, not giving meds a chance to work etc. Really Fucking annoying!

JaneTheVirgins attitude is sadly very very common! And the deflection onto the op's comment about a regretted action which she acknowledged was unacceptable is also fairly typical. Frankly you sound burnt out and probably shouldn't be doing the job any more.

The relief I felt at finding us a dentist with the same issues with pain treatments who UNDERSTOOD was unreal! I've spent most of my adult life avoiding dentists for exactly this reason!

Dd is annoyingly stoic, hates making a fuss but I can tell from how she's tensing her face and holding any affected body parts when she's in a lot of pain (I have tried to explain to her she needs to be more honest and less stoic) appendicitis was dismissed as mild trapped wind on one occasion.

"I too have had patients that tell me it is 15/10 while chatting and watching TV" another medic mentioned reading - has it occurred to you they may be doing those things as a distraction? Agreed unlikely for the most severe pain but for the level below that entirely possible - it's what I do!

I laboured for 28 hours with no pain relief after induction and when the pain was bad I kept focusing on a poster on the wall and reading it to myself.

"Patients lie" very rarely! Most of the time we just know how fucking dismissive and unsympathetic most medics are now!!

"Many people feel if they say a higher pain score they get seen faster, treated better. Which is of course not true." Except many patients have found it IS true - that the patients who are most vocal get the fastest most effective treatment!

"it was implied it was psychological" yep! Another major issue - try getting taken seriously for pretty much any physical ailment bar a limb hanging off if you have a mh dx!

DaveMinion - thank goodness anaesthetists do keep an eye on things while patients in surgery - when I had my 2nd GA and said to them about the issues I'm likely to have they dismissed me initially then after I was told the anaesthetist had "got a shock" when it became clear I needed more and was near to coming round not long after surgery had started. But really I do wish medics would listen! This particular issue is STARTING to be recognised and researched more seriously but I can't help but wonder if that would have happened sooner if medics were more open to accepting what patients tell them!

"HPCs 'measure' pain by physical signs like pulse rate, and the person's behaviour, not just how the person rates their own pain." And again not all patients present the same way, I have a naturally very low bp (to the point when it's been taken at a "not ill" time eg for contraceptive checks they've not believed the result and done it again), pulse rate and body temp so when they're in the "normal" ranges that means for me they're actually quite elevated.

"This isn’t even getting into the fact that women’s pain is taken less seriously" OMG yes!

Yes, some people might lie about or exaggerate their pain, but I see a general cynicism and lack of empathy these days when it comes to pain. Just look at how women post c section are only given paracetamol now. I've encountered a fellow nurse who accused a resident of 'putting it on', then the person was subsequently diagnosed with peripheral vascular disease which can cause severe pain in the lower limbs. The person died.