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.

The dic who was giving me steroid injections in my back didnt seem to be getting my personal signal all was ot well. Asked the nurse to hold my head still....then I started screaming.
Are docs a bit immune to pain responses as they know they have to forge on and deliver some treatment and it's for the best but at some point get a bit distanced from peoples reactions?

The other thing to mention is that we should all be following the WHO pain ladder for pain management. It’s a little different perioperatively but postoperatively and in acute settings it is the way pain should be managed. It was how mine was managed in a&e.

Start with paracetamol first (IV paracetamol is a very effective painkiller and is used routinely in surgery).

Then move into second line drugs like ibuprofen, diclofenac and tramadol

Then move onto morphine etc.

My experience is it doesn’t always get put into practice. But if it did it would assist HCPs with assessment if those who have overestimated their pain score.

@Graphista I’m an operating department practitioner. A very little known about role but I’m also trained to know how to see how anaesthetised you are (all the monitors show us how much you have on board and how deep you are and also how close you are to waking up), if you are breathing on your own or not, if you have had muscle relaxant if it is still working or not (some we need to reverse and some not). It’s a complicated process. We also look at your observations when you came in and use those to assess your responses to stimulus to see pain etc. So be assured it’s not just the anaesthetist it’s us assisting them too and we can alert them to things happening to you.

As I said everyone is an individual and they ask family history of anaesthetic for a reason as responses are often similar. So keep fighting your corner. There are still some old school anaesthetist around who don’t like change to routine but individualised care is so important.

The thing is everyone is speaking from an individual POV, from their own experience, @JaneTheVirgin sees hundreds of patients a week, so you get pretty good at identifying those who are truly in pain. Medics are also humans, humans make the occasional mistake. Do you mistakes in your job ?

I don't call the dismissive and dis engaged attitude I see in my colleagues as 'the occasional mistake, no. When hcps make a mistake, people suffer. When hcps are cynical and no longer care, people suffer. When hcps are lazy and can't be bothered to get the keys to the drug cupboard, people suffer. I've seen all these behaviours, on a regular basis all my adult life.

Janewhich 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 actually said up thread that it is much easier for me to just prescribe strong pain relief for every single patient. It makes my job easier, aassessments faster and patients happier and quieter when not being seen.

Its just that the 'good stuff' has a lot of side effects. Some more minor, like constipation. Others much larger, like respiratory depression, and opioid addiction.

I've worked in emergency medicine for 5 years, and critical care 4 years before that. I like to think I'm good at assessing pain, and treating accordingly, despite what everyone on this thread would have you believe. There's such a fine line between prescribing everything to ensure every patient is comfortable while also juggling that it may not be in their best interests.

I just think it's important for us all to understand that pain score is just a tool medics use, not the be all and end all of analgesic prescribing. It can't be.

Reading some of these stories is truly awful. I never want my patients to be in agony.

Yes I’m another one who gave birth with no pain relief and almost without medical assistance (just one very out of her depth student midwife), because the midwife didn’t believe I was very far along in labour.

I’m disabled, I have a lot of pain and I’m used to gritting my teeth and pushing through it. Not all of us scream and shout when we are in pain.

I have to have an hysteroscopy and biopsy this week. I have adenomyosis and suspected endometriosis, so am not expecting this to be pain-free.

The clinic doesn't offer sedation or gas & air. When she phoned me with the appointment details (it's a 2 week referral so not enough time for them to send a letter) the secretary said to take a couple of paracetamol beforehand as there might be "mild discomfort".

Once I had an operation that involved slicing and pinning together my bones. The surgeon left a cannula in my arm because he expected me to need strong intravenous pain killer.

When he came on the ward the next day I hadn’t been given anything and was crying quietly in my bed. He gave the nurses a dressing down and told them I needed morphine. After he’d gone they gave me some paracetamol and by the time my husband came for visiting I was in an awful state again. He had to absolutely harass the nurses for painkiller for me, it was awful.

A few years ago, I had an emergency D&C with only gas & air (the spinal anaesthetic hadn't yet taken effect and I risked losing my place in theatre) so I'm telling myself it won't be worse than that.

Oh, some people do lie.

An ex gave an oscar-worthy performance of a brain haemorrhage/compound fracture of his ankle/alien chestburster every time he fancied some of my prescription painkillers.

He never got them on my watch. Or found out where the key was to the locked cashbox where I kept them.

His face was a picture when he went to hospital and informed them that the pin in his ankle was coming out because he could feel it moving and therefore needed morphine to cope with the agony - they x-rayed his ankle and then showed him the image. No pin present - because there had never been one put in there when he broke it 30 years previously, but the small scar led him to assume he did.

But, on the other hand, I have felt rather murderous when asked by a doctor 'have you considered that you are feeling pain because you're depressed?' and offered antidepressants. Instead, I pointed out that the ongoing diagnosis and treatment from the hospital for inflammatory arthritis might have slightly more bearing upon my symptoms. They then read my notes and stopped being so fucking stupid.

If I'm describing a procedure to a patient I would avoid the word pain as it's sounds scary. Experiences and pain thresholds differ. Also we like to describe the sensation if possible (sharp scratch, pressure etc). However as a patient I always think injections hurt no matter how many times people say it won't (I think my pain threshold is pretty low!). I wouldn't specifically say something won't hurt if it might!

I personally think women have higher pain thresholds than men. My tattooist says that in over 20 years as an artist he has never NEVER had a woman tap out in the middle of a tattoo. He said he maybe gets 3/4 men a year who can’t hack it and leave before it’s finished.

He says it’s not that women aren’t in pain but they seem to deal with it better, slower breathing, distraction, whereas men seem to stop breathing and start freaking out

'discomfort' is just not true though.
discomfort is what I feel after sitting through a theater performance in slightly too small seats for 3 hours...

not someone stitching two pieces of my skin and flesh together.

not a dislocated elbow being pulled back into place.

not a broken bone.

'sore' is for me a scraped knee or a prick from a rose thorn.

@TheFirstOHN

I've recently had a hysteroscopy and biopsy, I found the pain to be similar to period pain or like having a coil fitted if you've ever had one. I didn't know I'd be having it done so no pain relief beforehand and I was laughing and joking with the nurses throughout. I hope this eases your mind a bit.

The clinic doesn't offer sedation or gas & air. When she phoned me with the appointment details (it's a 2 week referral so not enough time for them to send a letter) the secretary said to take a couple of paracetamol beforehand as there might be "mild discomfort".

That's fucking barbaric.

Thank you KitKatCHA
I have had four Mirena coils and having them inserted didn't cause me pain (although it does feel very unpleasant when the sound measure instrument touches the top of the uterus).

I'm feeling uneasy because my insides are in a worse state now than they were. Over the years I've had several transvaginal ultrasounds with no fuss at all, but the most recent one became so uncomfortable I nearly leapt off the bed, and even the abdominal ultrasound hurt. I hate to think what's going on in there.

I actually agree it’s barbaric you can’t have anything with a Hysteroscopy.

I don’t think I could cope having another Mirena put in (and I will be brutally honest I used to hoick my judgy pants to those we put in under ga until I had one myself - ifs fucking painful!). And that’s a much quicker procedure.

Yep I had major orthopaedic surgery including a total hip replacement, the bastards didn't give me my prescribed meds even though I asked constantly because it took two nurses to dispense. My temperature was through the roof and I kept telling them it was a pain response, they only believed me when tests came back negative for infection. I had to call my consultant from my hospital bed after two days of agony. I also developed a DVT because I couldn't mobilise after surgery due to pain

My daughter had a nasty fall off a horse last year and dislocated her shoulder

The doctor told her that putting it back would be a ‘little bit uncomfortable’

That was fine, it would have only panicked her

I was however, totally pissed off when he told her to ‘stop being silly’ when she cried

She’s pretty stoic, she wasn’t screaming or shouting, she just went very quiet with tears streaming down her face

I have IBD and have had several colonoscopies with no pain relief at all. And after shitting through the eye of needle for 10 hours things are delicate down there. The nurse seemed quite annoyed at me quietly crying to myself one time. And yet in other areas you get given sedation as it’s thought too painful without. What’s that about?? Where some people get pain relief and some don’t?

But I totally get that going in there with anything going ‘this is gonna fucking hurt like fuck’ isn’t helpful for sure, j just don’t necessarily think ‘this might be s but uncomfortable’ is helpful either.

And yes some people do lie to get drugs. For sure. I have fibromyalgia and arthritis and a back/pelvis issue that causes a lot of pain, and over the years I’ve learned what works for me when I’m in crisis however this turn runs the risk of looking like drug seeking behaviour to say ‘this is what works for me’. I don’t envy hcp’s trying to work out the difference and I do get it.

I find that some HCP's are really bad for judging pain levels if you don't seem to fall into their usual patterns.

I only had a midwife in the room for my DS's birth because my MIL went out and demanded one come in. The MW was chuntering to my MIL that I was fine because I was quiet, until MIL pointed out to her that DS was crowning and she and DH had been telling them for nearly an hour that me being quiet was a sign I wasn't coping as I'm a chatterbox.

I also absolutely hate it when someone lies to my DD. She has many medical procedures and we have an honest "this will be sore, but only for a minute" or "this will hurt, but you'll stop being sick/feel better" policy because it's hard enough getting her in there. Without any word to us in the last month alone we've had two tell her something wouldn't hurt when it would, one of whom we'd ask not to say, but he overruled us thinking he knew better.

Dave I'm aware of your role existing I was just simplifying in my example, I'm an ex nurse myself but this (anaesthesia) isn't my area of expertise.

I'm a Scot of Irish descent with red hair and almost transparent skin (this is where I'll have completely befuddled those with no knowledge of this issue - but there may well be redheads posting on this thread for whom this could be a lightbulb moment) red hair is I believe linked to the gene mutation that has only very recently started to be investigated - although there was apparently even prior to this an adage by anaesthetists "redheads need more anaesthetic". When I went under GA though I was (artificially) blonde at the time which could have thrown them and at that time I wouldn't have thought to mention it - that leads to greater sensitivity to certain types of pain and a poor response to anaesthetic generally.

Dentist I mentioned is also a redhead. He's fantastic, I had full on dentophobia when I first went to him, he was recommended by a friend who'd had similar issues. He was very patient and understanding and he has a system of his own "sign language" for patients to communicate with him during treatment and he NEVER pushes on if you're complaining even of "just" discomfort (due to my physical disability the strain on my neck and shoulders during treatment can be a problem too), he'll pause and you tell him when to carry on. He's also more than happy to top up pain relief though I'm sure he sticks to recommended guidelines and doesn't go nuts! I had 2 impacted wisdom teeth when I started with him and I was able to get them both out the same day simply because I trusted him and he didn't skimp the pain relief! And gave me rest breaks.

I've VERY rarely come across good Gp's who aren't dismissive of these issues but honestly it's murder finding a good one - and when you do they're popular so it's nigh on impossible to get an appointment! I've one at my current surgery who "gets it" on the pain relief - it's just occurred to me her husband is a redhead, maybe that's why maybe he has same issue? So what I do is happily take appointments with other GP's for other issues/ailments but when it's a pain issue I will ask for her.

"JaneTheVirgin sees hundreds of patients a week, so you get pretty good at identifying those who are truly in pain." Or they get jaded, numb and burnt out and need to move to a different role or leave. Yes everyone makes mistakes (and hopefully learns from them) but I think it's obvious from her posts that's not likely the case here.

"Not all of us scream and shout when we are in pain." Also true. I'm a blether to hell normally (as anyone who's complained about my long posting style would probably agree 😂) but when I'm in pain I "go into myself" my ex freaked when I was in labour as I barely uttered a word! He was used to me getting everyone's biography and then 28 hours conscious and not speaking! When I became very ill and very worried for baby during the labour the very simple "don't you DARE leave us!" I said to him had more impact than it normally would have. Things then got VERY scary, it was like I'd sensed it, dd got very distressed and my heart & lungs decided to play silly buggers!

My mum noticed it when I was younger due to what was (much!) later dx as endo. Again she was used to me Blethering on, she started to twig that when I was quiet it was REALLY bad pain and would fetch me painkillers and other meds, hot water bottle/ice packs etc without me having to actually say.

When I was treating patients I learned to suss out their different personal reactions to pain, some were loud/aggressive, some were weepy, some were quiet, some would even grimace in such a way it looked like they were smiling. Perhaps I had particularly good training/mentoring on this but I was never taught to assume that just because a patient is quiet/uncomplaining doesn't mean they're not suffering. As I then went into geriatrics that was useful knowledge as the generations I cared for generally didn't complain even when in significant pain. Plus of course many had lost verbal capacity, communication skills etc

Some it was very subtle things like a slight change in skin tone or iris colour...

ThefirstOHNthats outrageous! I "only" have endo and even having my abdomen palpated when NOT on my period can cause pain if they catch me wrong!

"That's fucking barbaric." Totally agree - but it's VERY common in relation to treatments/procedures performed only on women.

Dontbeadick - and yet as a pp said (and there's several studies support this) men get faster and stronger pain treatments than women. Men are listened to and believed more.

@Graphista definitely. I ping awake from GA and then spend 24-48hrs wired and wide awake recover very quickly from them. Also a bleeder (red hair again...)

Yep bleeder here too, which AGAIN they don't bloody listen and then get caught out!

"Oh you DO need another dressing change" yep told you I bleed a lot! Not my fault you didn't listen.