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AIBU?

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Original poster

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

153 replies

OwlBeThere · 26/05/2019 05:13

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.

OP posts:
greenelephantscarf · 27/05/2019 06:54

If someone is fast asleep, opens their eyes and says '10' and then falls asleep again, they are unlikely to be given much in the way of pain relief.

many many people go quiet/sleepy as a pain response. you know, to cope with (to them) extreme pain. maybe that's what's happening here?

NewAccount270219 · 27/05/2019 07:32

Our recovery nurses are taught not to ask if the patient is in pain, but if they are comfortable. If they use the word "pain", most patients say yes. However, if you ask if they are comfortable, also most patients say yes.

I think that's because it's unclear to people what they're being asked, and what the person asking is offering? If I were asked if I 'was comfortable' after an operation I'd think they were asking if I needed more blankets/the loo/etc. 'Is your pain relief working well enough?' is a different question - and it's also different to 'are you in pain?'. I had my thyroid out recently - I was comfortable after I came round from the GA in that I liked how I was propped up etc. My neck hurt - yes, I was in pain - but not to an extent I didn't expect or that I couldn't cope with, so I didn't need extra pain medication. To me those are three separate questions.

greenelephantscarf · 27/05/2019 07:37

I think that's because it's unclear to people what they're being asked, and what the person asking is offering? If I were asked if I 'was comfortable' after an operation I'd think they were asking if I needed more blankets/the loo/etc. 'Is your pain relief working well enough?' is a different question - and it's also different to 'are you in pain?'.

^^ absolutely this.
who the hell trains hcp?

Chouetted · 27/05/2019 11:56

I would 100% interpret "Are you comfortable?" as being an enquiry about what I was lying on/in.

I'm in a bit of pain now because I'm on my period, but I'm also lying comfortably in bed, and that comfort is helping me relax and compartmentalise the pain.

ineedaknittedhat · 27/05/2019 12:29

I wouldn't ask someone if they were comfortable if I wanted to identify pain. Comfortable means, are they warm/cool enough, pillow situation, position in bed etc. Most people would assume it means this.

Not using plain speech leads me to think that the subject of pain is being avoided, not to prevent a person's from focusing on it, but to save the nurse the job of fetching pain relief. People will often tolerate significant pain because they don't want to make a fuss - not everyone is a drug addicted drama queen. Giving people the opportunity to speak up about their pain in an open manner by using accurate speech is key. Using euphemisms doesn't work and doesn't encourage open communication.

missminagrindlay · 27/05/2019 13:40

God, the British are so ridiculous about pain. 'Comfortable' 'sore' 'stings'. Just so typical of the beat around the bush culture we have. Ludicrous!

DaveMinion · 27/05/2019 14:17

Also taught in recovery to ask if patients are comforable. And you do know if people are in pain because they will not be asleep. A comfortable, pain free patient will be asleep. A patient with true pain will be awake and writhing about on the bed and asking for pain relief.

Once a patient is in recovery you are actually pretty limited to the amount of pain relief you can give them. They will have had paracetamol in theatre, possibly paracoxib or ketoralac (non steroidal anti-inflamatories). Also morphine and fentanyl. They might even have patient controlled analgesia and/or a block or spinal/epidural for post op pain relief. Depending on surgery, you need to look at the risks of post operative nausea and vomiting and what the effects of the pain relief you give has on them so if they are vomiting you don’t want to give too many opioids as that will make that worse. Then you also cannot give oral pain relief like OxyContin etc.

So it’s really a big balancing act managing post operative pain. And isn’t as simple as just saying do you have pain? yes it’s a 10. Ok I will give you all I can and then they won’t stop vomiting for days. It’s a case of using our training and experience to assess each patient as do all the nurses/odp’s here.

greenelephantscarf · 27/05/2019 14:35

A patient with true pain will be awake and writhing about on the bed and asking for pain relief.

I don't really know what to say about that without swearing.

ineedaknittedhat · 27/05/2019 14:38

Don't they have anti emetics any more then?

jewel1968 · 27/05/2019 14:51

I find it really difficult to rate pain. I have experienced some things widely considered painful:
Childbirth X 2 with no pain relief
Sciatica
Prolapsed discs
Frozen shoulder
Perforated eardrum
Dry socket
Cellulitis

I honestly can't describe what the pain is like on a scale. One consultant having looked at MRI scan was surprised I was walking. I also tend to withdraw into myself. I don't ask for drugs as they don't have much impact and make me sick. It is afterwards I get a sense of how bad it was. Bizarrely I will moan more about a cold or suchlike.

Nat6999 · 27/05/2019 15:04

I've had surgery both in NHS hospitals & private hospitals. The pain relief after surgery in NHS was poor, never given on time & stopped when they thought I shouldn't be in pain, didn't ask if I was still in pain. In the private hospital my pain relief was written up before I went to theatre, I was told what I would be given & I was told to tell them if I needed more, they increased my pain relief every time they needed to do something like removing a drain or catheter, they even gave me some before they moved me from recovery to the ward, I was never in pain because they made sure I wasn't. That is how it should be, you should never have to beg for pain relief, it should already have been given to avoid the pain in the first place. I was in A & E with a gall stone attack, all I got given was paracetamol that I couldn't keep down as I was throwing up with the pain, I was never offered anything stronger, in the end I discharged myself, went home & saw my GP who gave me strong pain relief & anti sickness tablets so I could keep the pain relief down. I appreciate that the NHS is on its knees, but that is no excuse for leaving anyone in pain.

DaveMinion · 27/05/2019 15:16

Don't they have anti emetics any more then?

Of course. The are given routinely as part as an anaesthetic.

But on the other side of the coin, side effects of pain killers and anaesthetic drugs is nausea and vomiting. You don’t want vomiting if you’ve had abdominal surgery for example so it’s a fine balance. You can give all the anti emetics on the prescription chart and a patient will still be vomiting. And unfortunately we will withhold opioids in that case because it will compound the situation.

I feel no matter what us hcps say we are fighting a losing battle and it’s wrong.

DaveMinion · 27/05/2019 15:22

A patient with true pain will be awake and writhing about on the bed and asking for pain relief.

I don't really know what to say about that without swearing.

Bad turn of phrase sorry. I meant a patient in pain requiring opioids. We use a pain scale of 1-3 in my dept so that’s a patient with 3. So 1 we would wait and see. 2- paracetamol if not had in theatre or tramadol. Hope that clears it up. I wasn’t implying anyone was lying.

YesQueen · 27/05/2019 15:24

@DaveMinion I guess it's just because people deal with pain differently

I was stood up, outside and vaping with cauda equina because the only way I could cope was vaping and pacing. I couldn't speak to anyone or stop pacing as then it really got bad. Triage did spot me and I got seen very very quickly and given morphine (I had already taken paracetamol max dose, 60mg x 4 dihydrocodiene, naproxen and diazepam and nothing was touching it)

My broken ankle and foot nearly didn't get x rayed because I was walking on it with no swelling but it was fractured in 4 places

teacuptale · 27/05/2019 15:34

This has been an interesting thread. I think my labour pain wasn’t deemed to be too bad as I wasn’t screaming. When I’m in intense pain, I go very quiet and close my eyes. I’m not after an award for that, it’s just that not everyone screams when they experience severe pain.

smallereveryday · 27/05/2019 15:45

I will never get over the consultants SECRETARY asking me to 'pop up on the couch so Mr ** can do a little bone marrow ' ...

goose1964 · 27/05/2019 16:18

I was looking on NHS direct and they have pain as mild, moderate and severe, with descriptions of each, ie constant and annoying for mild to stops you doing normal activities for severe. I found this far more useful from the normal 1-10 when categorising my pain. Normal is mild but when it flares it is usually moderate but can be severe.

SimonJT · 27/05/2019 16:23

I had my appendix removed 18 months ago, I had been to the GP with pain who referred me on and then the problem was diagnosed, I was then put on the list for elective surgery.

About two weeks later it got really bad in the night, at about lunch time it was unbearable so I went to A&E (weekend), who sent me home with paracetemol. It ruptured on the way home and I was then taken to hospital unconscious in an ambulance and triaged by the same medical team! “You should have told us how much pain you were in” I bloody well did but they ignored me.

cranstonmanor · 27/05/2019 17:11

If in severe pain I go sit quietly in a corner watching netflix trying to distract myself (but not actually following what I see due to the pain). Reading this thread I should apparantly be screaming and writhing if I want help. Good to know, I'll remember that.

MontStMichel · 27/05/2019 20:09

A patient with true pain will be awake and writhing about on the bed and asking for pain relief.

When I fell down the stairs and broke my fibula, I was in true pain and writhing about on the floor in agony - I was incapable of thinking about pain relief! Later in A & E, I was still in true pain but not writhing about - but I could not weight bear on that leg?

I did not need to lie to be seen quicker - I told them the truth, and was sent to x ray after a 5 minute chat with the triage nurse!

Do you consider patients are not in true pain, a couple of hours after breaking a bone? I can honestly say the codeine they gave me, did not begin to touch the pain for the first week! It was about as much use as a chocolate teapot!

Graphista · 27/05/2019 20:19

My mum has the opposite reaction to anaesthesia than me it works too well in a certain way - GA Knocks her for days! So her being very drowsy even sleeping doesn't necessarily mean she's not in pain it just means she's too sedated to respond. It's possible to be feeling sedative effects and still be in pain.

I think it's clear from this thread that making assumptions is neglectful. Not every patient responds to or deals with pain in the same way and hcps need to remember that and not have blanket rules.

They also need to use plain English in assessing via verbal communication.

I too would respond to "are you comfortable?" With an answer based on how comfortable I was in the bed! I wouldn't jump to thinking it was a euphemism for "are you in pain?" Especially when not fully with it!

"Don't they have anti emetics any more then?" Also an excellent point.

I can't help but wonder if the reluctance to relieve patients pain isn't informed by money & time saving considerations, perhaps not necessarily by hcps (although I suspect it may be true for some) but informs current training?

I too am now wondering exactly what is going on with training that we've got hcps with such inaccurate set ideas of what "in extreme pain" presents like.

Marmablade · 27/05/2019 20:53

When in back to back labour with SPD & a 9lber with a 98th centile head I kept saying 'it really hurts' but because I wasn't swearing for painkillers I wasn't taken seriously. Except when I'm in real pain I go into 'stoic focus' mode and seem utterly calm. I know my pain and if I say it really hurts you can be sure it f-ing kills!!

iolaus · 27/05/2019 21:00

Problem is pain is subjective

To me a 10 is 'die rather than continue on' - I've never got that high (and I've had a back to back birth with no pain relief)

The tattooist laughed at me when I rated the experience worse than birth but better than the dentist

The torn diaphragm was horrendous (and probably is close to the top of pain scale) - as was the ludwig's angina and dry socket (actually the tooth pain was worse - probably an 8 or 9, diaphragm around a 7)

The perforated uterus which apparently should have been agony - maybe a 3

Marmablade · 27/05/2019 21:45

Re a PP about NHS vs private pain relief.

I had 2 similar operations 1 on NHS 1 private and the pain relief privately was perfect. It was always on time. I was rarely in pain and when I said the paracetamol and ibuprofen wasn't enough I got oramorph. On the NHS I got paracetamol and ibuprofen but rarely on time and refused oramorph or it would delay my discharge. But if I'm in pain surely you shouldn't be discharging me till it's under control?

IceBearRocks · 27/05/2019 21:52

@yesqueen firstly should that's Yaaas Queen aka Scott Mills ?
Secondly .....if you had CA at least you had a reason for someone to stick finger up bum!!!

Suspected cauda equina ..... Literally couldn't move from wheelchair DH found in A&E......Given Valium and oramorph!

Surely you can tell by the face ...my disabled DC is nonverbal....we look at him!