ejreiss
12-29-2006, 12:34 AM
I was just wondering what you guys think about the pain scale system. You see I have currently been trying to get the doctor to up my pain medication and was wondering how much he considers my pain scale response when deciding to prescribe pain medicine. Before any of my back problems the worst pain I have ever had was probably pulling a wisdom tooth. At that point in my life I would have rated that at about a 9 on pain scale. Then after my back went out the first time it was the worst pain I've ever felt and at that time I would of rated it a 9. Then the only pain I had worst than that was the third time my back went out and that pain was so bad I was crippled and couldn't even roll over in bed or move at all. This pain was extremely severe and I never even thought any pain could be this bad. Now my hole pain scale thing has changed completely as this pain was about twenty times worst than my first back injury. If I knew then what I know now I would of rated my first back injury as about a 3 on pain scale. You see what I am getting at. The pain scale is only relative to how much pain you have ever felt in your life. I was just wondering how much the pm doctor uses this scale when determining pain medicine amounts. Now knowing how much pain one can actually have and the fact that I am now permanently disable from nerve damage and scar tissue from three major surgeries and several other procedures I am trying to get the doctor to up my 60 percs a month to something that is long acting as I am in pain 24/7 and feel I need something around the clock to restore function and sleep regularity. He does not want to try anything other than the percs which in my opinion should only be prescribed for acute pain. I was wondering what you thought because I am telling him my pain on a regular basis now is around a 4. I know a 4 dosn't sound like much but my four is probably most peoples 10 and I was wondering if you thought he is underprescribing me because of this. At my pain scale of 4 it is still impossible to lead a productive semi-active life and I need something more to be somewhat functional yet he still refuses to try anything new. Please help I need to know how to approach doctor to let him know how much I need to try some other things in order to control my pain and get back part of my life that has been missing now for three years.
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djemcee
12-29-2006, 01:13 AM
I have always just went in and said, "this drug or amount is not cutting it". I read about xyz drug and I want to give it a try.
It amazes me how many people seem almost scared or timid to speak openly to their pain docs. They are hired by you. They would not have a job if not for their patients. Be open and tell him exactly what you have said right here in your post.
California Chris
It amazes me how many people seem almost scared or timid to speak openly to their pain docs. They are hired by you. They would not have a job if not for their patients. Be open and tell him exactly what you have said right here in your post.
California Chris
ejreiss
12-29-2006, 01:44 AM
Believe me I have tried saying it for the last three months. I see my pm doctor every month and he is not hired by me. He is hired by workman's comp and he is the only doctor they will permit me to see. I repeat I have been determined permanently disabled and work comp has to treat me for future back related medical needs for the rest of my life. The only problem is the judge dosn't regulate how they treat me and as long as I go to their pm doctor they are legally treating me or should I say undertreating me. I tried to get them to send me to another doctor for 2nd opinion but they will not allow me to do so. So I would deeply appreciate your opinions on my initial post.
djemcee
12-29-2006, 02:02 AM
Well with that additional information, I would not know what other options you have. If you have been telling him this for 3 months, what else can you do. I know that is your question, but it seems that he's not going to budge no matter what you say. Just go in with maybe a spouse or someone around you daily and maybe have them speak to your doctor as well and vouch that you are in constant pain, and that you are not productive at the pain level you are currently at. I had my significant other come in with me once to meet the doc so he could see that there was a supportive person in my life and a second person with no motive to lie to tell him that they witness you in pain and feel that there has got to be something else to help. To bad there is not a machine we all could hook up to that would just show the dr the pain our brains are feeling.
Oh Well, wish I could have helped.
Good Luck,
California Chris
Oh Well, wish I could have helped.
Good Luck,
California Chris
Fabrashamx
12-29-2006, 04:09 AM
Hi Ej,
I don't really like the 1-10 pain scale tool for that very reason, someone with 3rd degree burns in their past is going to have a much higher '10' then someone who once hit their thumb with a hammer. People almost always have to adjust their idea of '10' pain after surgeries or childbirth, but does that mean that the '10' pain they had before those expieriences were not worth treating aggressivly? I don't know! :dizzy:
I think its better to talk to your doctor about how pain is effecting you day to day, sleep patterns, working, depression, ect. rather than throwing numbers at them.
That said, it sounds to me like the doctor you are seeing is adamant about his prescribing limits, and I think you have to resign yourself to the fact that this is what you have to work with until you can find a way to get to a doctor outside of the workmans comp circle.
Maybe there are other non-narcotic medications he would be willing to try in conjuction with your percocets, to help make them more effective. There are medications that will make a pain med taken in conjuction with them stronger, or he could put you on a routine of a strong anti-inflammatory like toredol.
I am reminded of the yiddish parable about the man who went to his rabbi and complained, that his house was crowded, noisy, and messy, his relatives had moved in and he was miserable. The rabbi told him to go home and take the cows, sheep, chickens and pigs out of his barn and bring them into the house to live for one week. The man did and went back and yelled at the rabbi, are you crazy, now its much worse, the smell and the mess and the noise are terrible! The rabbi said he was sorry, and for the man to go home and put the animals back in the barn. The next week the rabbi sees the man walking along humming and asks him how its going, he says, 'oh, it's wonderful! my house is so clean and quiet and spacious now, Im so glad I didnt listen to you!'
What I mean by that is that sometimes we are so focused on the idea that we dont have enough, we forget that we do have some, and it helps a lot more that nothing would. I know that feels like small comfort to you now, but things will get better for you. Hopefully someone will come along with better advice and can help make you more comfortable. Sending good thoughts your way, Fabby :wave:
I don't really like the 1-10 pain scale tool for that very reason, someone with 3rd degree burns in their past is going to have a much higher '10' then someone who once hit their thumb with a hammer. People almost always have to adjust their idea of '10' pain after surgeries or childbirth, but does that mean that the '10' pain they had before those expieriences were not worth treating aggressivly? I don't know! :dizzy:
I think its better to talk to your doctor about how pain is effecting you day to day, sleep patterns, working, depression, ect. rather than throwing numbers at them.
That said, it sounds to me like the doctor you are seeing is adamant about his prescribing limits, and I think you have to resign yourself to the fact that this is what you have to work with until you can find a way to get to a doctor outside of the workmans comp circle.
Maybe there are other non-narcotic medications he would be willing to try in conjuction with your percocets, to help make them more effective. There are medications that will make a pain med taken in conjuction with them stronger, or he could put you on a routine of a strong anti-inflammatory like toredol.
I am reminded of the yiddish parable about the man who went to his rabbi and complained, that his house was crowded, noisy, and messy, his relatives had moved in and he was miserable. The rabbi told him to go home and take the cows, sheep, chickens and pigs out of his barn and bring them into the house to live for one week. The man did and went back and yelled at the rabbi, are you crazy, now its much worse, the smell and the mess and the noise are terrible! The rabbi said he was sorry, and for the man to go home and put the animals back in the barn. The next week the rabbi sees the man walking along humming and asks him how its going, he says, 'oh, it's wonderful! my house is so clean and quiet and spacious now, Im so glad I didnt listen to you!'
What I mean by that is that sometimes we are so focused on the idea that we dont have enough, we forget that we do have some, and it helps a lot more that nothing would. I know that feels like small comfort to you now, but things will get better for you. Hopefully someone will come along with better advice and can help make you more comfortable. Sending good thoughts your way, Fabby :wave:
erfan
12-29-2006, 05:43 AM
DJ, some Docs might consider it suspicious to ask for a specific med.
Shoreline
12-29-2006, 11:02 AM
Hey EJ, I understand not wanting to be over dramatic and certainly understand your point. When unimaginable pain becomes your reality, you do have to reset you pain scale. You doc needs to know what a 4 means to you.
PM docs shoot for pain control, that's all, A successful pump trial and implanted pump is one that relives 50% of your pain most of the time. So I equate the #5 to 50% relief. I also wrote out what my scale means to me, how I function at each level, what action I have to take and what action needs to be taken medically. This way I know me and my doc are working towards the same goal. For example a 10 is the unimaginable pain we haven't yet experienced, each time we experience something greater, we have to reset our pain scale to include what we have experienced and what we now consider unimaginable.
From my experience, a 10 means you should be in the ER begging for sedation trying to catch your breath, a 9 means you should be on your way to the ER or trying to get an ER apt with your PM doc. You can't walk, can't eat, even communication is difficult. This type of distress can be visibly seen, it can be measured by BP and heart rate, it can be seen in the color of your face and through the windows of your soul “your eyes”, and so on down to a 5 where I can function with the help of meds, I can walk or find distraction from the pain by being engaged in an activity that’s takes my focu off the pain..
If I told my doc I was at a 4 but wanted him to increase my pump, I would probably be denied for the first time since having the pump implanted. Expecting to live below the 4 range given the severity of my injuries, the stability of my spine and my prognosis, wouldn't be realistic. It's taken 5 years to get this all hammered out and to reconcile that this is as good as it will get unless I want to over report my pain and feel impaired by medication.
With the pump managing 50% of my pain and the minimal impairment caused by intrathecal medications, using BT meds does feel impairing, using too much BT meds makes me fall asleep, causes urinary retention, doesn't allow me to function normally and I don’t feel safe driving. So I don't use BT meds when My pain level is in the 5-6 range. I use BT meds to prevent pain from climbing out of control and hitting thee 7-9 range. The BT meds work if I'm at a 7 and take longer to work at an 8 or may require the max dose I’m allowed, Sometimes they still feel like tic tacs and don't work at all. But that's not the docs fault or a sign of lack of communication or uncaring on my docs part. That's just the way it is.
Personally, Given the pain scale my doc understands that I use, reporting a 4 wouldn't require any action on his part. I may use a heating pad for additional comfort, or soak in the tub or stretch or meditate, But a 4 is tolerable and beyond what I know we are shooting for.
This is what you wrote.
I was wondering what you thought because I am telling him my pain on a regular basis now is around a 4. I know a 4 dosn't sound like much but my four is probably most peoples 10 and I was wondering if you thought he is underprescribing me because of this. At my pain scale of 4 it is still impossible to lead a productive semi-active life and I need something more to be somewhat functional yet
I understand your 4 may be a 10 to someone else, but a 4 to my doc means I'm doing as well as we can expect. I wouldn't use a 4 to describe disabling pain or pain that prevents any quality of life. It honestly sounds like you are under reporting your level of pain and his lack of response is probably due to the way he interprets what a 4 means. There are some examples of a 4 on the IRANDAL pain scale or the childs pain scale that uses a smiley face for a 1 or no pain at all and an extremely panicked and distressed face for a 10. The scale covers everything in between and a 4 on those scales doesn't show extreme stress, panic or a level that requires immediate action. On those universal scales that do use descriptive terms and do suggest the need for different levels of medical action. A 4 doesn't mean call the ambulance and break out the IV meds in the hospital. It means give you some motrin or tylenol 3, tell you to stretch and exercise. Change position, soak in the tub or use self hypnosis or a relaxation technique if you can't seem to adapt to that level of pain.
It sounds like some of the extreme pain you have experienced and your attempt to keep things in perspective, is leading you to under report pain. Reporting 4 pain but saying you are totally disabled and have no quality of life by 4 pain suggest you don't have the ability or coping skills to tolerate any level of pain or discomfort, when that's far from the truth. Obviously you have experienced much greater levels of pain. , so reporting 60% relief and a 4 doesn't equate to being totally disabled by pain by any scale I have seen or read or use myself.
Basically your number doesn't equate to your description. Just as I have seen people use extremely high numbers and under report the symptoms or use the number 10 while having a calm and rational conversation with their doc doesn't jive when their BP, pulse and appearance is completely normal. The 10 sounds like over reporting and doesn't equate with what the doc can see "extereme distress as shown by the smiley faces and can be measure based on vital signs. Someone with BP of 110/60 and a pulse of 82 , doesn't need a shot of morphine simpy because they report a 10. A shot of any IV or IM med would be dangerous to someone that has completely normal vitals. Where a shot to someone that's at 190/108 with a pulse of 138, isn't going to go into cardiac arrest from 5 or 10 mgs of IV morphine.
Try to create a concise document where you explain what 1-10 means to you, what action is required, what you experience, what you are capable of doing and what your level of function is at each number. Once you have gone over this with the doc ask him to staple this to the front left cover of your file so there isn't any misunderstanding when you report you pain level is a 4 and when you report you pan level as an 7 or 8.
Discuss the docs expectations and both your goals, what is he shooting for, what are you expecting frm pain management, are you both on the same page in that regard. II do believe it is tough to change a docs POV. Particularly when it’s comp and the doc is clearly looking out for the best interest of the company that’s paying him.
How is that request for another opinion going? This doc may never get it, If you feel that’s the case, there is no pont in wasting more of your life trying to make him understand. If you start fresh with a new doc, do the same things I suggested with the old. Make sure everyone is on the same page as far as expectations and their understanding of what each point on the pain scale means to you.
Good luck and Happy new year, Dave
PM docs shoot for pain control, that's all, A successful pump trial and implanted pump is one that relives 50% of your pain most of the time. So I equate the #5 to 50% relief. I also wrote out what my scale means to me, how I function at each level, what action I have to take and what action needs to be taken medically. This way I know me and my doc are working towards the same goal. For example a 10 is the unimaginable pain we haven't yet experienced, each time we experience something greater, we have to reset our pain scale to include what we have experienced and what we now consider unimaginable.
From my experience, a 10 means you should be in the ER begging for sedation trying to catch your breath, a 9 means you should be on your way to the ER or trying to get an ER apt with your PM doc. You can't walk, can't eat, even communication is difficult. This type of distress can be visibly seen, it can be measured by BP and heart rate, it can be seen in the color of your face and through the windows of your soul “your eyes”, and so on down to a 5 where I can function with the help of meds, I can walk or find distraction from the pain by being engaged in an activity that’s takes my focu off the pain..
If I told my doc I was at a 4 but wanted him to increase my pump, I would probably be denied for the first time since having the pump implanted. Expecting to live below the 4 range given the severity of my injuries, the stability of my spine and my prognosis, wouldn't be realistic. It's taken 5 years to get this all hammered out and to reconcile that this is as good as it will get unless I want to over report my pain and feel impaired by medication.
With the pump managing 50% of my pain and the minimal impairment caused by intrathecal medications, using BT meds does feel impairing, using too much BT meds makes me fall asleep, causes urinary retention, doesn't allow me to function normally and I don’t feel safe driving. So I don't use BT meds when My pain level is in the 5-6 range. I use BT meds to prevent pain from climbing out of control and hitting thee 7-9 range. The BT meds work if I'm at a 7 and take longer to work at an 8 or may require the max dose I’m allowed, Sometimes they still feel like tic tacs and don't work at all. But that's not the docs fault or a sign of lack of communication or uncaring on my docs part. That's just the way it is.
Personally, Given the pain scale my doc understands that I use, reporting a 4 wouldn't require any action on his part. I may use a heating pad for additional comfort, or soak in the tub or stretch or meditate, But a 4 is tolerable and beyond what I know we are shooting for.
This is what you wrote.
I was wondering what you thought because I am telling him my pain on a regular basis now is around a 4. I know a 4 dosn't sound like much but my four is probably most peoples 10 and I was wondering if you thought he is underprescribing me because of this. At my pain scale of 4 it is still impossible to lead a productive semi-active life and I need something more to be somewhat functional yet
I understand your 4 may be a 10 to someone else, but a 4 to my doc means I'm doing as well as we can expect. I wouldn't use a 4 to describe disabling pain or pain that prevents any quality of life. It honestly sounds like you are under reporting your level of pain and his lack of response is probably due to the way he interprets what a 4 means. There are some examples of a 4 on the IRANDAL pain scale or the childs pain scale that uses a smiley face for a 1 or no pain at all and an extremely panicked and distressed face for a 10. The scale covers everything in between and a 4 on those scales doesn't show extreme stress, panic or a level that requires immediate action. On those universal scales that do use descriptive terms and do suggest the need for different levels of medical action. A 4 doesn't mean call the ambulance and break out the IV meds in the hospital. It means give you some motrin or tylenol 3, tell you to stretch and exercise. Change position, soak in the tub or use self hypnosis or a relaxation technique if you can't seem to adapt to that level of pain.
It sounds like some of the extreme pain you have experienced and your attempt to keep things in perspective, is leading you to under report pain. Reporting 4 pain but saying you are totally disabled and have no quality of life by 4 pain suggest you don't have the ability or coping skills to tolerate any level of pain or discomfort, when that's far from the truth. Obviously you have experienced much greater levels of pain. , so reporting 60% relief and a 4 doesn't equate to being totally disabled by pain by any scale I have seen or read or use myself.
Basically your number doesn't equate to your description. Just as I have seen people use extremely high numbers and under report the symptoms or use the number 10 while having a calm and rational conversation with their doc doesn't jive when their BP, pulse and appearance is completely normal. The 10 sounds like over reporting and doesn't equate with what the doc can see "extereme distress as shown by the smiley faces and can be measure based on vital signs. Someone with BP of 110/60 and a pulse of 82 , doesn't need a shot of morphine simpy because they report a 10. A shot of any IV or IM med would be dangerous to someone that has completely normal vitals. Where a shot to someone that's at 190/108 with a pulse of 138, isn't going to go into cardiac arrest from 5 or 10 mgs of IV morphine.
Try to create a concise document where you explain what 1-10 means to you, what action is required, what you experience, what you are capable of doing and what your level of function is at each number. Once you have gone over this with the doc ask him to staple this to the front left cover of your file so there isn't any misunderstanding when you report you pain level is a 4 and when you report you pan level as an 7 or 8.
Discuss the docs expectations and both your goals, what is he shooting for, what are you expecting frm pain management, are you both on the same page in that regard. II do believe it is tough to change a docs POV. Particularly when it’s comp and the doc is clearly looking out for the best interest of the company that’s paying him.
How is that request for another opinion going? This doc may never get it, If you feel that’s the case, there is no pont in wasting more of your life trying to make him understand. If you start fresh with a new doc, do the same things I suggested with the old. Make sure everyone is on the same page as far as expectations and their understanding of what each point on the pain scale means to you.
Good luck and Happy new year, Dave
onyxgates
12-29-2006, 03:06 PM
I think the most important thing that Dave Shorline listed is what the pain scale means to you.
This is my interpretation (I feel the same way as you do)
10: Sure hope I am at the ER getting pain meds.
9: I hurt bad, laying on the heating/cooling pad. Relaxing and Resting.
7-8: Still hurting would like to lay down but probably too many obligations are tugging at my pants...this is the time I would like my doc to see rather than the usual 5-6 it seems I am when I see him. I am probably 35% at this level and 65% at the 5-6 level. All I want to do is go home and rest as I know nothing I have prescribed to me is going to help.
5-6: My usual level. I wake up oohing and aahing. If someone could get that knife out of my back, I might be able to do something.
3-4: Wow, it's been a long time since I have seen that number. I have an ache but nothing that is slowing me down. I feel pain but it's just a burn or an ache. I wouldn't take anything but an Ibuprofen at this level.
1-2: I feel a twinge when I lift up something or bend crazy otherwise not too bad. I wouldn't even dream of taking anything at this level.
[removed]
Goodluck!
This is my interpretation (I feel the same way as you do)
10: Sure hope I am at the ER getting pain meds.
9: I hurt bad, laying on the heating/cooling pad. Relaxing and Resting.
7-8: Still hurting would like to lay down but probably too many obligations are tugging at my pants...this is the time I would like my doc to see rather than the usual 5-6 it seems I am when I see him. I am probably 35% at this level and 65% at the 5-6 level. All I want to do is go home and rest as I know nothing I have prescribed to me is going to help.
5-6: My usual level. I wake up oohing and aahing. If someone could get that knife out of my back, I might be able to do something.
3-4: Wow, it's been a long time since I have seen that number. I have an ache but nothing that is slowing me down. I feel pain but it's just a burn or an ache. I wouldn't take anything but an Ibuprofen at this level.
1-2: I feel a twinge when I lift up something or bend crazy otherwise not too bad. I wouldn't even dream of taking anything at this level.
[removed]
Goodluck!
onyxgates
12-29-2006, 03:11 PM
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djemcee
12-29-2006, 03:55 PM
DJ, some Docs might consider it suspicious to ask for a specific med.
Not demanding, rather asking. I read a ton about meds on the net, and sometimes I will go to my Pm and tell him about the drug I have read up on. I then simply say "I think I would like to give that a try and see if it may help". He usually will agree (because I have done my research and know that it is used for my condition), unless of course he doesn't feel it will help, or it's not used for someone in my situation. I think sometimes even docs get near sighted and forget about some of the remedies out there. I think it is good to show that you have been researching a specific drug, you know alot about it, and you can seriously go in to your doc and have a decent conversation with him about the drug. My Doc will simply say "I don't think that will help you, or let's give it a try, it can't hurt". I think PM is alot of trial and error. Hopefully less error ;) .
California Chris
Not demanding, rather asking. I read a ton about meds on the net, and sometimes I will go to my Pm and tell him about the drug I have read up on. I then simply say "I think I would like to give that a try and see if it may help". He usually will agree (because I have done my research and know that it is used for my condition), unless of course he doesn't feel it will help, or it's not used for someone in my situation. I think sometimes even docs get near sighted and forget about some of the remedies out there. I think it is good to show that you have been researching a specific drug, you know alot about it, and you can seriously go in to your doc and have a decent conversation with him about the drug. My Doc will simply say "I don't think that will help you, or let's give it a try, it can't hurt". I think PM is alot of trial and error. Hopefully less error ;) .
California Chris
ejreiss
12-29-2006, 05:05 PM
Shoreline and onyxgates- Thanks for your response. That information helps me considerably. I am just trying to make some sense of this all. I don't know if my doc refuses to give me any other meds because I am only reporting a 4 on a regular basis and he dosn't realize the level of my disability or if he does not want to prescribe anything else because he is just against it or if he does not want to prescribe anything else because he is more concerned with the best interest of the work comp ins carrier than he is my well being. Maybe I've just been under-reporting my pain level because I know what a 9 is. I've been in the intensive care unit because my pain was so intense that I wasn't even breething correctly. Because of this my blood oxygen level fell to dangerously low levels so they admitted me into intensive care. Now when I say I am at a 4 or 5 this is only relative to that intense pain I've experienced which most people have never experienced in their life. I do consider myself to have a very high tolerance for pain but my level 4 is just to high to function on a regular basis. Maybe I'll try to explain this to him next vist and see if it gets me anywhere. I'm so angry because work comp situation is so much more complicated than other insurances and it's been a battle to get them to approve anything before I settled my case. Now that I have settled it they just want to brush me off totally and not even approve a second opinion.
tyler7
01-02-2007, 11:36 AM
Ahh, the good ole' trusty 1-10 Pain Scale.
I love it when I'm sitting there in the ER waiting room (certainly with all of my history of kidney stones on the side, sometimes I've felt like I lived there), and I happen to be able to hear someone else talking to the nurse in triage and they're like "my pain's 10 out of 10", and mind you they're relatively calm when they say this. :rolleyes:
I've in fact even later had a laugh with some nurses on this point, because it just seems ridiculous. It's like, DUDE, if you were really a 10/10, as in "the worst pain of your life", you wouldn't even be able to verbalize the fact that you were 10/10 :P The way they'd know you were up that high is because you'd be screaming and babbling so incoherently they'd think you were speaking in tongues. :D
So, suffice to say, I've found not very many people have much a grip on the classic pain scale at all. Though, I suppose I'd feel sorry for you if you did :rolleyes:
I love it when I'm sitting there in the ER waiting room (certainly with all of my history of kidney stones on the side, sometimes I've felt like I lived there), and I happen to be able to hear someone else talking to the nurse in triage and they're like "my pain's 10 out of 10", and mind you they're relatively calm when they say this. :rolleyes:
I've in fact even later had a laugh with some nurses on this point, because it just seems ridiculous. It's like, DUDE, if you were really a 10/10, as in "the worst pain of your life", you wouldn't even be able to verbalize the fact that you were 10/10 :P The way they'd know you were up that high is because you'd be screaming and babbling so incoherently they'd think you were speaking in tongues. :D
So, suffice to say, I've found not very many people have much a grip on the classic pain scale at all. Though, I suppose I'd feel sorry for you if you did :rolleyes: