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  • Pain scale & reporting to the doctor

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    Old 09-11-2015, 07:05 PM   #1
    Sparkgap
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    Angry Pain scale & reporting to the doctor

    Does anyone else find that these arbitrary numbers can provide very little accurate information as to what the patients actualy pain level is over a period of time? I really hate it. Some docs give a print-out of a persons face to show the discomfort level.

    IDK about anyone else but I grew up with severe pain from working very hard since I was about 9 years old (movine 80-100lb logs into a trailor - I kid you not) and often inured myself - not to mention the vast number of injuries of playing 3-4 contact sports a year.

    I was brought up to keep the pain inside and complaining about it often led to reprimand and stories of (walking uphill, pulling a bus of kids, both ways to school, then delivering Newspapers for 3 hours ater & before school )

    Too much complaining often resulted in heated argument between parents (obviously my fault...) so I learned to not complain unless it was totally cripling (which has led to life long physical ailments b/c I was too fearful of my dad to tell the truth about my situation.

    So, when the doc asks high and low pain levels, it could be a 3 at lowest, but that may last 30-45 mins a day, highest may be 8-9 which may be 1-6 hours a day - with various levels & lengths of duration in between.

    IT seems that they only ask these questions to CTA (cover THEIR az) instead of really figuring out how bad and how often a person is suffering.

    does anyone else feel the same about this issue?

    I know I have heard other people claim 9-10 on the scale for day's to weeks, yet they managed not to miss work and even have nice weekends. I wouldn't be able to leave the bedsofa/recliner if that were the case and possibly end up in the hospital. I'm not saying that I dojn't handle it as well, as they rate a wasp sting at like a 7-8.

    It seems that honest people get the shaft while those who lie, request meds, etc, seem to get is requested all too often.

    Sorry to vent, I just hate so much about a subjective scale which is by no means, in any aspect, an accurate way of measuring discomfort level.

    Onc I had a broken thumb (3 places) and I rated it at about a 5 while the ER doc said most would rate at a 10. Until you really experience a 10, you have no idea. That is when you are begging for relief.

    Last edited by Administrator; 09-11-2015 at 10:49 PM.

     
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    Old 09-12-2015, 09:21 AM   #2
    tortoisegirl
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    Re: Pain scale & reporting to the doctor

    I agree. My levels vary widely, and its so subjective (I assume I've never had a 10, and 9 is incapacitated). I think the average pain level before and after pain management treatments is just one of the best ways doctors can evaluate how we're responding to it.

    I think the before vs. after is the most important. They want to make sure its worth it (ie. they wouldn't keep someone on opioid meds without significant relief), if our pain levels are increasing (or decreasing) over time, etc.

    I circle the range of pain levels for the month (ex. 2 to 8), then my average (ex. 4). Both with and without my meds and treatments. My doctor however also asks my level of function as a percent (100% being full time work without restrictions). Best wishes.

     
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    Old 09-13-2015, 04:06 PM   #3
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    Re: Pain scale & reporting to the doctor

    I guess I may be in the minority here but I don't really have a problem with it. I mean it's just one tool in the bag to help a doc know where things stand. For the record, my doc always ask what my pain level is now. If I've had some serious outbreaks during the month, I am sure to mention it so he knows what I've been dealing with. I am usually in the 5 range when I go to the doc, and occasionally a 6. I'm sorry you're having problems with these things and can only hope things get better in the near future for you and all of us CP'ers!

     
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    gmak (10-08-2015)
    Old 09-14-2015, 05:35 AM   #4
    Sparkgap
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    Re: Pain scale & reporting to the doctor

    I guess I should clear up the fact that I really don't have a problem with them trying to get an idea of where the pain is at - it's just more of a major frustration because it varies so much throughout the month that I don't know when to base these ratings on. Also, when I have an appt I very often don't have severe pain, unless it's near a time of surgery, as I am not doing anything to aggrivate it at the time.

    Now if my appointment were during work at say the grocery store stocking shelves with soda bottles/cases, that would be an accurate representation of my pain level if I were having to put forth moderate exertion and flexion of my problem areas. Having an appt after a days rest with minimal activity is going to show that my level is fairly low compared to mild-moderate work.

    I guess I am most concerned with whether the doctors understand the above issues and take that into consideration or not. Unfortunately I have had some doctors who seemed to need some of the most obvious facts pointed out then I get a reply like it's a revelation of some kind. On the other hand, I don't want to go overboard with details and make it seem like I'm talking down to the doc, as if he couldn't have extrapolated those things on his own. It really feels like a Catch-22 in some cases.

     
    Old 09-14-2015, 07:23 PM   #5
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    Re: Pain scale & reporting to the doctor

    What is the question specifically asking for--a pain level then and there at the appointment, or does it not specify? The forms at my pain doctor ask for average in the past month, and I also circle my min/max range (they do this for both pre and post treatment). If your doctor is only asking for your pain level at that moment, I agree that isn't very helpful for you or them. If I got that question I'd literally cross the applicable words out and put "month" or whatever and do the min/max/average thing lol. Also, discuss with your doctor what activities are reasonable for you to be able to do while maintaining what pain levels. Best wishes.
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    Old 10-08-2015, 07:38 AM   #6
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    Re: Pain scale & reporting to the doctor

    Hi Spark Gap, I realy don't have a problem with the pain scale either. I think my docs are prett bright people and know when people are blowing smoke and truly in pain. There are other symptoms of distress like BP. They have our records and I think they understand the difference between someone that has never had surtgery and stating their pain is a 10 and someone that has endured multiple surgeries and reporting an 8. First off if someone was in 10 pain, they wouldn't have walked into a clinic on their own feet and would most likely be on their way to the ER, not sitting in a room waiting to pick up a script. I reserve 10 for the worst pain imaginable. Since I have never had my arm ripped off by a piece of farm equipment I simply don't use 10. With each surgery I've had to reset my entire pain scale when unimaginable pain becomes my new reality. Docs are bright folks and they have to ask those questions and document they asked the questions. I don't think over reporting will get someone more meds or better treatment than someone that reports more realistically. Nobody sits at work, or drives themselves to the pain clinic in 10 pain. Its ridiculous and unbelievable. Having multiple pain sources doesn't amp up the pain level either. when I see a laundry list of injuries my first thought is what is the primary issue that has them sitting in front of the doc. Is it really the wrist they broke at 9, the sprained knee at 15, The bunions they developed in their 20s and oh yeah don't forget the arthritis and back pain they developed in their 40's along with the migraines they go to the ER several times a month for. Most frauds expose themselves within a year of treatment, usually by never being satisfied regardless of what is done and by Having unrealistic expectation of treatment and of results.

    At some point I believe doctors expect us to modify our lifestyle. If my back hurts that bad, bad enough to require long term treatment with Class 11 narcotics I would not get on a horse and go camping in the mountains and sleep on the dirt floor of my tent. Water skiing, Kayaking and Bronco busting wouldn't be on the list of things I miss doing. Morphine, Dilaudid and Fentanyl aren't medication to make golf and tennis more enjoyable.

    If they understand your case, your quality of life issues and your individual situation, they understand your concept of 7 or a 8 on a pain scale. That's just my understanding from talking with PM docs for the last 30 years. Long before opiates were even used for chronic pain. OxyContin, Duragesic, Kadian, Avinza, LA Oxymorphone and Hydromorphone and all these high power, high dose meds including Percocet 10 didn't even exist prior to 1998 when OxyContin first hit the market. I had 3 multi level spinal fusion in the 90's and I was never given anything stronger than 5 mg Percocet because it would have been absurd to prescribe dilaudid at the time and nothing other than morphine was even available in pill form. Cancer patients suffered and died in horrible pain prior to 1998.

    Now we have a generation of people complaining they cant bake a cake without their old elbow injury causing 10 pain. Or play 18 holes with out the back injury from JV football acting up and causing indescribable misery. Here is a crazy Idea, Buy the cake from a store and avoid the pain completely and try miniature golf if walking an 18 hole pro course for 3 hours is too strenuous. Other things in life like walking through a grocery store, climbing the stairs on their porch or to get to their bedroom, getting out of a chair or bed are a little harder to avoid. I think as long as you keep things realistic you will be fine with the pain scale. Don't worry about what you hear in the room next door, I usually get a little chuckle from some of the stuff people say to get meds. The lady in the room next store that is disappointed after months of treatment, trying 4 different LA opiates combined with BT meds that didn't exist 17 years ago and her pain is still a 2 or 3 on most days and she thinks the docs job to make all her pain disappear. Of course on bad days her DDD related back pain that hasn't required surgery yet is still a 10 despite that 75 mcg patch and 20 mg Oxycodone for BT. Don't sweat what other are saying and doing. Just make sure the doc understands your individual situation and can document that he asked some questions about the intensity of your pain.

    Good Luck, Dave

    Sorry, Im having a hard time but my sarcasm isn't directed at you. Just trying to make a point and add a little humor.

     
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