Pain Scores

Obtaining a pain score on a scale of 0-10, o being the absence of pain and 10 the most painful,  is commonly done in healthcare settings. I don’t usually give second thoughts about pain scores because it is a tool instrumental in alleviating a patient’s discomfort.

But today, it dawned upon me that it may not be that simple some times. I’ve often read in medblogs and patient blogs(especially RA-er blogs) that EMDs are very cautious about drug-seeking behavior. I now have a patient whom i personally admitted on Monday. He’s healthy with no underlying morbidities or past medical history. His pain score since admission before his surgery was 7(his is an orthopedic surgery case), and has gone down to 6. 6 has always been his score after his first post-op day. In his e-IMR(electronic inpatient medical record), IM Pethidine was ordered PRN, which is given only after paracetomol and tramadol have failed to work.

As a nursing student, i made sure to obtain his pain score frequently. But i only got a 6 everytime. I reinforced to him that is he couldn’t tolerate it, we could give him an injection for it. It has been given to him before, so i was sure he’d know how to ask for it. In the midst of these, i forgot that my patient was an IVDA(IV drug addict- confirmed or not, i’m not sure). Suddenly everything fell into place.

His pain score was consistently high. He looked quite comfortable- i.e. he didn’t look like he was in distress. No signs of diaphoresis, increased respiratory rate, grimacing etc. He looked comfortable basically. He could even joke with us and poke fun at our CI! Pethidine(or Meperidine in the US- Demerol) is an opioid analgesic, and it was very likely that it was drug-seeking behavior. We cannot exclude that possibility, although he didn’t make demands, nor did he request for any, even until he fell asleep.

*sigh* I wished i had notice it earlier, but fortunately i realised it early enough. I wish i could have practised more critical thinking. Maybe the ‘red herring’ was the fact that he was a post-surgery patient with external fixators(with rods and pins) and i wanted him to be comfortable(cos’ heck it does look painful!).

Oh well. A new lesson learnt on-the-job which school will never teach!

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