Re: JCAHO Sets New Standards for the Assessment and Management of Pain

From: Jean (
Sat Feb 10 23:41:25 2001

At Fri, 9 Feb 2001, Janet Karam wrote: >
>Dear Mary,
>I think pain is a very hard thing to exrpess in words or numbers...I do
>think a number gives the docs a more accurate measure than words.
>Maybe they want a measure for how we are tolerating the pain....more than
>what the pain actually is?...You're "4" could be someone else's 8 or 2.
>As a massage therapist I have seen that barely applying pressure to can be
>too much for one person, and not near enough for another if I dig my elbow
>into their muscle!
>At least this way we can give the doctors a measure of how we are tolerant
>we are of what we are experiencing.
>Wouldn't it be nice though if we could touch something and have our pain

>>---- Original Message -----
>From: "Mary Wade" <>
>To: "Multiple recipients of list ADHESIONS" <>
>Sent: Friday, February 09, 2001 3:58 PM
>Subject: Re: JCAHO Sets New Standards for the Assessment and Management of
>> Do any of you feel that the 1 to 10 scale for rating adhesion related pain
>> falls short of what we need to describe how we feel? Over the years, I
>> been asked often by docs to rate my pain on a scale of 1 to 10. I always
>> asked them to tell me what 10 was. "well..that's the worst pain you've
>> had" "OK...I thought...that was labor." So compared to that..I always
>> that my adhesion pain was from 4-6...sometimes even 7. It seemed to me
>> those 4-6 numbers were not ever very alarming numbers to the docs. Those
>> numbers never seemed to move them to take my pain too seriously. I tried
>> explain that it was not so much the INTENSITY of the pain that was
>> crazy-making...but the CHARACTER of the pain. It's one of those pains
>> makes your body say, "Get rid of this...get it OUT." There was always an
>> urgency to my pain. It was not a passive ache or pain. I told others
>> I was trying to explain what it was like...that it was like walking around
>> with your shoes full of rocks and not being able to take the shoes
>> off...ever. Does this relate to what some of the rest of you have
>> experienced? Or are we all different? Just curious! Mary
>> At 05:18 PM 2/9/01 -0600, you wrote:
>> >On 9 Feb 2001, at 11:38, Helen Dynda wrote:
>> >
>> >> "Research clearly shows that unrelieved pain can slow recovery, create
>> >> burdens for patients and their families, and increase costs to the
>> >> care system."
>> >
>> >When I was in the hospital there were posters up for "Pain -- the
>> >other vital sign." There is a great deal of activity in hospitals and
>> >nursing practice around assessing pain just as temperature, pulse,
>> >and blood pressure are taken.
>> >
>> >Last winter I attended a conference for people working with cancer
>> >patients and heard an excellent discussion of pain by an ER
>> >physician and a anesthesiologist. Both were adamant that the
>> >patient's perception of pain was the only way to assess it.
>> >Anesthesiologists have become central in developing pain control
>> >methods.
>> >
>> >As I read the messages on this list each day, I become more and
>> >more convinced that the first step to managing pain is simply to
>> >have it acknowledged. When we perceive that our doctors don't
>> >believe we have pain, we are frightened, discouraged, and hopeless.
>> >
>> >I usually assess my pain on a scale of 1 to 10 where ten is
>> >unbearable. It really helps to realize that the pain does vary with
>> >what I eat and how tired I am.
>> >
>> >Kate
>> >Kate Murphy
>> >

Janet & Kate, I agree, it is very hard to rate pain on a 1 to 10 scale. If 10 is suppose to be the worse pain you have ever felt....for one, "how does the doctor know "what" the worse pain was that you ever had to compare this to (example: one person's might be labor, another a broken leg, another arthritis or just a sprain could have been "that" individual's "worse" pain they ever felt! Some people are lucky enough to never have had to endure really bad pain to know what real bad is. Even with child-birth many women have unbearable out-of-their mind pain and others have very little pain.

I myself had 16 hours of seconds-apart excruciating labor pains, was out of my mind in pain, 107 temperature and with water broke, plus too small of a pelvis to ever deliver normal. I almost died.....but I never screamed, just moaned. To me that would be "my" #10 but is that #10 to the next person??? If my present doctor wasn't there and doesn't know what pain I went through then how does he know what "my" #10 is or anyone elses for that matter???

I also agree that the nature of pains greatly differ which makes it hard to compare. Sharp pains can be unbearable and make you gasp for breath or even scream depending on the cause (for the seconds or minutes you have it), cramps can also be unbearable although in a different way when you have them 24 hours a day 7 days a week for a year!

I don't think the Manoski Pain Scale works very well either, since according to that you are still able to work and perform social activities even though you need narcotics every 3-4 hours for pain. Until the scale reaches a point of not being able to work you are supposedly having difficulty reading & conversing!!

I can read & converse and even sit although in pain all the time. I am unable to walk un-aided and even intensify the pain when walk with aide. I am not on narcotics though unless Darvocet is considered a narcotic(not that I wouldn't like to be so I could function). I definitely could never go out to work at a job like this though, especially involving standing or walking.....concentrating well enough to work efficiently would be a problem with the pain. My pain makes me very grumpy, restless, less tolerant of people and everything else, and the more I push myself to put up with the pain the worse it gets until I must give in & lay down. I also have no social life for the past year. Sometimes the pain is very intense cramping, sometimes sharp, sometimes pressure pains like exploding, sometimes less intense cramping and pressure do you rate it over-all??? I can't even stand or bend to make meals or clean or it makes the pain much worse, but I am not moaning with my pain so what number do they have for that, I didn't see it on the scale???

Mary...the rocks description was good!



Jean (from PA)

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