Feel My Pain

Feel My Pain

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We are a surgical orthopedic practice. Every day we see patients in pain. We ask them to  describe it; location, duration, sharp or dull, constant or intermittent, but we really have  no way of measuring someone else’s pain. The tools we use now are inadequate and the  information we get from them is misleading.

Let’s Talk…

Our job as medical professionals is to assess our patients and to treat their pain safely and  appropriately. This gets harder all the time as opiates are prescribed frequently, and are  expected by most people, especially in the Emergency room. Those lovely Press Ganey  scores (patient satisfaction surveys) are going to be low if we don’t send someone home  with some kind of medication.

There are many different ways for the patient to tell us how much pain they are in. There  is the “0-10” Numeric pain scale, the Visual Analog scale (a horizontal line where the patient  marks on the line where their pain intensity level is), or the Wong-Baker Pain Scale where  faces range from Happy (0) to severe (10) for the patient to point at to visualize their pain. In all of these, the number is supposed to be 0 for no pain and 10 for the worst pain imaginable.  This is where things get tricky. If you have ever been in labor or had a kidney stone, you are actually aware of how bad pain can be. You know you can’t actually function (walk, talk,  laugh with your friends) when you have a 9/10 pain. You certainly cannot go to work, drive  your car and go out to dinner, and yet, at least 50% of patients who walk through the door have  a 9/10 pain level. Why?

Part of it is our fault. Patients are told in the hospital they will get one pill for 5/10 but two pills for greater than 7/10 (who actually thought of that???) Patients feel that they will not get any attention for a lower, more realistic pain score. They are unaware that we look at movement, facial expressions and demeanor along with listening to what you are saying. If you tell me  you have a constant 3/10 back pain with elevations to 5-6/10, I am much more likely to believe you than if you sit in on our exam table, swinging your legs and talking on your phone and tell me it is 9/10 all the time.

“I have a high tolerance for pain”. Most common phrase in a Dr.’s office. Second most common  is “I’ve just gotten used to it”. First of all no one can actually judge their tolerance for pain. The  mechanism of pain is where the tolerance comes in. If you have a disc or bone pressing on a  nerve root, the pain is excruciating. If you have a broken bone, soft tissue injury or just had  surgery, the level of pain is different for each. You do not “get used to” pain. It decreases. Trust  me, the first labor pain is the same as the last. You do not get used to it.

It’s very difficult to get a patient’s actual symptoms described to you. You need to observe,  listen closely and be non-judgmental. You need to see what else is going on in your patient’s life. Pain is linked closely with depression. If your patient is going through a loss, such as a divorce or a death in the family, you can be sure the pain they feel will be increased. The  opposite is also true. A happy, well-adjusted patient will generally report much less pain for a similar injury.

What can we do? We as medical professionals need to listen and observe our patients better. We need to actually explain the pain scales and make sure a 3/10 is treated with the same level of concern as a 9/10. We need to treat the mechanism of pain instead of the symptom itself.  Using ice, elevation and anti-inflammatories instead of narcotics, massage and stretching instead of muscle relaxers. We need to realize that sometimes people do need pain medication and give it to them without bias or judgement.  Until we find a better way of measurement, it is up to us to use our training and our observation skills to “feel their pain”.

Citations

  • Azimi P, Nayeb Aghaei H, Azhari S, Shazadi S, Khayat Kashany H, Mohammadi HR, Montazeri A. An Outcome Measure of Functionality and Pain in Patients with Low Back Disorder: A Validation Study of the Iranian version of Low Back Outcome Score. Asian Spine J. 2016 Aug;10(4):719-27. PubMed PMID: 27559453
  • Shaw WS, Hartvigsen J, Woiszwillo MJ, Linton SJ, Reme SE. Psychological Distress in Acute Low Back Pain: A Review of Measurement Scales and Levels of Distress Reported in the First 2 Months After Pain Onset. Arch Phys Med Rehabil. 2016 Sep;97(9):1573-1587. PubMed PMID: 26921683

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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