What is the most pain you have ever felt

[phillysailor]

Another component of pain for me is that if I understand the why or what it is much easier to handle than pain from unknown causes.

There is a significant component of fear and control in the perception of pain. Many people have endured horrible pain if they can understand it will end or be reduced at a certain point, or if it is serving a purpose.

But being powerless to understand why, or have any control over when or how much pain is coming makes it worse. Combined with the opposite of empathy, as Ed described, and the effect is predictably a worsening of pain. In fact, the pain may then be interpreted as torture.

Can you clarify what you said about my interpretation of a 10 point pain scale is? And in the next sentence you say It's also the most common interpretation by those who are asked the question.

Sure. In order to be useful, a scale has to have an upper and lower boundary, with repeatable results from the same observer over time and some degree of inter-observer consonance.

Pain is also associated with psychic effects as your narrative of painful events reveal, and as I discuss above. These help create varying interpretations of where perceived pain lies on a 10-scale. But allowing patients to switch to a Spinal Tap "These go to 11!" scale deprives a scale of its utility.

In my previous post I tried describing pain in a Beaufort-like way, where outward manifestations of pain can help assign more accurate numerical representations. I'll try again here.

If a patient is speaking intelligibly at all times, uses correct syntax and a variety of sentence structures, pauses appropriately to listen, displays understanding and "tracks" a conversation normally yet shows vital sign abnormalities and reports severe pain with a known cause, I'd assign them a 5-6.

If they were highly pressured in speech, tearful, gasping but capable of orderly speech or ability to follow simple commands, I'd rate that a 6-7 based on how often they were out of it with spasms of pain.

If they were screaming occasionally, and only able to curse or say "please" repeatedly that'd be an 8. An interview may only answer a single question, so choose carefully.

If there were no comprehensible words in the presence of very concerning vital signs, plus a waxing and waning consciousness... that's a 9

And once they'd gone unconscious, developed arrhythmia or other similar life-threatening alterations in vital functions, that's a 10

I understand that no patient in pain uses this scale. Zero. It's just a clinical scale I use.

When I use it, anyone capable of higher-order thought process, like getting justifiably offended by an insensitive bedside manner, is no more than a 6. A patient's judgement is so distorted by the time their pain is a 7 that they can't really be trusted to make rational or fair assessments.

Anyone with pain of 8 couldn't be bothered with interpersonal communication except to beg relief, and a 9 can't form sentences, just guttural sounds.

Anyone with pain 5 or greater I'm 90% likely to give opioids +/- benzodiazepines during our interview, or just after I chat with them, so not only will they get some pain relief, I'll calm their psyche as well and reduce memories of one of the worst episodes of their life.

Anyone with pain 7 or 8 gets general anesthesia just as soon as I can establish it. They cannot sit or lie still for a nerve block or an epidural without powerful sedation, so that limits my options. If in labor, a woman may be able to cooperate between contractions so... maybe. Depends on their coping skills.

Anyone with pain of 9-10 is crashing and needs resuscitation.

 

[Titilingus]

My lovely wife of 17 years came back to California from a six-week vacation in Hawaii to the house we'd just bought, and I'd been busting my buns for those six weeks to make habitable, new hardwood floors etc... After picking her up from the airport, I gave her flowers and the grand tour, which she liked.

Then she sat us down on the sofa and calmly said, "I don't want to be married any more." "What? Can we talk about it?" "No." "Can we go to counselling?" "No." "Well what do we do?" "Nothing. I already filed for the divorce."

Stunned shock, then pain that I'd never imagined possible.

Pain is not just physical.

That's shit. There is nothing I can say to relieve the pain, apart from her leaving has opened the door to you finding a better lady with whom you can enjoy the rest of your life with.

 

[LB 15]

Crushed ring finger sailing, with the ring stupidly still on. Flattened the tip completely initially.

Cut the ring off with wire cutters after the finger got infected and blew up, still really bad by the time saw a doctor an it was a candidate for amputation. It was yellow and purple. Doctor didn't 'kit-up' before touching the swollen digit with the tip of a syringe. It exploded puss and blood all over his white shirt and tie. The temporary relief was enormous. Antibiotics saved it.

Had other painful things, but bone crushes are right up there. Finger still a bit spoon-like.

How did your fingernails go? Break any?

 

[burndoc]

Ive used clonidine for years, which has been very helpful for emergence especially with aggressive young males (wild beast anaesthetic). Dexmedetomidine is something I’m slowly getting to terms with as now cheaper and off patent. Knowing when to turn it off in the longer case is the challenge.
Unfortunately we don’t have atipamezole like the vets use to reverse it, as would be useful especially with ICU cases. I would have thought it could be marketed in humans by now.
When I started we used a range of IT local anaesthetic for spinal depending on the case duration but after the lignocaine issue we only have bupivicaine available, a pity.

not a fan of dex or diprovan for long term. Overnight inhalation injuries I will continue. We are able to infuse low dose ketamine in unit and floor and give boluses for dressing changes, a godsend. Started using IV lidocaine drips to decrease inflammation but still looking at it

 

[burndoc]

Pain management. What a roller coaster that has been over the years. Over my career as a medic the philosophy regarding pain management - at least in the prehospital setting which correctly tracked general medical views - porpoised from very limited to aggressively manage pain back to very limited several times over the years. Each time there seemed sound medical reasons but I always found it odd that it vacillated so much. Make no mistake, some of it political both internal and external to the medical "establishment". When I started you would get a MS order for 2mg IVP. Really? Never mind. Then later the ordering algorithm changed to give 10mg IVP in 2mg increments and titrate to effect. Better.....then back again.

Our education merely skimmed the surface of what there is to know about the administration of narcotics and now much later other agents, but I'll bet I have given gallons of MS over my active years for any number of medical conditions, not just for pain relief but other pharm effects like vasodilation in certain medical conditions. One thing I learned.........everybody perceives and tolerates pain differently...and there are many different reactions to narcotic pain meds. One persons overdose doesn't touch anothers pain. The 10 scale is meaningless because it relies on 1) your personal perception/experiance of pain and 2) a comparison to the "worst pain you've ever felt" being the proverbial 10. Pretty subjective stuff. Frankly I found a persons general anxiety, respiratory rate and pulse rate the best indicator of true "relief"....at least in the acute setting. Additionally, different people get relief from one agent more than another. Pain from say......an isolated extremity trauma might not (often did not) get much if any relief while we were very successful with say cardiac pain in relieving the pain and reducing anxiety and therefore the load on the heart.

My hat is off to those Doc's trying to navigate that minefield of pain relief. Its far more complex than the average person understands.

I get an opioid report card from where I work. I treat fucking burns, they hurt, i give meds. Much less than the past but come on. I stop when wounds closed

 

[Ed Lada]

There is a significant component of fear and control in the perception of pain. Many people have endured horrible pain if they can understand it will end or be reduced at a certain point, or if it is serving a purpose.

But being powerless to understand why, or have any control over when or how much pain is coming makes it worse. Combined with the opposite of empathy, as Ed described, and the effect is predictably a worsening of pain. In fact, the pain may then be interpreted as torture.

Sure. In order to be useful, a scale has to have an upper and lower boundary, with repeatable results from the same observer over time and some degree of inter-observer consonance.

Pain is also associated with psychic effects as your narrative of painful events reveal, and as I discuss above. These help create varying interpretations of where perceived pain lies on a 10-scale. But allowing patients to switch to a Spinal Tap "These go to 11!" scale deprives a scale of its utility.

In my previous post I tried describing pain in a Beaufort-like way, where outward manifestations of pain can help assign more accurate numerical representations. I'll try again here.

If a patient is speaking intelligibly at all times, uses correct syntax and a variety of sentence structures, pauses appropriately to listen, displays understanding and "tracks" a conversation normally yet shows vital sign abnormalities and reports severe pain with a known cause, I'd assign them a 5-6.

If they were highly pressured in speech, tearful, gasping but capable of orderly speech or ability to follow simple commands, I'd rate that a 6-7 based on how often they were out of it with spasms of pain.

If they were screaming occasionally, and only able to curse or say "please" repeatedly that'd be an 8. An interview may only answer a single question, so choose carefully.

If there were no comprehensible words in the presence of very concerning vital signs, plus a waxing and waning consciousness... that's a 9

And once they'd gone unconscious, developed arrhythmia or other similar life-threatening alterations in vital functions, that's a 10

I understand that no patient in pain uses this scale. Zero. It's just a clinical scale I use.

When I use it, anyone capable of higher-order thought process, like getting justifiably offended by an insensitive bedside manner, is no more than a 6. A patient's judgement is so distorted by the time their pain is a 7 that they can't really be trusted to make rational or fair assessments.

Anyone with pain of 8 couldn't be bothered with interpersonal communication except to beg relief, and a 9 can't form sentences, just guttural sounds.

Anyone with pain 5 or greater I'm 90% likely to give opioids +/- benzodiazepines during our interview, or just after I chat with them, so not only will they get some pain relief, I'll calm their psyche as well and reduce memories of one of the worst episodes of their life.

Anyone with pain 7 or 8 gets general anesthesia just as soon as I can establish it. They cannot sit or lie still for a nerve block or an epidural without powerful sedation, so that limits my options. If in labor, a woman may be able to cooperate between contractions so... maybe. Depends on their coping skills.

Anyone with pain of 9-10 is crashing and needs resuscitation.

Got it thanks.

 

[Point Break]

I get an opioid report card from where I work. I treat fucking burns, they hurt, i give meds. Much less than the past but come on. I stop when wounds closed

Lotta pressure on you guys - not just the burn guys but all of you that treat painful medical problems - to not “over prescribe”. In my never to be humble opinion most of that “surveillance” is not patient focused but is image “we’re doing something to combat the opioid crises” focused. Toss in a few politicians and attorneys and Docs are really hampered in providing care according to their judgement and experience. Sad case of cultural and corporate overreaction.

 

[SHayes]

Two bone marrow extractions. Second one, the Dr. didn't take enough out, so he went back in.....THE most excruciating pain I have ever endured.

I'll second this one. During my battle with luekemia I had seven of them.

 

[Goodvibes]

I get an opioid report card from where I work. I treat fucking burns, they hurt, i give meds. Much less than the past but come on. I stop when wounds closed

Bad hand injury, had a few.

Emergency Unit,

"Pain level 1 -10? we have to clean the debris out before working on it later."
"ah, just sitting here? only 5, but I won't be able to hold still if you fuck with it!"
Shot of morphine, I don't really like it, always disappointing because I expect more than it delivers.

tick tick tick ...
"Pain level 1 -10 we have to do something soon."
"ah, 4? But if you fucking touch it those tools on that tray ... "
Eyes roll. Shot of morphine, WTF?.

tick tick tick ...
"Pain level 1 -10 come on mate, be good, we are trying to help."
"I can still feel the breeze across the wound, strap it down to work on it, I might complain loudly!"

Out of patience (pun intended) out comes the local anesthetic in what looks like a horse sized dose. Injections from the mid-wrist down. Complete fucking bliss!

Now smashed and completely pain free, "GO for it boys and girls!"

Does anyone know where the remote is?

 

[Titilingus]

I get an opioid report card from where I work. I treat fucking burns, they hurt, i give meds. Much less than the past but come on. I stop when wounds closed

I get an opioid report card from where I work. I treat fucking burns, they hurt, i give meds. Much less than the past but come on. I stop when wounds closed

I am in no way medically trained, apart from a quick sf combat medic crash course, so I know FA compared to your expertise. I have mentioned in my previous posts in this thread about the shock/pain of burns I went through, it is good to read it from the medic's/doctor/surgeon points of view and how you see the table.
It has opened my eyes and really helped.
I understand that to fully neutralise the pain meant you kept me in a balance of "too much morphine= subdued breathing and incubation" and "too little morphine=extreme pain, distress and heart failure". I know I had the pain element thankfully.

All I can say that the balancing act is extremely fine and I thank you for all that you did and do. I am happy to have survived, and I thank you for all your help to future patients.

Fair winds.

 

[Titilingus]

Ps I mean that in a good way, but text can read differently. In short, I owe people like you my life, thank you so much.

 

[burndoc]

I am in no way medically trained, apart from a quick sf combat medic crash course, so I know FA compared to your expertise. I have mentioned in my previous posts in this thread about the shock/pain of burns I went through, it is good to read it from the medic's/doctor/surgeon points of view and how you see the table.
It has opened my eyes and really helped.
I understand that to fully neutralise the pain meant you kept me in a balance of "too much morphine= subdued breathing and incubation" and "too little morphine=extreme pain, distress and heart failure". I know I had the pain element thankfully.

All I can say that the balancing act is extremely fine and I thank you for all that you did and do. I am happy to have survived, and I thank you for all your help to future patients.

Fair winds.

Thank you. It is an unfortunate side of the work we do is causing pain to people. The initial pain of the burn is replaced by donor sites, dressing changes, getting out of bed and ranging contracted joints. It is tough on the team knowing what we do hurts our patients. Knowing what I do disfigures. Anything I can do to decrease pain and anxiety I will try. It’s difficult when a patient says they would cringe when they hear us in the hall because they knew what was coming.
However, they are grateful usually in the end.

 

[Wet Spreaders]

Had my second rotator cuff rebuild in 2 years last Friday. Still have the nerve block in and working well - it probably runs out of juice sometime this evening or early tomorrow. This time it was a lot more comfortable than the last - they did a biceps tenodesis with that one and I'm sure that was what hurt - the shoulder surgery without the accompanying biceps looks like being a breeze. So far no hydrocodone - probably won't need it. I'll find out 3 hours after the little light on the box goes red.

 

[P_Wop]

That's shit. There is nothing I can say to relieve the pain, apart from her leaving has opened the door to you finding a better lady with whom you can enjoy the rest of your life with.

Nope. I'm one and done as far as that goes.

 

[Wet Spreaders]

Had my second rotator cuff rebuild in 2 years last Friday. Still have the nerve block in and working well - it probably runs out of juice sometime this evening or early tomorrow. This time it was a lot more comfortable than the last - they did a biceps tenodesis with that one and I'm sure that was what hurt - the shoulder surgery without the accompanying biceps looks like being a breeze. So far no hydrocodone - probably won't need it. I'll find out 3 hours after the little light on the box goes red.

I watched the ultrasound of them putting the nerve block in - very interesting. Also, I think a beginner was doing it because there was an older doctor telling her what to do - push here, drive around that, don't poke such and so etc. Lots of crunching and popping sounds as they were making their way through layers of whatever on the way to the nerves. Block working well, but a lot more blood than last time welled up under the dressing - the new girl doing the block procedure probably needs a little more practice.

 

[Point Break]

Thank you. It is an unfortunate side of the work we do is causing pain to people. The initial pain of the burn is replaced by donor sites, dressing changes, getting out of bed and ranging contracted joints. It is tough on the team knowing what we do hurts our patients. Knowing what I do disfigures. Anything I can do to decrease pain and anxiety I will try. It’s difficult when a patient says they would cringe when they hear us in the hall because they knew what was coming.
However, they are grateful usually in the end.

I had a 1 day rotation on the burn unit during my paramedic clinical training time. I lasted 1 hour and called my instructor and told her I was done. Wasn’t going back, what was next on my rotation. She said you have to finish your rotation there. I told her if that was the case I quit. Fortunately for me she relented.

Over my 37 years I received some burn care but never on the unit all outpatient do you know it wasn’t very bad. Over that time we’ve probably had 20 go through Sherman Oaks, several with catastrophic life changing burns. They and we (we tend to flood the place when one of ours is injured) have always been treated wonderfully, compassionately, and with amazing clinical expertise. Burn folks are really special people. Angels really……..doing a job most people cannot even come close to imagining. I hold them all in the highest regard and with much affection.

 

[Goodvibes]

Nope. I'm one and done as far as that goes.

Had a best friend who did the same.

My wife and I had known them since school. He was Our Best Man, and I theirs. For a few years but she returned after he Cashed-out as a well known CFO/CEO. Late one night after diner with them I asked her how she spent her time while they were apart? Without batting an eyelid she said "Well, mostly, I just fucked my brains out!" He, didn't react.

They then spent six months traveling around the world First Class, played the top XX golf courses in the world, then ... she left him again.!

A few years later I met him for diner while in the same city. He had no expectation of finding someone to 'get old with', didn't want to. He was gone a few years later and she didn't bother to let us know. I discovered a Memorial Posting on his Golf Club's website when he wasn't answering his phone messages.

I suspect he went through his share of pain, may have been what finished him.

 

[hobot]

Anyone up for a dislocated jaw?

 

[Trovão]

getting kicked in the nuts while playing soccer...

 

[Point Break]

I'd rather not reply in public to specifics seeing as I was attacked for being scum of the earth by anti military crowd for being patriotic in this thread: https://forums.sailinganarchy.com/threads/240363/
PS, my post was the thread starter but I asked for it to be deleted, I am "deleted nember". I didn't realise how much hate there is out there towards us. However, talking here has really helped me more than you know.

Jeepers. Sorry. I find it less vexing to just ignore that stuff. It’s only a problem if what they say matters. It doesn’t. Drive on.