Pain Measurement

[geminilee]

Originally Posted by Saint James

No doubt childbirth is painful for many people (My mom claims that it wasn't for her, so for whatever it's worth, it varies), but I don't think it's the worst imaginable - certain cancers, diseases, and severe traumas are probably worse.

It is among the worst (for many/most births) that is normally experienced, I think, and it is one that a lot of people can relate to. Certain illnesses and traumas can reach the level of absolute pain (10 dols) but few people percentage-wise will ever experience those, and such levels are incomprehensible to the healthy and whole. I think that is why it is commonly referred to as "the worst" pain.

[Squirt]

I read a article about the recent uplift in cases of gout, and a doctor interviewed who had suffered from it said her gout pains at their worse were more painful than her childbirth pains at their worse. Of course, that's only one person but I have heard that gout can be excruciatingly painful.

[RivkahChaya]

My labor pains were more like horrible intestinal cramps, quite honestly. I've never had dysentery, but I imagine it feels something like that. Labor is more exhausting than anything, it that for many women it goes on for a long time. Most really awful pain lessens after a while, as either healing begins, or enough tissue damage occurs that there's no more pain reception. Then, after several hours of contractions, you have to push out the baby, which is a lot of hard work, and can take hours.

However, if you just want to talk pure pain, my worst pain experience was my tonsillectomy-adenoidectomy recovery. The first three days after that surgery were way off any scale I've seen. If that was a ten, then the first few days after my c-section were a five tops, and there were comfortable positions I could find, plus, I got all the pampering and sympathy in the world. The tonsillectomy was out-patient, and I got only about six hours in the hospital recovery, during which my normally sympathetic husband started to whine about being bored, and when we were going to get home. And they bloody well sent me with pain pills. It would have killed them to send liquid pain medication?

So labor and childbirth, painful aspects aside, is an ordeal. And you can't choose to compartmentalize it while it happens. It really, really happens, if that makes sense.

[geminilee]

Originally Posted by RivkahChaya

My labor pains were more like horrible intestinal cramps, quite honestly. I've never had dysentery, but I imagine it feels something like that. Labor is more exhausting than anything, it that for many women it goes on for a long time.

I wouldn't generalize your experience out to other women. There is a wide variation in how painful labor and the actual birth can be. When I was born my mother experienced little pain, but when my older sister was born my mother seriously hurt. She also tore, and had a very painful recovery. In comparison, my mother had her tonsils out as an adult and was drinking cokes that same day.

[AnglRdr]

Originally Posted by geminilee

I wouldn't generalize your experience out to other women.

I don't think she was, actually.

[geminilee]

The quote about labor being more exhausting than anything sounded to me like she was. I could be wrong, though.

[Zorro]

The one thing I have ever experienced that was more painful than labor was six months later, when I had double pneumonia and a staph infection. Viscous fluid filled up the space between my lungs and chest wall, and I needed chest tube emerbency surgery to save my life and drain the fluid. The pain of trying to breathe through that in the days leading up to that, and of having to breathe and then get the chest tubes removed was worse than 21 hours of labor.

[TripleAAA]

Originally Posted by RivkahChaya

My labor pains were more like horrible intestinal cramps

I'm guessing you never had back labor then?

Actually, the worst pain I ever had was a gallstone attack. I told the doctor my pain was a 10. He said 10 was like childbirth. I said "Ok, then 11".

[Eddylizard]

I always find that "how much does it hurt between 1 and 10" question quite difficult to answer. It is fairly subjective at the end of the day, but I suppose it is all they have. "Err I'll pick 6. No 8. Actually make that 7." It's not a quiz show. I maybe have never experienced a 10, so how the heck do I calibrate my personal pain meter?

I'm also guessing that since tolereance to pain in the same or similar wound varies between individuals, if you say 6 they give you x cc of lidocaine (or whatever) and if you say 8 they give you x+10 cc.

When I had the snip they simply said "we'll give you a local - if you want more just say 'more' " IIRC I asked for more three times.

[AnglRdr]

It is a relative scale, Eddy, since pain is subjective. 10 is supposed to be your worst pain ever, and then it goes down from there.

[Beldaran]

Originally Posted by Eddylizard

I'm also guessing that since tolereance to pain in the same or similar wound varies between individuals, if you say 6 they give you x cc of lidocaine (or whatever) and if you say 8 they give you x+10 cc.

I'm lost, if tolerance varies like you say (which it does) how would giving every patient who has a pain of 6 the same amount of medication help?

As far as I've learned in nursing school, the number doesn't determine the amount of medication but it helps to determine the type. A patient I had was complaining of level 10 pain after surgery, so we went straight for the IV medications. Someone complaining of a 5 or 6 may get oral medications.

IMO, the number really only starts to be useful after a few times of having the patient rate their pain. At first it's just guess and check with the pain medications, but then after a while you learn that when this specific patient rates their pain at 8 .5mL of medication takes care of it, but for the patient next door they'll need 1mL to wipe out level 6 pain.

More on topic, my Aunt has two kids and has also had a kidney stone. She's said more than once that the pain of having a baby was much easier to deal with than the pain from a kidney stone. And she did have back labor with her oldest child.

[geminilee]

Originally Posted by Beldaran

I'm lost, if tolerance varies like you say (which it does) how would giving every patient who has a pain of 6 the same amount of medication help?

Even if the pain were the same on some absolute scale, giving the same amount of medication wouldn't work. Different people have different tolerances to chemicals. The amount of medication that might take care of your pain and knock you loopy might leave me hurting and unaffected.

In my experience doctors start out with fairly low doses, regardless of the level of reported pain, and ramp it up if it is ineffective. Sometimes, that is; sometimes they just expect patients to deal with a slightly reduced level of pain.

[RivkahChaya]

Originally Posted by Beldaran

As far as I've learned in nursing school, the number doesn't determine the amount of medication but it helps to determine the type. A patient I had was complaining of level 10 pain after surgery, so we went straight for the IV medications. Someone complaining of a 5 or 6 may get oral medications.

Correct me if I'm wrong, but don't the IV meds kick in faster, albeit with more risks, like infection at the site of needle insertion?

Someone with a 5 or 6 might have the same pain as someone with a 10, if we had an objective measure, like stress hormone levels and blood pressure, that was worth the trouble of applying. But the person who states that the pain is 5 or 6, is not driving you crazy begging for relief, or making you feel bad, because they are obviously miserable and need relief. And the 5 or 6 person can respond to distractions, like the TV, a friend to talk to, or just the anticipation or feeling better, long enough for the oral medicine to take effect.

So the number does matter. Part of it may simply tell the medical personell how the person copes with stress-- someone who rates a hangnail a 10 probably does not cope well. Unless something has been missed, like the hangnail has progressed to septicemia that isn't visually obvious, but the former is more likely. That is still important information. Maybe instead of a really large dose of morphine, the patient needs a small dose of Tylenol + codeine, and a little Valium as well.

[firefighter_raven]

Originally Posted by Beldaran

I'm lost, if tolerance varies like you say (which it does) how would giving every patient who has a pain of 6 the same amount of medication help?

As far as I've learned in nursing school, the number doesn't determine the amount of medication but it helps to determine the type. A patient I had was complaining of level 10 pain after surgery, so we went straight for the IV medications. Someone complaining of a 5 or 6 may get oral medications.

IMO, the number really only starts to be useful after a few times of having the patient rate their pain. At first it's just guess and check with the pain medications, but then after a while you learn that when this specific patient rates their pain at 8 .5mL of medication takes care of it, but for the patient next door they'll need 1mL to wipe out level 6 pain.

More on topic, my Aunt has two kids and has also had a kidney stone. She's said more than once that the pain of having a baby was much easier to deal with than the pain from a kidney stone. And she did have back labor with her oldest child.

When I was still active in EMS, the main purpose of the pain scale in the pre-hospital setting was to determine if the pain was getting worse or better. So take a cardiac pt for example, we arrive and the pain is a 8. We give him nitro and recheck the pain and it's down to a 5-6. It tells us that one the nitro is working and 2 that the pain is cardiac related.After the full run of nitro and their is no pain relief, that would upgrade the treatment in the ER and also start looking at other possible sources.

But as others have said it is extremely subjective. When my appendix became inflamed and later perforated, I pretty much ignored it for 4 days.
I was just really uncomfortable and unable to sleep but felt more like a brick sitting in my gut. I finally went in and when asked about the pain rated it a 4 until she pressed on the appendix which made it a 6.
That was where being an former EMT was bad, I had dealt with several patients with appendicitis and they always called their pain 7-9 and like sharp knives in their belly. Since mine wasn't like that, I just wrote it off as leftovers not sitting well.

While childbirth is extremely painful, how many can actually compare it to other extremely painful events and give us a reliable scale?

[Beldaran]

Originally Posted by RivkahChaya

Correct me if I'm wrong, but don't the IV meds kick in faster, albeit with more risks, like infection at the site of needle insertion?

:snip:

So the number does matter. Part of it may simply tell the medical personell how the person copes with stress-- someone who rates a hangnail a 10 probably does not cope well. Unless something has been missed, like the hangnail has progressed to septicemia that isn't visually obvious, but the former is more likely. That is still important information. Maybe instead of a really large dose of morphine, the patient needs a small dose of Tylenol + codeine, and a little Valium as well.

I'm confused, are you agreeing with me or disagreeing? (Or just expanding on what I said?)

I didn't say the number didn't matter, I said the number didn't directly relate to a specific amount of medication.

Yes, IV medications work faster, and yes, people reporting lower numbers for pain are typically more willing to wait for the relief and have the possibility of being able to be distracted while waiting. That's what I meant by my comment about the number helping determine the type of medication.

I was just trying to explain that there is no magic formula for the amount of medication given based on the number someone rates their pain. The formula I've seen nurses use is something like "< the highest dose prescribed + how much pain they physically look like they're in - actions making them look like a drug seeker + years of experience giving medications = dose at this exact moment".

[Christie]

All I can say about labour pain vs others kinds of pain is that so far in my life the worst pain I have experienced is the labour pain I had with my first child. If there is worse pain than that in store for me I don't want to know about it .

Frankly though what bothers me about the whole is labour pain really that bad kind of discussions isn't the eternal "yeah well my root canal work was worse than my childbirth" anecdotes it is that labour pain is the only pain I'm aware of where people have been told (often by doctors, psychologists and the like) "it's all in your head". Uh yeah. Do people with broken legs ever get told crap like that?

[RivkahChaya]

Originally Posted by Christie

All I can say about labour pain vs others kinds of pain is that so far in my life the worst pain I have experienced is the labour pain I had with my first child. If there is worse pain than that in store for me I don't want to know about it .

I'm one of those who said I have had worse pain. But on just one occasion, mind you. And that fact that I got tons of sympathy, and reassurance from everyone that yes, what I went through was in fact, extremely painful, and I shouldn't feel bad about wanting loads of medication, or let anyone tell me I should try to tough it out, was helpful.

Frankly though what bothers me about the whole is labour pain really that bad kind of discussions isn't the eternal "yeah well my root canal work was worse than my childbirth" anecdotes it is that labour pain is the only pain I'm aware of where people have been told (often by doctors, psychologists and the like) "it's all in your head". Uh yeah. Do people with broken legs ever get told crap like that?

Sing it.

I especially hate being told that by other women, who act like the fact that I used pain medication during labor shows callous disregard for my child, and that maybe I shouldn't even be a mother if I'm not willing to suffer a little for his sake. Someone said "There's no epidural for the teenage years."

[AnglRdr]

Originally Posted by RivkahChaya

Someone said "There's no epidural for the teenage years."

Well, no, but liquor and Xanax is a pretty decent substitute.

[Beldaran]

Originally Posted by Christie

Frankly though what bothers me about the whole is labour pain really that bad kind of discussions isn't the eternal "yeah well my root canal work was worse than my childbirth" anecdotes it is that labour pain is the only pain I'm aware of where people have been told (often by doctors, psychologists and the like) "it's all in your head". Uh yeah. Do people with broken legs ever get told crap like that?

From what I've seen in hospitals, I can't say I've seen it told to the patient's face, but nurses will report off on a patient and say things like "That guys broken ribs can't hurt as bad as he says they do." In this specific case, apparently people in the military are supposed to have magic powers that make things hurt less as well, because apparently there was no way a Marine could be bothered by broken ribs.

In that scenario I asked the nurse if she'd ever personally had broken ribs and she said she hadn't. As politely as I could I pretty much told her she didn't have one single clue as to how bad it hurts.

I've also heard nurses label patients as drug seekers with little to no info to back it up, and others get pegged as attention seeking if they ask for too many pain medications. So yeah, if I hear those kind of things as a student nurse, I'm sure it's been told to patient's faces as well.

[Esprise Me]

Originally Posted by Christie

Frankly though what bothers me about the whole is labour pain really that bad kind of discussions isn't the eternal "yeah well my root canal work was worse than my childbirth" anecdotes it is that labour pain is the only pain I'm aware of where people have been told (often by doctors, psychologists and the like) "it's all in your head". Uh yeah. Do people with broken legs ever get told crap like that?

If it makes you feel any better, I get that crap all the time for non-baby-related reasons. I seem to require a larger dose of local anesthesia than most, and if I have one more dentist, dermatologist, or gynecologist tell me I can't possibly be feeling real pain, because they gave me the anesthetic, and I just need to relax, well, let's just say the next thing you hear from me will show up in the Horrors forum, with snopesters debating whether such an attack is even physically possible.