The problem with pain scales (Rate your pain from 1 to 10)

[zinfamous]

Where is @Darwin333 ? He fell into hot tar. I can't imagine.

The most horrifying account of anything that I have heard or read anywhere.

 

[JEDIYoda]

What pain scale?
I had all my wisdom teeth pulled with nothing deaden the feeling...no novacaine or laughing gas or anything!
Then after I went right to work after sleeping for a few hours!!

 

[s0me0nesmind1]

I think the bigger problem is that some people are more addicted to pain medications than others. It's not so much a problem of what pain medicine is given while in a hospital IMO.

When I am actually under the knife from the multiple surgeries I've had in my life .... Yeah, I want the GOOD SHIT. That doesn't mean prescribe me with it to take it over the course (in pill form) of the next few months - but while I'm in the hospital I legitimately want the strongest stuff possible.

I haven't ever had addiction-like symptoms where I crave it after the fact... but like said, that is something everyone has differences in (how much they tolerate, how easily they become addicted).

 

[zinfamous]

I think the bigger problem is that some people are more addicted to pain medications than others. It's not so much a problem of what pain medicine is given while in a hospital IMO.

When I am actually under the knife from the multiple surgeries I've had in my life .... Yeah, I want the GOOD SHIT. That doesn't mean prescribe me with it to take it over the course (in pill form) of the next few months - but while I'm in the hospital I legitimately want the strongest stuff possible.

I haven't ever had addiction-like symptoms where I crave it after the fact... but like said, that is something everyone has differences in (how much they tolerate, how easily they become addicted).

that is indeed part of it, but what is important to understand with the history of oxycodone, in particular, is that Perdue pharma was increasing the dose per titration, and recommending overall larger dosage from year to year of the drug's development.

Initially--it really was (and still is for those that really do need it) a wonder for pain: when originally developed, it was very difficult to develop addiction and had essentially zero withdrawal effects. It was extremely successful. A few years in however, Perdue started pushing their marketing scum to start recommending it for all sorts of ailments, well beyond its efficacy. They also started increasing the dosage per pill, which meant that the carefully-metered late afternoon-morning timing was compromised. People started developing side effects that were, in effect, real withdrawal symptoms. These became interpreted as "additional pain" and the recommendation was to up the dose even further. This is actually where the serious addiction began with the vast majority of patients. You reach the limit of your prescription, you are now thoroughly addicted and suffering from withdrawal from the medication, and so your only recourse is to hit the streets. (Remember that, for many many years and up until very recently: withdrawal was largely believed to be impossible with oxycontin, because the industry was still working off the data and use of the first generation of medication that was available. This is the real duplicity in the whole affair)

That is actually largely what happened. I do agree that some unscrupulous physicians share a lot of blame here, but most were generally ignorant of what Perdue was doing with their formulation in subsequent generations. In fact, Perdue specifically kept this under wraps, because they explicitly knew what their drug was doing...but the cheddar was just too good to pass up. As a prescribing physician with long, established patients that have been on this medication for so long, you essentially continue the path that has worked best for them. When things start changing, without any clear knowledge of what that drug is now doing, it's hard to lay much blame on them. This is a 95% Perdue and 5% health care industry problem.

 

[s0me0nesmind1]

that is indeed part of it, but what is important to understand with the history of oxycodone, in particular, is that Perdue pharma was increasing the dose per titration, and recommending overall larger dosage from year to year of the drug's development.

Initially--it really was (and still is for those that really do need it) a wonder for pain: when originally developed, it was very difficult to develop addiction and had essentially zero withdrawal effects. It was extremely successful. A few years in however, Perdue started pushing their marketing scum to start recommending it for all sorts of ailments, well beyond its efficacy. They also started increasing the dosage per pill, which meant that the carefully-metered late afternoon-morning timing was compromised. People started developing side effects that were, in effect, real withdrawal symptoms. These became interpreted as "additional pain" and the recommendation was to up the dose even further. This is actually where the serious addiction began with the vast majority of patients. You reach the limit of your prescription, you are now thoroughly addicted and suffering from withdrawal from the medication, and so your only recourse is to hit the streets.

That is actually largely what happened. I do agree that some unscrupulous physicians share a lot of blame here, but most were generally ignorant of what Perdue was doing with their formulation in subsequent generations. In fact, Perdue specifically kept this under wraps, because they explicitly knew what their drug was doing...but the cheddar was just too good to pass up. As a prescribing physician with long, established patients that have been on this medication for so long, you essentially continue the path that has worked best for them. When things start changing, without any clear knowledge of what that drug is now doing, it's hard to lay much blame on them. This is a 95% Perdue and 5% health care industry problem.

Not sure if it's just Perdue or whatever - but yes, overall agree with what you're saying.

I say that because I've watched tons of documentaries and shows concerning the opiate crisis - and seeing shit like prescribing people 540 pills of oxy or other opiates for a ONE MONTH PRESCRIPTION just makes my jaw drop.

Personally, I point it squarely at doctors first and foremost, because they are the ones that should be the ones doing the assessment. they are the first line of defense IMO. They should be the most reliable because that is their SOLE JOB - Assess people and see if they are truly sick and if this pill/medication will actually help them. 2nd line of defense should be the pharmacy. 3rd line of defense should be the drug company themselves... But maybe I'm just crazy with that line of thinking.

 

[balloonshark]

I hurt my back last year and later than night in bed my knee started hurting just as bad as my back (sciatica?). It hurt so bad the following days I had to take breaks and sit down near tears several times while fixing my filtered water and coffee when I got up. The hydrocodone they perscribed barely helped and the muscle relaxer did nothing. To make matters worse I felt like a damn criminal when I had to ask for more since they only prescribed me 15 at a time. Then I got constipated and I just quit taking both and started taking Tylenol. It was one of the longest months of my life.

 

[zinfamous]

Not sure if it's just Perdue or whatever - but yes, overall agree with what you're saying.

I say that because I've watched tons of documentaries and shows concerning the opiate crisis - and seeing she like prescribing people 540 pills of oxy or other opiates for a ONE MONTH PRESCRIPTION just makes my jaw drop.

Personally, I point it squarely at doctors first and foremost, because they are the ones that should be the ones doing the assessment. they are the first line of defense IMO. They should be the most reliable because that is their SOLE JOB - Assess people and see if they are truly sick and if this pill/medication will actually help them. 2nd line of defense should be the pharmacy. 3rd line of defense should be the drug company themselves... But maybe I'm just crazy with that line of thinking.

Well, Purdue because they developed and own the patent, and specifically marketed okycontin for the type of abuse that has happened. This is all pretty thoroughly documented. They are, essentially, worse than Big Tobacco, and it is the same sort of evidence re: internal testing and product development, known problems with the drug, known dosing and side effects for years: but market it for increased profits, regardless of the damage. Internal memos specifically instruct their marketing department to lie to physicians and pharmacists about the redesigned drugs. For years.

When they specifically lie to the health industry for decades about what is in their medication, what are you supposed to do? That's what makes this difficult: there was a pretty well-established history of okycontin's rather safe efficacy in certain patient populations, but eventually monstrous greed took over and Purdue blatantly changed their formula to target as much profit as they could, with zero disclosure.

Basically: Purdue is hosed, and it couldn't happen to a worse cadre of shitstains.

This is really quite thorough, if you're interested in their history.

https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain

Physicians definitely have a huge responsibility, and you're supposed to be able to trust to their best recommendations. But much of that relationship has really changed in recent years....and guess why? Drug company marketing campaigns. It's no other way. Now, you've got endless advertising telling patients what they need, not what their doctors think they need. Now, your doctor is dealing with your poorly-informed ass telling them that "Nu uh! The TV told me I need this!" I mean, you now people and how frustratingly intractable they can be when they are convinced that no one else is as smart as them. Right? ....right? ;)

These days, physician visit times are limited to something like an average of 10 minutes or less and, due to the nature of our rotational health care system where a new job possibly means you go to an entirely new health care system, you rarely develop any kind of history with your PCP/Internist. These folks don't know you, anything about your history, and are supposed to diagnose some specific thing that you come in for, the first time ever, and select the most reasonable option based on what little they are allowed to know about you. I mean, it's simple reality. Obviously it's not how things should be, but it seems that this is what we prefer.

 

[kn51]

So is it Perdue or Purdue? Sort of a big difference.

 

[Exterous]

That'll learn you to move on me. Furniture is heavy. :colbert;

Sorry about the back. PT help? Mine's great as long as I don't pick up heavy crap.

It helped some. Activity and lifestyle changes seem to be more helpful. And probably the injections

I hurt my back last year and later than night in bed my knee started hurting just as bad as my back (sciatica?). It hurt so bad the following days I had to take breaks and sit down near tears several times while fixing my filtered water and coffee when I got up. The hydrocodone they perscribed barely helped and the muscle relaxer did nothing. To make matters worse I felt like a damn criminal when I had to ask for more since they only prescribed me 15 at a time. Then I got constipated and I just quit taking both and started taking Tylenol. It was one of the longest months of my life.

If it is sciatica then there are some exercises that seem to work quite well, especially the lower back extension

 

[local]

Ruptured Appendix was my 10 back in '99. Bad enough that I cannot recall most of it. I do remember writhing on the ER lobby floor yelling obscenities in front of my mother and grandmother, that got me a room at least but they refused meds until they properly diagnosed what the problem was. Fast forward 15 years when I had a gall bladder attack and the first thing they did in the ER was give me a morphine injection, all I did was walk in and say I thought I was having a gall bladder attack. Drugs certainly seem easier to get these days. I have an ongoing neck problem but nothing that showed up on an MRI so the doc offered me pain meds over the phone, I declined.

Morphine was the shit but I cannot stand hydrocodone and always request tramadol instead, the doctors always look at me like I'm a weirdo that doesn't want the good stuff.

 

[brianmanahan]

this is the scientific definition of the pain scale:

 

[brianmanahan]

i think i maxed out at a 7 or 8, though i thought it was a 10 at the time

spent 12+ hours feeling like someone had jackhammered my head. morphine wouldn't touch it and doctors wouldn't give anything stronger than that. unable to sleep, unable to eat, unable to get up.

i wasn't crying like the little guy in the pain scale but i couldn't stop moaning. every time my heart beat it felt like someone was kicking me in the head with a steel toed boot.

 

[Cuular]

:S how are you now?

Slight limp with a titanium rod replacing the bone in that leg. And during seasonal changes the pain can be pretty awesome. Over all not to bad.

 

[brianmanahan]

Morphine was the shit but I cannot stand hydrocodone and always request tramadol instead, the doctors always look at me like I'm a weirdo that doesn't want the good stuff.

weird, morphine must work differently for different people or parts of the body

when they gave it to me i felt no decrease in pain whatsoever

 

[MagnusTheBrewer]

this is the scientific definition of the pain scale:

That's the most generic non helpful definition of the pain scale I've ever seen.

 

[sandorski]

Pain scale is deff a joke. I've had a 10, but I also fractured 2 vertebrate when it happened. I've seriously seen people say 10 and they are talking fine... not possible.

I crushed a vertebrate and had 0 pain. Had a few tooth aches where all I could do was squirm and pound on my leg occasionally(although that was quite often).

Pain Scales only make sense per Individual Patient tracked over time. Just to have the Patients perspective. Otherwise the numbers are close to meaningless.

 

[s0me0nesmind1]

i think i maxed out at a 7 or 8, though i thought it was a 10 at the time

spent 12+ hours feeling like someone had jackhammered my head. morphine wouldn't touch it and doctors wouldn't give anything stronger than that. unable to sleep, unable to eat, unable to get up.

i wasn't crying like the little guy in the pain scale but i couldn't stop moaning. every time my heart beat it felt like someone was kicking me in the head with a steel toed boot.

Same - I never went full 9/10. The most I ever did was 7/8.

The main thing I was trying to get (that actually helped with the pain levels was something that started with a T... can't even remember to this day what it was.

 

[brianmanahan]

That's the most generic non helpful definition of the pain scale I've ever seen.

back when i had surgery they had that dumb thing hanging all over the hospital, LOL

and every time a nurse came in the room they would ask me to give them a number on this scale

 

[brianmanahan]

The main thing I was trying to get (that actually helped with the pain levels was something that started with a T... can't even remember to this day what it was.

tramadol? that's the only one i can think of that starts with a T.

my grandpa pretty much can't bend his back unless he's taking that stuff every day.

 

[s0me0nesmind1]

tramadol? that's the only one i can think of that starts with a T.

my grandpa pretty much can't bend his back unless he's taking that stuff every day.

Probably, sounds about right. That is what they had me on when I would say pain level of 7-8 during my brain surgery stuff.... Well, more specifically, the diagnosis of having electrodes stuck to my brain.

 

[zinfamous]

So is it Perdue or Purdue? Sort of a big difference.

well, one sells you salmonella, the other serious addiction.

 

[zinfamous]

Same - I never went full 9/10. The most I ever did was 7/8.

The main thing I was trying to get (that actually helped with the pain levels was something that started with a T... can't even remember to this day what it was.

?

 

[Red Squirrel]

I tend to be pretty honest with mine. I don't think I've ever "scored" more than a 7. I was in extreme pain once because of a boile and I don't recall exactly what I said but probably was along those lines. I've never broken a bone before so I can't imagine how much that has to hurt, so it's hard for me to rate something a 10 when I've never felt what breaking a bone is like. I kind of set that as a benchmark as it's probably one of the worst pains one can feel.

 

[rh71]

It's of course subjective considering they ask the "worst pain YOU'VE ever felt". I've had what I would categorize as 10 a couple times. It wasn't the pain I felt when rupturing my spleen over 20 years ago - that was more of a *something's wrong, but it doesn't really hurt - maybe a 7. I also fractured my right foot at the 5th metatarsal - that was maybe an 8. The big ones for me started a year or so ago when I was curled up in a ball on the floor with what I now know was a bowel obstruction. Sitting on the toilet didn't help and I could barely sit there for longer than a minute anyway. I couldn't find a single position I could rest in for any length of time - it was torture. It finally passed somehow after a couple hours. Then it happened again a few months ago. Stomach is completely bloated and there's nowhere for anything to go. I had diarrhea for a week leading up to it with constant dull pain but this was the point where I couldn't even stand up straight anymore. Worse was I was out for my son's hockey tournament in Canada rather than the comfort of my own carpet at home so I found myself in a public toilet thinking the worst. Long story short, a parent who's an ER doc recommended I cross back over into Michigan (insurance reasons) so my wife drove me to the ER some 40 minutes later while I was rolling around in agony. Sweating profusely walking in, I soon found myself diagnosed with a twisted colon requiring emergency surgery - that was easily a 10 for me. Surgeon showed me a pic of my now-removed foot of colon and it was the girth of my thigh. After surgery where they opened my stomach vertically 6" again (since spleenectomy), I would classify accidentally coughing as a 9 on the pain scale, except those are only brief moments of pain. I've had stomach pains for years now on and off (explains why I didn't go to the hospital last year), but given the big picture, the typical stomach cramp is only like a 6.

Crossing back in the US certainly saved me a ton of money. They billed over $35k for the 1st surgery and another $25k for the reversal a couple weeks back. Just $6k out of pocket max for me since it's In-Network. Small victories.

 

[rh71]

I tend to be pretty honest with mine. I don't think I've ever "scored" more than a 7. I was in extreme pain once because of a boile and I don't recall exactly what I said but probably was along those lines. I've never broken a bone before so I can't imagine how much that has to hurt, so it's hard for me to rate something a 10 when I've never felt what breaking a bone is like. I kind of set that as a benchmark as it's probably one of the worst pains one can feel.

When I was forced to jump from stairs suddenly and landed on the side of my bare foot, I fractured my bone - not even a complete break, but there was an almost-immediate rush of adrenaline followed by uncontrollable shivering. I thought I heard a snap but didn't know it was broken for sure, though my body's response was pretty telling. It was painful but it was also sending crazy signals I couldn't subdue. People sometimes ask if they broke a bone but if they're not feeling anything remotely close to that, I doubt it's broken. My son fell directly on his elbow from monkey bars' height and he was in a ton of pain which he typically never shows, but not even that turned out to be broken.