Pain Education   CASE SCENARIO

1.    How do you explain the pain scale to Pt.?     I ask the patient to rate their own pain using a 0 to 10 scale.    0 being no pain at all and 10 being the worst pain they can imagine.    I also help them to understand the pain scale I tell them that 5 and below they can think of other things but 5 and above the pain is all they can think about.    I also state that 10 is a broken arm and that you can think of nothing else.   


2.    How do you know the patient understands their pain and use of the pain scale.?     You don't know.    But you can get glimpses of their understand or lack of understanding.    When you enter a patient's room you begin gathering data both objective what you see and experience and Subjective what the patient tells you.    If I walk into the room of a patient and they are talking and laughing on their phone and they tell me their pain is 10/10  there is a disconnect there.    I try to figure out of the person just doesn't know what the pain scale really is or they don't understand what I'm getting at.    I always try to accept the persons own pain number  but if that pain number does not match the objective data I try to explain the pain scale more thoroughly.    I often will ask when they have experienced the worst pain in their life.   Some times   patients just have never experienced serious pain and so have nothing to judge by.

3.	Is patient able to recognize and respond to emergencies,  changes and /or worsening of current symptoms?     This is a difficult question.    This patient has some challenges in dealing with pain.    According to the scenario she has history of "chronic back pain"   this means that she probably has had to deal with pain every day and so her judgment about pain is defined by the amount of pain she has to deal with every day.   I try to gently ask the person " what pain level do you live at every day or at your best?"    That question usually will begin a dialogue about what is realistic goal for her pain management.    I try to find out if she has unrealistic pain goal such as a goal of 0 for pain.    A person with chronic pain we will probably never get to 0 on her.   What I am looking for is a realistic goal for our work together.   I also want to help her understand the difference between pain that is different and an emergency and chronic that pain that we will probably not be able to take away from her.

4.	What validation methods did you use to verify that Pt. understands pain management and their comfort goal is being met.     I always try to use what the patient tells me about their pain.    I try to let the patient know that their concerns about pain have been "heard"   and that together we are gong to work on this pain together.   Often times patients come in not so much for pain medicines but just to have their pain concerns heard and validated by someone else.    Patients come in with a long history of being told they are crazy or that their pain was not important.    I also begin to notice clues.    If I begin to notice that the pain level the patient states (subjective)   begins to match what I am seeing as their pain level (objective)   then I begin to feel the patient is understand pain management and if they state that their pain is at the level of the goal we set at the first then I feel we have met their goal.