Monday, July 14, 2014

Pain Tolerance

I think it's every doctor's pet peeve when the patient says that they have a high pain intolerance.

It's probably mostly because patients who say that almost invariably have a very low pain tolerance. Patients who say that are always the worst babies and always the ones constantly begging for pain medications. I don't know if the patients are lying or just have so little insight into themselves.

I don't think I have a high pain tolerance. I think I actually have a pretty low pain intolerance, and that I am sensitive to even small amounts of pain. But on the other hand, I'm not much of a complainer in general. When I was in labor, the nurse kept yelling at me that I had to tell her when my pain level was high. She said to me, "You're too quiet! I can't tell if you're having pain or not!"

How about you? What's your pain tolerance?

16 comments:

  1. Who knows! Labor wasn't that bad for me, but... I got an epidural at 8cm.... and who knows, maybe it was an easy labor. Mostly, I don't want to find out whether I have a high pain threshold. I agree it's annoying when patient's say that though, and in general your observation is 100% accurate.

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  2. Well... on a scale of 1-10, I rated a dislocated elbow a 5. What do they usually rate?

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  3. I have asked for pain killers one time in how many years? Gallbladder. Its the stupidity tolerance level I have that is low.

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  4. It depends on the area of my body. I have a VERY low pain tolerance with anything related to my mouth. But anything else, I can grit my teeth, and bear it with the best of them.

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  5. I'm an absolute child when it comes to any sort of pain, but my 1-10 pain score tends to be a little off base to my observers, I mean, I am plainly not coping but I am still insisting my pain score is 2/10.
    Reason?
    See a bowel infarct. That makes you re-evaluate the "worst pain you can imagine".

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    1. I still think the 1-10 pain scale is idiotic unless the patient analogizes what each number signifies to him/her. I'm with you, I rarely say pain is above a 3 because I have seen people die excruciatingly awful deaths from cancer, and my pain doesn't come close to that. But that doesn't mean I'm feeling great, either......

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    2. Sadly it is the best we have got. I like to think of it more as a scale for measuring of the pain relief I am giving is effective, rather than how much pain relief I need to give.

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  6. I've found the opposite to be true as well. Patients who think they have a low pain tolerance frequently tend to have a pretty high pain tolerance. For example, the woman I admitted once with kidney stones who was sitting peacefully on the stretcher in the ED and said to me, "I was expecting them to say nothing was wrong and send me home. I mean, my stomach hurts a bit, but I've always thought I have a pretty low pain tolerance and the only reason I even came in was that my husband thought I looked sick."

    Personally, I think I have a fairly high pain threshold but a low pain tolerance. I broke my arm once and I really didn't have any pain. Blood draws and IV starts don't bother me at all. But when something does hurt, I'm definitely going to be interested in some painkillers.

    -Some random resident

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  7. It annoys me when patients say that too. It is almost as if they are trying to impress upon you the importance of their pain because any "normal" pain would be OK for them, but this particular pain is terrible and they need meds right away. It's like they're saying "I am really super tough, so if it's hurting ME then you know it must be bad" in an attempt for you to take it more seriously than you normally would.

    All of this is completely overshadowed by the fact that your pain is only felt by you and no one else -- there is no real objective measure for pain. We are all different. Just describe how you are feeling if you are able to, and we will do our best to correct the problem.

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  8. I once heard: "I have fibromyalgia, so you should know I can handle a lot of pain."

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  9. From a patient's perspective, I wish there were a better way to say "this is too much pain for me right now" without getting into numerical scales (which sound objective but aren't) and pain threshholds. I probably have a mid- to low- pain threshhold, but I have a high interest in hiding pain from the public, including doctors. This means I'm probably going to have to be screaming in order to not say "hi, how are you?" when the doc enters the room. But nonetheless, he should assume that if I'm sitting in his office at all, I'm at least midway up my own personal 10 point pain scale.

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  10. I think the problem with the one-ten scale is the people who don't understand that it stops at ten. 25/10 kind of defeats the purpose. I'm working in a peds ER this month, and they've got a three-color scale used mostly for sickle cell pain crises- green= no pain, no meds needed; yellow= some pain, but come back to me to see if I need meds soon; red= i need pain meds now. Works a treat, at least for kids.

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  11. I broke tib-fib when I was 17 and hopped around on it for a week before I went to the ortho doc. I even won a freestyle swimming race during that time.

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  12. When I'm about to have blood drawn, I like to let nurses know that I am bad with pain, just so they understand why I'm getting pale and measuring my breaths! Of course, it usually doesn't hurt a bit, and I get to laugh at myself and compliment their skills. I wonder if dozens of other patients are saying the same stuff? I think I will deviate from script and just make small talk in the future. I do like to reassure people that I won't pass out though!

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  13. Heh, this is a huge pet peeve for me too. I secretly wonder if there is some physician that just wanders the wards telling people what amazing pain tolerance they have.

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  14. Hmm... It drives me crazy when nurses insist on a number to rate the pain without asking any questions to find out context. A 10 means you've passed out from the pain, an 8 means it hurts so bad, you're puking. A 6 is pretty bad and you're sure there's something seriously wrong, a 4 is broken fingers/toes/ribs/hand. A 2 means take a Tylenol and get on with your life - I would never bother the doctor with something so trivial. Natural childbirth: 7-8; cracking head open on diving board: 10; kidney stones: 6-8; pancreatitis: 6-7

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