Pain

The way people handle pain is awesome. Medicine as a field pretty much hates pain. Its too subjective. Consequentially, we had to try and make it more objective and the visual analogue pain scale was created. No one uses this, they just use the 1-10 scale. It doesn't work.

I think a lot of pain is actually cultural. Young Hispanic males and black females tend to vocalize and externalize their expressions of pain. Old white ladies tend to be exceedingly stoic. There are always exceptions of course.

My favorite is when I walk in a room and someone is sitting there, quiet, reading a magazine. Their problem--pain. Vital signs are all normal, not tachycardic, not hypertensive. So I start talking to them and they are telling me about how terrible their pain is. So I get ready to pop the question. "On a scale from 1-10 where 1 is pain that is barely noticeable and 10 is the worst pain you could ever imagine. As bad as you might imagine having an arm slowly torn from your body would feel." I literally describe the scale with those terms.

So this same person, then looks me straight in the eyes and calmly says, "my pain is a 10." Holy hell. My brief experience has led me to a couple realizations about the 1-10 scale.

1) If someone says their pain is 10 out of 10, its probably closer to 6 out of 10 at most.
2) If someone says their pain is 6 or 7 out of 10 its probably actually a 9 or 10.
3) Anything 5 or less is probably accurate.

As far as treating pain, this is what I've learned.

1) Vicodin is the most potent pain reliever known to man. More people with 10/10 pain say its cured by vicodin than any other substance. It does for pain what the "Z-pack" does for URI's.
2) If Vicodin doesn't work, Dilaudid and Phenergan will.

Ah, the drug seekers. I love them. My favorites are the ones that make God awful retching noises that everyone in the ER can hear but never actually bring anything up. The good ones will keep this up for hours, even after getting Zophran, arguably the most effective drug ever conceived to treat nausea. For a drug seeker, having a kidney stone is like winning the lottery. They come in writhing in pain, making the retching noise, and sure as shit have a stone that shows up every time on CT. How can anyone argue against treating that--especially when they tell you they are "allergic" to all NSAIDs. Brilliant.