Yes I'm in pain!

Interesting point you make. I am definitely guilty of saying " they ask for pain meds, but then I have to wake them to give them the pills, how much pain could they be in?". Of course, when I had surgery, post op I was in so much pain all I did was sleep... ironic I never applied how I felt to my patients. Thank you for bringing this up. I will definitely keep it in mind.

Agree with you! A few days in the hospital after a craniotomy have made me look at every one of my patients differently. The biggest thing for me was how badly my throat and chest hurt to cough, and I was only intubated a few hours for surgery. I can't imagine some of these little ones ( I work peds) how they must feel after days to weeks of being intubated. And my cough lingered for weeks! My actual surgical pain wasn't that bad after the first day or so, but man, the throat and chest pain. I won't forget it!

Thank you so much for this! Yes, you can sleep when in dreadful pain. I think it is a defense mechanism for the body. That doesn't mean we shouldn't medicate!

The college of nursing in which I am currently enrolled has made it hugely clear to every single one of us students that just because the patient is sleeping does not mean that they are not in intractable pain. It's so sad that some of these patients don't get treated when they should.

That's what a PCA pump with a basal rate is for-now if you could just get that across to some surgeons. I don't get the reluctance to use PCAs with a lot of doctors.

Thank you. I never would have caught this. This is probably something you can't understand until you've been there.

People will shut down when faced with pain and adversity. Like the depressed person who sleeps to escape the world. When you are experiencing pain a defense mechanism is to shut down to a place to try to make it bearable. I think being a patient makes one a better nurse.Well said!

I had a necrotizing fasciitis in an episiotomy due to a misplaced suture (never have a baby in a university hospital in early summer) and never had such pain before or since (including HNP and back surgery). I will never forget the nurses whow would not medicate me when I couldn't even move in bed. Made a difference in my practice, though.

A good reminder.Thanks. I noticed in PACU , keeping a check on HR was often a good cue into how much pain a pt was really in even if they appeared groggy.

Always better to err on the side of giving the pain med. Sometimes people in excruciating pain are dozing because they are exhausted.I don't show pain on my face and have a high tolerance to most kinds of pain, but I get cellulitis every so often and am in agony. Luckily I have a fabulous doctor who writes for what I say works and the nurses for whatever reason don't argue if I tell them I need 2 percocet every 4 hours the the first 16 hours and then PRN.

My mindset is to look for reasons to not give pain meds, not reasons to give them. Those reasons are rather exceptional--completely unresponsive, denies pain completely (even then I'll give something PO before transferring the patient and continue to reassess), respiratory rate less than 8 or otherwise completely inadequate such as with sleep apnea, maybe BP if it's really lousy but I'd just treat the pain then correct the BP most times. Otherwise, I consider it my job to give as much relief as possible without unduly compromising safety.I'd rather have a patient that's too sleepy than one that hurts too much. I can always let 'em wake up a touch prior to transfer if necessary.Some folks fail to consider how often the patient may be drowsy due to drugs such as benzos, antihistamines, or even lingering gas if it's shortly after arriving in the PACU, etc. yet have uncontrolled pain. As mentioned, you can look at the heart rate, but don't forget that it's just one piece of the puzzle. You might not see much of a bump in the beta-blocked patient, nor will the tachycardic patient necessarily be hurting. Also, in chronic pain there generally isn't much change in heart rate.

Some patients may be trying to practice self-hypnosis, or trying to escape into a painless part of their mind. I have done this when a patient, post surgery. A nurse came up, put her hand on my forearm without saying anything, to see if I was awake, I opened my eyes and looked at her, so she asked me how I was doing. I said, a lot of pain! She was puzzled because I was so still. (I was so still, because I was trying not to breathe because it hurt so bad to breathe), and was excruciating to move in the slightest, so I was perfectly still.She would have thought I was resting quietly, except she put her hand on my arm, and asked me. Thank god she did. She called the doc, and got the PCA order turned up. God bless her!