Attention RN's and doctors...different pain levels?

[Kindle 8,667]

I'm just curious about the major differences in the levels of post op pain people post about on here. Some people seem to be in excruciating pain that require high powered narcotics and they aren't able to get up and around for weeks. I (fortunately) had no pain, just low level soreness. I didn't take any pain meds (besides 2 days of a sublingual NSAID) and I was driving and shopping and taking care of myself, dogs, cats and horses immediately. Even went back to work as a vet tech after 7 days. And then there is everyone in between.

Is there that big of a difference between surgical technique and periop drugs, or is everyone's pain perception just that different? For you health care professionals, do you see this much variation in pain levels for other "standard" surgical procedures like hysterectomies, cholecystectomy, cardiac bypass, hip replacement, appendectomies, etc.

[Mrs.RRn 2,111]

Some people are just sissies.

Just kidding.

Everyone experiences pain differently and reacts to pain differently. Also, attitudes of pain & feelings towards pain medications vary as well.

For example: instead of feeling pain, some may feel hot, nausea, aggravation.. It manifests itself in a different way.

It's very interesting to have a 30 year old patient crying in pain from a kidney stone & having a 60 year old cancer patient with mets everywhere smiling & refusing medication. I think much of it is perception, self control, and beliefs.

Just an opinion.

[Fluffnomore 1,235]

This is one of my (only) beefs with medical professionals, particularly post-op nurses. It is really almost impossible to judge someone else's pain.

I had an emergency gall bladder removal in 2008, a "lady parts" surgery in 2011, and the sleeve in 2013. My post op pain level was minimal in 2011, slightly worse for the sleeve, and excruciating for the gall bladder. I don't know why, but I suspect that I had been really sick and/or run down prior to the gall bladder surgery and everything was worse as a result. I also happen to be a bit soft-spoken in that situation, and so the result was that the nurses routinely downplayed my requests for pain medication. With the sleeve, I was way more on top of it and took whatever they'd give me; and requested it at the earliest times they would let me.

At any rate, I'm replying only because I am the same person with multiple surgical experiences and don't consider myself either a tough guy or a wimp. I think it just completely depends. I do have a friend who almost goes into shock when she accidentally hits her head or stubs her toe, and while sometimes I think, "Drama queen" to myself, I also don't really doubt that she feels pain way more intensely than I do.

[1Day1Life4Now 882]

I've probably had 11 or 12 surgeries in my adult life and I can say they were all different as far as pain is concerned. I would say that as a general rule I have a high pain tolerance but when you have been sliced open and body parts moved and shifted, you have no idea what kind of pain that can cause another person. People hurt differently, heal differently, and feel differently. Their reality is their reality so who are we to judge? I do feel pushing yourself through the pain and doing more sooner is far preferable to waiting till the pain subsides. Another thing to consider is that everyone's fitness level is different prior to their surgeries and those with diabetes and other illnesses heal more slowly. There are so many variables when it comes to pain and healing.

[beeteroo 166]

I do anesthesia for a living and it's crazy the differences people have with pain. Everyone is completely different. And I mean everyone. I have to tailor my anesthetic and pain medications to what each person needs. For example for two gastric sleeve patients of the same surgeon/age/health status/size: will give one person astronomical amounts of pain medications during the surgery while the other receives a below average dose. After the surgery this usually continues to be the case. The person that needed more pain meds during the surgery will need more after.

Another interesting thing is that different pain medications affect people differently. For example while I was post op in the hospital they gave me morphine for pain. It made me nauseous and didn't control my pain at all. I was sleepy, dizzy, and in pain. When they switched to dilaudid for my pain control I could actually walk and my pain was controlled with no nausea. I went back to work after a week off and have done fine. Very little pain but I feel extremely lucky for this. I am very weak still.

No one really knows exactly why all of these things occur differently for different people. All of us have pain receptors in our bodies and some have more pain receptors causing those people to have more pain. Different medications that people take can cause an upregulation (more are actually produced) of those pain receptors and these people have more pain.

People with chronic pain already before they have surgery will require more anesthetic and more pain medications. With all of us obese people we are all generally in chronic pain of some sort simply from carrying around an extra 100 lbs. It gets worse as we get older too.

[beeteroo 166]

This is one of my (only) beefs with medical professionals, particularly post-op nurses. It is really almost impossible to judge someone else's pain. I had an emergency gall bladder removal in 2008, a "lady parts" surgery in 2011, and the sleeve in 2013. My post op pain level was minimal in 2011, slightly worse for the sleeve, and excruciating for the gall bladder. I don't know why, but I suspect that I had been really sick and/or run down prior to the gall bladder surgery and everything was worse as a result. I also happen to be a bit soft-spoken in that situation, and so the result was that the nurses routinely downplayed my requests for pain medication. With the sleeve, I was way more on top of it and took whatever they'd give me; and requested it at the earliest times they would let me. At any rate, I'm replying only because I am the same person with multiple surgical experiences and don't consider myself either a tough guy or a wimp. I think it just completely depends. I do have a friend who almost goes into shock when she accidentally hits her head or stubs her toe, and while sometimes I think, "Drama queen" to myself, I also don't really doubt that she feels pain way more intensely than I do.

I've noticed that when a surgery is done emergently that the patients hurt way more than in planned surgeries. It is because your body is already not at peak before the surgery (because you've been sick) and your autonomic nervous system is out of wack. You actually feel more pain because of all of these factors. The fact that you weren't as vocal about your discomfort did make them believe that your pain wasn't as bad as it really was. You were probably very ill and simply didn't have the strength to ask for pain meds. It's also possible that while you were in surgery your anesthesia provider wasn't able to give you enough pain medication because you were so ill. When someone is ill during surgery they can't give you as much pain medication or anesthetic or you could have severe complications and even death. This could be one of the reasons you woke up in so much pain in the post op area.

[Kindle 8,667]

Beeteroo, thank you so much for your reply. Just what I was looking for from someone "in the trenches". My two theories were individual differences vs surgical technique and periop anesthesia/Meds. You definitely confirmed the answer.

Fortunately I must be one with "dull" pain receptors and good healing properties. Not only was my VSG not painful, but I had a C4-C5 cervical fusion several years ago and recovered from that pretty well. Left the hospital less than 24 hours after surgery, and took hydrocodone and Valium for the first week. (The muscles spasms in my shoulders and back were worse than the actual surgical site) Switched to Tramadol and went back to work after 10 days. I was skiing 3 months postop.

[Fluffnomore 1,235]

Beeteroo, thank you. That is the best explanation I've ever heard. I tend to be very honest and direct, so if I say, "I am really in a lot of pain" I do mean that. Unfortunately, I figured because I said it calmly it was never heard. But I think you're right. It was also so HARD to get up the energy to demand, and I really suffered because of it.

The joke was, when they admitted me they sent a resident in to check me in, and she suggested outside my door (loudly enough that I could hear it) that they send me to the psych ward for a workup. She decided that I was faking my symptoms to get painkillers, because I just wasn't presenting the way she expected me to. When she came back into the room I explained to her (quite rudely, apparently, LOL) that I was a mother with two school aged children, and if all I wanted was painkillers on a Friday afternoon I would go get a margarita. My doctor went back to her with my surgical results and basically told her that she needed to be careful; if she had sent me away I could have died. (Ha. Take that, disbeliever.)

Ironically when I got the sleeve I had been working out for a couple of months; I had ab muscles; I recovered like a dream. It was really so different and I never understood completely why.

[MichelleInCA 22]

For example for two gastric sleeve patients of the same surgeon/age/health status/size: will give one person astronomical amounts of pain medications during the surgery while the other receives a below average dose. After the surgery this usually continues to be the case. The person that needed more pain meds during the surgery will need more after.

Just out of curiosity, how do you know if the patient is in pain while they're under anesthetic? Is it by heart rate or something?

When I woke up I recall complaining about pain in one of the incisions. I told them it was a 4 AND that I wanted some pain medication. That probably didn't make sense, 4 not being very high, but the surgeon checked on me, and they gave me a 'bolus', whatever that is!

They gave me IV Tylenol and an advil-like anti-inflammatory during my stay. Those worked better than the pain button. Surgeon said it sounds retro, but it's 'very 2014' that they're reducing narcotics and going more toward traditional pain meds.

I took Loritab for 4 days after surgery, then it was fine. Maybe I'm in the middle. I worked out a lot before surgery and was at work 8 days after.

[CrazyJaney 775]

I've been a nurse for 18 years. I worked 14 of those in ICU. It's truly not a one size fits all. You start out at what's an acceptable "normal" range and then see where it goes. If we sound a little jaded, it's only because we really, truly have an epidemic of over prescribed, narcotic loving patients out there. I hate to say that because NO patient should endure uncontrolled pain. But things sure have changed in 10 years. However, Post op patients vary so much and you always take their word for it, especially the first 2-3 days. We are taught to help the patient assess their own pain on that 0-10 scale. It is not legitimate to expect 0. There is going to be pain with surgery. So you try to help a patient understand that 0-3 is tolerable pain. At a 6, your getting pretty uncomfortable. If you say you're a 10, you shouldn't fall immediately asleep after you say it, request a cheeseburger, or need to go outside and smoke. 10 is like amputation. You're writhing, sweating, crying, screaming, puking, tachycardia, hypertensive. That's why nurses get jaded. I've had 5-6 surgeries, all with varying requirements for pain control. I've never needed narcotics for more than a week. 1-2 days gall bladder, 4 days with sleeve. Now, when I had half my labia removed (yes, my very delicate lady parts), I was miserable for about 7 days. It hurt like hell and was subject to positioning. Ortho pain is also intense but in a different way. I usually switch to plain Tylenol or Motrin after a few days and have done fine. All IV narcotics make me nauseous. I'd never take Demerol ever again. I'd much rather have po meds. Pain is highly subjective. Anxiety levels, lack of sleep, muscle tone, and coping skills all play into it. Narcotics are just one piece of pain control, albeit a big one in the early days. For every patient not well controlled, there are 2 on that unit (or more) who play a serious game to get over medicated. It's easier to identify these people now because there are computer programs that help docs see prescriptions filled recently. "Doctor shopping" is harder to do these days but still happens. These people detract our attention from the sweet, quiet cancer patient, the one who really needs help getting up. It's hard for lay people to understand but drug addiction in a hospital setting is epidemic these days. Narcotics and pills are the new cocaine. It's hard not to get jaded. But good clinicians can use an assortment of skills, including appropriate narcotics, to make the patient comfortable. Sometimes it takes switching to another drug to see if it helps. Sometimes it's uninterrupted sleep, a back rub, a good bath and getting up to walk. Our jobs would be immensely easier if the cook book recipe worked on everyone!

[MichelleInCA 22]

Speaking as a patient, I really dislike the look of suspicion on nurses' or doctors' faces when I've asked for pain meds. I feel like I have to apologize or explain myself. I've never abused and sure don't want to be on the drugs. I can't imagine getting surgery just to score meds, does that really happen?

I went to the ER with a herniated disk once and it was only when the doc could see my back muscles spasming that he was sure I wasn't just trying to score drugs. I was in agony with my arm up in the air. That's a sad state of affairs!

What surprised me for the VSG surgery was they didn't have any prescriptions to help me sleep, yet they told me not to use the button unless I really needed it, even though it did help me sleep for a bit. The effect being I was awake most of the night, with people coming in to change IV bags, check vitals, take blood etc. I lost count of how many times I had to ring for help -- IV alarm is going off, I need to pee, etc. Everyone was very nice, but wow, I couldn't wait to get home for some sleep!

[CrazyJaney 775]

Interrupted sleep is probably the hardest part (for me) when I'm in the hospital. It definitely messes with my coping skills. Unfortunately, you can inly be assessed for complications when you get woken up for vitals, lab.

I wouldn't say people seek out surgery to get pain meds. Like I said, pain during and after surgery is implied. It's usually always legit. Most drug seekers get admitted with chest, abdominal, back pain or headaches. Those are the usuals. That's not to say many patients who get admitted with one of those aren't legit.. But diagnostics have to show something to continue narcs. Usually it's a medical and not surgical complaint.

The problems with surgical pain management become more challenging when the patient has been on long term pain pills at home before surgery. They can have over saturated pain receptors. They are HARD to keep comfortable and still keep alive and breathing. Those are usually back surgery or some type of ortho surgery. It's legit pain but sometime no amount of med is going to help. Again, the goal is to keep the patient breathing and without complications of over sedation. If you look at childbirth as an example..... There are women who go into labor completely against epidurals and some if them succeed without. There are some who tolerate a lot of pain but then just can't anymore, and then there are those who are freaked out at any pain and want to feel nothing. Everyone is different. Everyone tolerates pain differently. I wasn't pain free for several weeks after VSG but I only used the lortab for 4 days. The pain was tolerable, I know it's not that way for everyone. I would be concerned if I still felt a need for narcs 3-4 weeks out. I still am tender 8 weeks out but I can't imagine needing pain meds for this long. I'd be worried I was leaking or something if I had that kind of pain.

[beeteroo 166]

Just out of curiosity, how do you know if the patient is in pain while they're under anesthetic? Is it by heart rate or something? When I woke up I recall complaining about pain in one of the incisions. I told them it was a 4 AND that I wanted some pain medication. That probably didn't make sense, 4 not being very high, but the surgeon checked on me, and they gave me a 'bolus', whatever that is!

Yes their heart rate and blood pressure starts going up. I said the same thing post op....that my pain was a 4. They told me that if my pain level were a 5 or higher I would receive pain meds.....lol. Guess what? my pain was a 5 or higher until I left the hospital. It's better to stay on top of the pain control than it is to try and catch up when your pain is excruciating.

[beeteroo 166]

Beeteroo, thank you. That is the best explanation I've ever heard. I tend to be very honest and direct, so if I say, "I am really in a lot of pain" I do mean that. Unfortunately, I figured because I said it calmly it was never heard. But I think you're right. It was also so HARD to get up the energy to demand, and I really suffered because of it. The joke was, when they admitted me they sent a resident in to check me in, and she suggested outside my door (loudly enough that I could hear it) that they send me to the psych ward for a workup. She decided that I was faking my symptoms to get painkillers, because I just wasn't presenting the way she expected me to. When she came back into the room I explained to her (quite rudely, apparently, LOL) that I was a mother with two school aged children, and if all I wanted was painkillers on a Friday afternoon I would go get a margarita. My doctor went back to her with my surgical results and basically told her that she needed to be careful; if she had sent me away I could have died. (Ha. Take that, disbeliever.) Ironically when I got the sleeve I had been working out for a couple of months; I had ab muscles; I recovered like a dream. It was really so different and I never understood completely why.

That is awesome! You showed that resident!

Reminds me of when my son fell of his bike a couple summers ago and his arm was hurting. He cried and cried (he is really dramatic). My husband was so irritated because he had gone to pick him up from the middle of the road (where he fell and was lying) There were cars lined up waiting for someone to get this kid out of the street. Lol. He was about 6 blocks from home. I can only imagine how hilarious the situation was really. He was 12 at the time....he's still dramatic. So i took him in to have it xrayed. My husband was sure that he was just being a drama king. and guess what.....broken.....very badly. My son was lying there in the bed saying I sure hope it's broken so dad feels bad. And yes dad felt so bad about it. You can never tell how bad someone is really hurting. You have to take their word for it.

And I love your response......if I wanted painkillers I would have a margarita! Lol.

[Fluffnomore 1,235]

LOL Beeteroo. That is exactly what I did after the sleeve. When I was asked, or when it was getting close to the timeframe, I'd buzz them and say my pain was a 6. It was closer to a 4. They'd bring the dilaudid, I'd sleep, and when it wore off I'd get up and walk the halls a few times. I will never be in the situation of not being able to get relief again, if there is anything I can do to help it. But the interesting thing is that I didn't have to take any of the painkillers at home. They gave me my last shot for the road about an hour before discharge. At home, I tried to take the liquid codeine and couldn't get it down (taste) and that was it. I was fine without it, and was amazed.