The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: knee deep in Goo on May 27, 2006, 02:32:15 AM

Title: Pain scale system
Post by: knee deep in Goo on May 27, 2006, 02:32:15 AM
0-1 No pain
2-3 Mild pain
4-5 Discomforting - moderate pain
6-7 Distressing - severe pain
8-9 Intense - very severe pain
10 Unbearable pain"
Title: Re: Pain scale system
Post by: knee deep in Goo on May 27, 2006, 02:34:44 AM   

This is a pretty good website that is a good read for people who are learning about this pain scale system.   Its weird to hear that it even exists.. when you are new to pain.
Title: Re: Pain scale system
Post by: KatieO on May 27, 2006, 02:49:33 AM
That was actually, after all these years, the first time I have seen that written out clearly. I knew what zero meant, and 10, but that was a lot clearer about what comes in between. Now I feel like I can even answer that question, and even will put it on my information pages that I hand to Dr. Fulkerson. I can say that I am rarely if ever 3 or less, quite firmly somewhere in the 4 to 6, often hanging out at 6 (like now). Yuck!
Title: Re: Pain scale system
Post by: knee deep in Goo on May 27, 2006, 03:02:38 AM

There is another website put out by styker  knee replacement..

They  have a pain management area  that asks you to rate you pain by doing daily activites.

Getting out of bed

However  never had time to go to the web site daily to rate all these items on a daily basis.

Also when I sent away for TKR detail..  zimmer sent a nifty jar opener.. thingy thing....   Free stuff is always nice.

Title: Re: Pain scale system
Post by: KatieO on May 27, 2006, 03:09:27 AM
I have seen different scales, asking how much pain impacted certain things. I find that much more illuminating.
But nothing as good as a free thingie opener! I sent off for free stuff from Oil of Olay the other day. Yay for free stuff. Enough of all this damn pain!!!
Title: Re: Pain scale system
Post by: stgiles16 on May 27, 2006, 11:10:22 AM
The thing that irritates me the most about this pain scale is that when the doctor asks what your pain is like, you have usually been sitting still for a couple of hours and it has decreased from what it normally is.   My pain levels change pretty dramatically some days and I feel like a fraud when everytime that I see the OS , my pain is about a 3 when with any activity, it shoots up to a good 5 or so. I would prefer for them to ask my pain  levels during specific activities, then they could get a better picture of what our normal days are like.

Title: Re: Pain scale system
Post by: KatieO on May 27, 2006, 01:19:24 PM
Ohmygod! Missy! You have so hit the nail on the head!  Thank you sooo much for naming that. I have had these exact feelings (do i sound excited?) but never was able to verbalize them like you did. That is exactly right. I have been sitting there, waiting, icing in the car. I am stiff and sore but nothing like in a normal day. They are always so specific: what is your pain like in this moment? That is the wrong question! I am so pumped for seeing Dr. Fulkerson. I am getting so much clearer in how to address him.
Thank you Missy!!!!!
Title: Re: Pain scale system
Post by: Nettan on May 27, 2006, 02:22:50 PM
A good thing is to rate not only after activities you have done, also what time on day it is and if there's swelling or anything else. So a diary with pain scale in you can say.
It's like when you are trying new should always try later on the day as the feet swell.

Title: Re: Pain scale system
Post by: KatieO on May 27, 2006, 06:48:57 PM
So you don't think it would be effective and informational to just whine and say MY KNEE HURTS?
Title: Re: Pain scale system
Post by: Nettan on May 27, 2006, 06:51:26 PM
Haha...but even better to show when you have pain and not ;D
Title: Re: Pain scale system
Post by: KatieO on May 27, 2006, 07:35:51 PM
Do you want me to be logical???? Even sensible??
Title: Re: Pain scale system
Post by: Nettan on May 27, 2006, 07:38:02 PM
You need to tell exactly how you have it..and leaving a diary like this can be helpful. I know myself that it's sometimes hard to describe when the doc ask cause you are thinking about so much when you finally are there.
Title: Re: Pain scale system
Post by: sharon74 on May 28, 2006, 04:37:42 AM
My whole problem with the scales is what is a 6 to me is most likely an 8 or 9 with someone else.  So, how is this supposed to help me???  Luckily for me I have been going to my OS for over 16 years so he knows when I show up there is a problem.  My scale goes more like this:

0-2 - barely feel anything
3-5 - irritating
6-7 - I am saying OUCH
8 - wimpering
9 - crying
10 - cussing out loud
Title: Re: Pain scale system
Post by: knee deep in Goo on May 28, 2006, 11:03:02 AM
0-2 - I wouldnt know there is a pain scale system for this type of pain.. 
3-5 - Gardening too much
6-7 - working threw the pain and its bad.. oh boy its bad..
8 - Making those eh eh eh sounds .. just to stand up.
9 - crying and holding temper trantrums
10 -physco calling doctor..   ( Now bare in mind .. Tooth pain has sent me to this place once or twice..  and well once before operation I had to panic call doctor with intense pain with my tear filpping over. )
Title: Re: Pain scale system
Post by: sharon74 on May 29, 2006, 08:06:53 AM
Hey Knee - you sound alot like me on your scale   ;D
Title: Re: Pain scale system
Post by: Janet on May 31, 2006, 01:01:33 AM
I never know how to rate that, either. Actually, I haven't had a doctor ask me to rate it on a 1-10 scale in a long time. Maybe they are finally learning that pain is very subjective and it makes more sense to ask about activities! Anyway, I came up with my own scale. If asked to rate my pain, I tell that them I figure a 5 means I want to take something for the pain, and rate it from there. It might not be very scientific, but that way I am always evaluating my pain against a specific number that means something to me.

Title: Re: Pain scale system
Post by: KatieO on May 31, 2006, 01:10:03 AM
How is your pain today, Janet? I hope you had a good day! It is too hot here and there is rumblings of thunder in the distance. Hoping for RAIN!
P.S. My knee hurts!
Title: Re: Pain scale system
Post by: sharon74 on May 31, 2006, 03:50:06 AM
Janet, my OS hardly ever asks me to rate my pain - it is at the hospital they pounded it on me for surgery.  I think they may have asked once or twice at my OS, but that is about it.

Hope everyone is doing well, and mostly pain free!
Title: Re: Pain scale system
Post by: blackbeltgirl on May 31, 2006, 01:39:06 PM
When I went for PT after my last surgery they had a gazillion page form, and I had to rate my pain during all sorts of activities.  Going up stairs (about 10).  Going down stairs.  Getting up from a sitting position.  Walking for 1 block, for 5+ blocks.  Standing still (like when you're in line).  And on and on and on.  I remember consciously putting myself in a position to do some of those things, because I'd bene avoiding them, and couldn't tell anyone how they made the knee feel.

But I'm more like Janet. 
     Either I don't notice it (0-1)
     it takes me a while of some mild nagging irritation to realize it's my knee (2-3)
     I decide to take ibuprofen and keep going (4-6)
     I decide to take ibuprofen and stop (7-9),
     or I look at the world like everyone's crazy for thinking I'm doing anything more than laying on the couch wishing I could be out doing more. (10)

Fortunately, I rarely get past a 6, 7 max.  And most of my days range somewhere between a 2 and a 4.

Whoever had the rain, please send some our way.  So far this year, we're way behind on rainfall, and they're starting to talk about drought conditions.  Again.

Title: Re: Pain scale system
Post by: laxplayer5 on May 31, 2006, 02:20:31 PM
Mine usually like this:
0-Which knee is it again? (the one with the big thing going from your hip to ankle LOL)
1-2-some little nagging
3-4- Ooh that hurts I better sit down for a minute
5-6- Ice Tylenol and ICe here I come
7-8- Breathjing hard and trying to lift knee into comfortable positon
9-- I'll be on the couch for the next hour or two or three... OUCH!
10- When is the ambulance coming!!!!!!!!!!!!!!!!!

I am generall at a 6, 7 or 8  :P, but I ususally hit a nine once a day  : :'(. Cross your fingers for meniscus repair.

Title: Re: Pain scale system
Post by: Leentje on May 31, 2006, 06:39:02 PM
We participated a post operative pain management research project and used painscales after TKR/THR/laminectomies/major vascular surgeries. We noticed people can rate pain better once we showed them the scales and explaining how pain can feel. We showed people a blanc line, on the other side (the side we saw as nurses) we saw a pain-rating scale. It helped us tremendously in what painmeds we could/should give post-op. However I need to say we never gave pain medications like some people got them here.

Like we never gave morphine! Never ever! The best pain med we gave was DipidolorR IM which is almost always effective. People with post-operative epidural paincontrol weren't allowed to receive any further strong painmeds.

Our drs changed their post-operative pain management protocol, people are now better treated and pain is something that is controlled, with minor painmeds.

It was a great help, minor work (the scale is easy to use), great outcome!

In the ER we do use morphine however only in major trauma cases and with people who suffer an MI (protocol). While it has to be thinned with water we only give it when people are monitored (heart monitor) as morphine IV can cause apnea!! (believe me it can!!!!!)

Title: Re: Pain scale system
Post by: stgiles16 on May 31, 2006, 07:57:28 PM
Helena, morphine is part of my pain management plan. I honestly dont think that it helps me much so I am weaning myself off of it. I am now up to 3 days between pills. I do have other meds that I can use when I need them but my pain management is for more than just knee pain. I also have fibro which can be a very uncomfortable  thing. Morphine is not given out as easily as you seem to think. It is very closely followed by the gov't and the doctors (at least my doctor is very careful). If there was something that worked that was not narcotic, believe me, I would be the first in line. I hate drugs. I use a TENS machine quite often instead of taking anything.

Title: Re: Pain scale system
Post by: Heather M. on June 01, 2006, 06:04:59 AM
I have had many doctors use the 1-10 scale, but they always specified that a 10 was "going to the ER" or "writhing on the floor, crying uncontrollably."  Unfortunately, I have had an experience with that kind of pain--had a laparoscopic appendectomy go bad, was cut open from guggle to zatch, and very nearly bled to death on the operating table.  When I was finally in recovery, they decided that my blood pressure was TOO LOW for pain medications!  So they gave me nothing...when I came to from my surgery, I really was rolling and crying and pretty much out of control.  So that is always the "10" in my book, and I make sure to say that when talking to a doctor or PT--that 10 is the worst pain imaginable, almost-ready-to-pass-out kind of pain.

And I agree that morphine is not given out like candy, here.  Day surgery cases usually get dilaudid or demerol after surgery.  I have only ever been given morphine when I was kept at least overnight in the hospital and the other stuff wasn't working--and I was on pulse monitors and oxygen.  Frankly, though, I much preferred my femoral nerve block over morphine!  The narcotics tend to give me awful hiccups--can you imagine having a violent attack of hiccups with 18 staples in your belly after abdominal surgery in which all of your internal organs were removed to clamp off a bleeding artery that had retracted deep into the stomach cavity...gah!!  That was one of the worst nights of my life.

Unfortunately, most arthroscopy and even TKR patients are given hydrocodone/Vicodin (aka Lortab, Lorcet and a couple other names).  This is because it's a much milder narcotic, only slightly stronger than codeine, which is rated for mild to moderate pain. Because of this, hydrocodone isn't monitored as rigorously by the DEA and state governments...and that means doctors choose to prescribe it because it's just less trouble for them.  It may be fine for some patients but others report ongoing pain issues and even debilitating, agonizing pain that threatens their recovery.  Frankly, I think it's a crime to undertreat pain.  A lot of newer doctors are being taught that pain is the fifth vital sign, as important an indicator of the patient's wellbeing as pulse, blood pressure, temperature, etc.  By all means, use the least potent medicine that is effective...but if that doesn't work, for the patient's sake, the doctors had better have a backup plan!!  Otherwise, other folks may get a chance to experience at 10 out of 10 on the pain scale....

Title: Re: Pain scale system
Post by: Nettan on June 01, 2006, 06:16:41 AM
Hey !!

I have been using morphine for several years..simply because of 3 severe pain and allergy to a lot of meds and because I developed seizures some years ago..they are now gone.
But I quit it a year ago by myself cause I didn't feel well of it.
But that was the toughest thing I have ever done..first the pain went up, then my whole body shaked,I was freezing, feeling warm, had spasms in my legs and after a week or 2 when that was gone..then there was the psychological part, as I have been sleeping for years and just woke up learning to smell and hear and react on things. Some sounds where very hard to hear..made me feel sick. But though I took it easy I will not be without the time i had my morphine casue when it worked for my pain it was like a miracle...I could live.
So now pain is worse, but my head is clear !! ;D
Pain is one of the worst things you can have...and it doesn't matter how you treat it, just that someone takes it seriously and try getting the pain down.
I do normally not get lower then around 6-7 on the scale...but with a bit of planning I can live with it.Okay, I have my days but in general life is pretty good. people around me say when you have more pain you talk more and maybe that is true, but it's great to find a way to ease pain ;D
Title: Re: Pain scale system
Post by: KatieO on June 01, 2006, 03:40:07 PM
Heather and Nettan,
While I am very hopeful that Dr. Fulkerson will be able to fix me (!!!!) if he doesn't, I really feel like I need to get my pain more under control. I do also live in the 5 to 8 range. I think my ten was when I was dilating super fast during birthing my girls. Like a train running out of control. But such a better pain than when from an injury! If there can be such a thing as positive pain (at least in looking back at it), that is child birth.
I had a horrible time weaning off methadone though it wasn't a bad drug to be on. I won't go back there. I take hydrocodone all day long and it only really does a little. i did have an interesting discussion with my pain management therapist yesterday. While i told him that my goal is to be pain free, we talked about if I would be content with having low pain and lower limitations. You bet ya! I could live with a 3 on that pain scale and getting 3/4 of my life back. But I am heading first for the big goal of no pain and being able to DANCE. (and walk and sit and stand and bend....)
I hate trying different drugs, though. They can really mess you up.
Title: Re: Pain scale system
Post by: KatieO on June 01, 2006, 05:00:47 PM
It's me again.
With talking about pain scales, I have been thinking about it more. Today, I had to take a bunch of stuff up and down stairs, a bunch of times. It zooms up the pain level. I don't know what number corresponds to this, but I get to the point where I tighten my jaw. That is a signal that the pain is rising and while I might be carrying on as normal, I am hiding what is going on. Took my hydrocodone at 3 hours instead of 4, and will try to settle down long enough to ice.
Here's something else I noticed. When I was thinking about my personal pain scale in my head, I noticed there was an abnoxious self blame thrown in. I was saying, well, if I do too many stairs, I CAUSE more pain, or if i walk too far, I BRING ON more pain. While this is true, I do have to live my life, and it isn't my fault that I have pain. I know this sounds obvious but maybe for other people who like to be in control (and aren't) this would sadly ring true. Or maybe I am the only insane one! Can I blame this on my Jewish upbringing? I dont' think so.
Title: Re: Pain scale system
Post by: Teresa_S on June 01, 2006, 05:26:11 PM
One of the most important things taught in nursing school in the US is that pain is personal. IF THE PATIENT SAYS HE HAS PAIN< HE?SHE HAS PAIN> Believe them, and treat it. It is also taught to ask them to rate it, and what helps that pain. There is a scale of 0-10  with pics of a face happy to grimacing and crying with pain that is shown to kids, and patients who have trouble rating or communicating. I have always hoped that I have never felt a 10 as it is supposed to be the worse pain you ever feel. I pray that I don't get any that is much worse than that I have already experienced. I believe it is universal to ask if a scale below 4 is tolerable witout meds and to treat anything 6 and above.

As for the meds, the universal comparison is most likely to how much equivalent morphine is required, or just to each other. THe government has put out a new salce of comparing eveything for the post Iraq soliders. I found out that the 100mcg Duragesic is supposedly equivalent to 360-480mg of Morphine. Perhaps, that is why 1mg IV every 6 minutes post op does NOTHING FOR ME. Here they do not use Demerol as it actually builds up in the body to where you reach a point the pain is much better controlled but it is at a higher level and harder on the liver, etc.  I never got much relief from the 20 or 40 or oxycontin BID or MS contin 40 mg bid with breakthrough beds or MS IR or Lorcet or Perocet. Here they only give the 5mg Percocet, but prescribe Lorcet at 10/500 which gives me better relief to take 20 mg of hydrocodone as opposed to 10mg or oxycodone. I was also given a months worth of Ultram 240 pills, and after 6 descided no noticable relief. I am sure that the duragesic I am on is not helping all that much after 10 years, that I have pretty much just become physically tolerant of it,  but do know that going without it would cause severe withdrawal, as converting would be such a large amount of morphine, I would be afraid as I am allergic to it if given very long IV, NOT allergic actually but start itching and swelling. Mostly an intolerance. It is recommended to convert to morphine and decrease by 10% every 3-7 days, depending on how long you have been on it, until you have gotten off the meds. BUT Then the pain really kicks in .  ost physicians are not even familiar with the pain meds for chronic pain and think you can just take a liitle of this and that and quit something else.

When in severe pain, it is hard to actually evaluate it calmly and on a scale. I know an old Os who does not practice anymore who used to write his order to give Demeral 75mg IM every 3-6 hours. NOT PRN or as needed but they could have it at 3 hours or any time up to 6 hours but if they didnot ask by 6 hours we were to give it every 6 hours to keep the pain from escalating out of control. IN addition, for his obese patients, or heaveier patients whom the med was just siiting around in the tissue and not being absorbed through the muscle as the fat tissue was too thick. HE ordered the meds be given with a spinal 5-7 inch needle in the tissue that is on the top of the shoulders below the neck so it could reach muscle. WE would cringe about giving it there. The problem with so much tissue is though, that the med sits around in the sub q tissue and just absorbs through it instead of systemically. and it takes longer, and may eventually reach a level of too much meds. I once had an OB with a c section on the next morning, and we were switching her to oral meds, She said she had had no relief from the  pca the night before. I checked her IV and it was infiltrated, and all the med was actually going into the sub cutaneous tissue, not the vein and was being absorbed so much slower she actually did not feel any relief. Another example is an older woman there ti basically have pain relief till death. She was writhing and rolling around in bed, and again, her morphine had been increased and increased but no relief, but the site when I checked it was infiltrated. We Spent 3 hours getting a central line in as she was so dehydrated, etc. and then they hooked up the morphine drip, NOT adjusting it for the hours it was being increased but she was not actually getting it due to the IV being infiltrated. AND she died in an hour or so, basically she got too much morphine over too short a time, without increasing gradually to her tolerance. Another example is never never NEVER cruch or cut an extended release pain med. A nursing home patient on hospice care could no longer swallow and an undereducated LPN cruched her extended morphine and gave it to her in applesauce, resulting in slower and slower respirations, until she died. THE dilemna was how far did they go to revive her as she was on hospice care to die. THE NURSE NEVER got in trouble, never lost her licence, as she should have, and never had to even go to a med class as the nursing home needed her and she was a "good employee"  SCARY.

Upon entering a patients room in pain, I begin by acessing what causes the pain to increase, and offer non medicine ways to relieve it like position change, heat , ice, distraction with conversation, change of subject, asking about family, etc. BUT I also give the med and return to reaccess the pain level in thirty minute. IN FACT< the nursing notes that chart pain meds have a place where you write the time you return to reaccess and how the patient rated befoe the med and 30 minutes later. In fact sometimes I will give toradol or motrin, and then go on to narcotic in 30-45 minutes if there is no relief. not of course on a post op. SO nurses who do not come back and reaccess , how do they fill out the chart? THEY FAKE IT> I once saw my nurse with the chart with the assessment on my roommate in her hands and the roommmate was in x ray and then she picked up mine, When she left I read mine and all about the color of my urine, pain, heart, lungs, etc, and she had not TOUCHED ME> SO I called her to my room and asked her about it, and she said "OH I must have mixed up you two and the two next door. " SO I looked at her and said "SO YOU made up all of them?" They sent me a patient advocate who said "You want an apology and you are not going to get it." I SCREAMED AT HER "YOU Bet I do , she falsified four peoples medical records, and basically committed fraud. SHE should be fired" INSTEAD I was dismissed. Later, that evening I got a call from the head nurse apologizing as she said she had never seen a patient treated that badly and altough she was head nurse at the other hospital when they merged she could now see why people complained so much about this hospital. Even my physican called and apologized saying that nurse called him and explained what had happened. IN fact,The RN had told the AIDE to come in and measure the left side to the right, and seveal other things pertinent to returning to surgery, and it was not even done. I was just dismissed.

I would advise everyone to lookup the IRAQ new pain med comparison. To see where you are on it. IT does not MATTER which med gives you the best relief, just that there is one that does. OF course, there is the big thing about oxycodone. A cardiologist once told me that ii is the most addictive med around. AND he would rather see somebody take four times the amount of any other med. There is a quality of percocet that makes the patient feel better whether it relieves pain or not.

AS a nurse, I believe a patient who tells me they have pain.I have been put in many bad situations asking physicians for meds for some of them,as drs. think many times they do not have pain. BUT I will continue to believe them as somebody has to help. Pain alters the perception of other problems, like nutrition, PT, etc. and their participation. RELIEVE the pain, and then work on getting them to move, and eat.
Hope everybody finds somebody to deal with their pain postively. Teresa   Please excuse errors my dane puppy is trying to bite as I type.
Title: Re: Pain scale system
Post by: Nettan on June 01, 2006, 06:32:35 PM
Teresa thank you for being such a great nurse...would love to have more nurses like you  ;D
Title: Re: Pain scale system
Post by: Doc79316 on June 01, 2006, 07:51:05 PM

Teresa - We could do with more nurses like you here in Birmingham. Those we have here right now could learn a lot from you and those who've I've been unfortunate enough to come across should be hung! I'm sure your baby dane was just trying to help you type.

KatieO - Childbirth has nothing on my knee pain. It was easy by comparison and at least there was an end to it.

Heather - I have reached (quite often over the past 2 weeks) a 10 on the pain scale. I believe I truly know what agony is. Morphine for some reason doesn't do a lot for me and the combination of pain meds I currently take seem to have a lesser effect every day.

Nettan - I've done as you suggested on Messenger and I've started a pain diary since yesterday. I Hope to see a pattern occurring so I can boost the pain control when necessary.

Fortunately for me my pain management appointment has come through - it's not until 17th. July though. Frustrating to say the least but for now I have to continue on pan meds that although have an effect and seem to change my perception of pain they don't take it away. I've already reached maximum doses and they're not working well. To try to go to work and do a "normal" day is incredibly difficult when I'm so spaced out I'm practically unconcious at my desk or in a meeting. People at work are very understanding but it will only last so long before my work suffers.

Hope everyone has better knee days than I d.

Take care,

Laura x
Title: Re: Pain scale system
Post by: KatieO on June 01, 2006, 08:30:33 PM
Please, accept my sympathy even if I can't offer anything useful! I am horrified at your pain levels. i don't think I have ever had a 10 for my knee. Child birth was an experience and had a mighty fine outcome. As you say, it doesn't relate to ongoing pain. I hope there are at least times at home when you can collapse into even a drugged state of relief. You have to have relief. I hope the pain diary gives you some insight. That is a long time to wait for the pain management appointment! Lindsay (I forget her geek name; can look half way through the thread of "can't tolerate anything tight on my knee") is 18 and has horrible RSD, among other problems. She is going to Phila in July to their pain management center for a very new treatment for RSD, supposedly actually a cure. Her original appt was Dec 2007!!! There is only one doc in the country doing this procedure. But he has trained someone and they moved up her appt to this summer! She is graduating from high school tomorrow by the way, and doesn't know how she will tolerate her gown on her legs.
Thinking of you...
Title: Re: Pain scale system
Post by: Doc79316 on June 01, 2006, 08:43:08 PM

Tnaank you for your concern. it's great that Lindsay is graduating tomorrow but to have suffered like that at 18, I don't think I could've coped. I'm sure she'll do fine tomorrow at her graduation.

As far as having something tight around my knee is concerned - it's impossible. I should wear a full length hinged knee brace but the velcro has been glued several times and my son has been playing with the hinges so I need a new one. I can't see me wearing it anytime soon though.

I can only put my intolerable pain levels down to the RSD. there is no other reason for it, and yes, when in that much pain you do end up on the floor writhing in agony.

Take care,

Laura x
Title: Re: Pain scale system
Post by: knee deep in Goo on June 02, 2006, 01:35:41 AM

Interesting article..

I am at a 7 today..  raining.. Wonder what its like to be pain free for a day.. I forget..   Oh wait.. If I lived my life in bed all the time.. I would be pain free..  But since that is not going to happen any time soon .. as long as I can... I will be crutching around..  and assorted body parts may hurt as well.. .. Can I actually put myself through  a two year  holding pattern..  ?      There is a point when your bearring the pain ..  is needless.. who are you hurting more ??? do you really need to sink to your lowest existence possible  before a young person gets a knee replacement..  or am I just at the point where I am crabby .. bcos  I pushed myself .. .. I didnt run a marathon .. all I did was get my butt into work. get coffee. . go to the bathroom three times and get lunch....on crutches..  oooo big day....  to me and to me only...   I did it.. not because the doctor is saying push your boundaries.. .. but I did it for me.. Who needs to see that simple things can be completed. 

Gosh this is why people retire.. isnt it ..
Title: Re: Pain scale system
Post by: KatieO on June 02, 2006, 01:49:22 AM
Knee Deep and Laura,
Sometimes life is too hard and I wonder if there is an alternative. I have thought about killing myself, actually, or more to the point, of somehow dying gracefully so that no one could blame me for being a wimp and killing myself. How pathetic is that? Pain just sucks. An eighteen year old manages, with crying and misery and all, and so do we. We get out of bed and get the coffee and do what needs to be done. Somehow. I am icing and pretty miserable at this  moment, nothing horrible, just enough to be VERY grumpy and hiding it completely from my boyfriend, whose house and computer I am at. I don't want him to know. I just can't get comfortable. Even in bed, it is sometimes not possible to find a position without any pain. I certainly wake up with pain. At least at Don's, no cats sleep on my feet. Cleo is a good kitty and one never moves a sleeping cat, but truthfully, she does hurt my knee that way. My pain is moderate, always there, maybe 4 to 7 on this scale, sometimes 8, but I also cannot imagine a time without pain. I can't remember. How DO we carry on? We do, though...
Title: Re: Pain scale system
Post by: Doc79316 on June 02, 2006, 03:46:39 AM
Katie et al,

We carry on becase we have to - for ourselves, our friends, our families, our work colleagues and just so that we get out of the house and have SOME quality of life, if that's what it can really be called.

Please don't kill yourself - just 'cos of your knee? It's not worth it. Don't let it get the better of you like I did.

Here it's 0345am and I have worken up after 40 minutes sleep because of pain. I am at 8 now and it's getting worse so have to take more meds just in case they may do something. Wish me luck - I'll be in work in 3 hours or so.

Take care,

Laura x
Title: Re: Pain scale system
Post by: christinaz on June 02, 2006, 07:33:57 AM
Just a different way I was given a pain scale or sensation scale.  If good leg is $1.00, how much is the bad leg worth?  Sensation-wise.....Good leg $1.00, bad leg $0.15.  Pain-wise.....Good leg $1.00,  bad leg $10.00.

Just thought this was interesting and a different way of showing degrees of pain or sensation.

Title: Re: Pain scale system
Post by: knee deep in Goo on June 02, 2006, 12:51:05 PM
Good Leg  I spent no money on it..  Bad leg..  Just in the last week  180.00 for copay on brace..   45.00 copy for  three shots..    97.00  for 3 months of mobic  20.00 copay for doctor     ..
Tongue   but I get your point on the money scale..   ..  ..

Title: Re: Pain scale system
Post by: KatieO on June 02, 2006, 03:18:40 PM
Hi all,
We went to bed last night and Don simply touched my knee and I jumped back. I hadn't realized it was so sore to the touch. And I did wake often, but nothing like big pain.
This sounds unbearable and of course, we do carry on. I was able to quit working a few months ago. I couldn't handle the pain and how everything i did made it worse while at work. The good side is that I have time to take care of myself, to rest, to meditate, to go to therapy and yoga, to write. The bad side (besides no income!) is that I have so much time alone at home. Without distractions.
You are sounding really low in the last couple of posts. Are you ok? (more or less) I am worrying about you. Are you feeling overwhelmed with pain and/or treatments? Can we help?
Title: Re: Pain scale system
Post by: Leentje on June 02, 2006, 03:37:29 PM
To correct  :

I didn't say morhpine in the US is prescribed just like candy, I just told the situation as it was where I used to work :-\

Secondly Nurses aren't always those who won't help, we ask the drs what more we can give and if they say "wait" then we can't give anything. We can keep on asking, but if the doc says no it's no...  Some drs are better than others, we can only update on the patients painlevels and ask them to do something. We (in the ER) can't even give painmeds without a drs order, not even those that you can get without prescription... Some people don't undestand that, but it's the way it is. If they take it out of their pocket and take it it's ok, we can't give it.


I am sorry that happened to you! It shouldn't happen, but I know of several alike cases. I would not do that, even not after our hospital management told us once that "administration is more important than the rest, you HAVE to fill in the charts, no matter if you did something on the patinets or not" (they HAVE said that!) :o Can you believe that?? I said "no way, better not do it and so not fill in the chart then lie!" If I make mistakes or forget something, I am the first to admit it! We are working with people and lives here! Not selling chocolate or something else!

Sorry if I offended someone, didn't mean it to sound like that...
Title: Re: Pain scale system
Post by: Janet on June 02, 2006, 03:59:05 PM
Another thought about pain meds. I'm not sure most of us are actually getting the ones that work! Otherwise, why would we be taking medications and still having so much pain? Doctors like to prescribe certain things, whether they work for you or not. Some of that, I'm sure, has to do with the government oversight.

As for living pain free, for many of us, that is impossible. Before my last surgery, my OS said the goal was to get my pain to a tolerable level. That worked for a while. Now my pain is worse (usually in the 4-6 range) and I have limited my activity to a bare minimum, so we are looking at further surgery.

Title: Re: Pain scale system
Post by: KatieO on June 02, 2006, 04:44:33 PM
Here's my thinking. IF Dr. Fulkerson can't do anything, then I need to try different meds. This isn't good this way. Also, I had a talk with my therapist about wanting to be pain free and it went in interesting directions. While that is a fine goal and should be stated, I agreed that I would be quite content with a lower pain level (3 or less) and much greater ability levels even if I couldn't do everything. I just want it to be MUCH better if perfect isn't possible. Is that too much to ask (of the universe)?
Title: Re: Pain scale system
Post by: stgiles16 on June 02, 2006, 06:24:43 PM
HI guys, I have been following this thread religiously because I totally understand living in chronic pain. I consider my last knee surgery a success because it did make my pain more bearable. I still hurt but not nearly as badly. I am weaning myself off of the MS Contin because it does not help. I have fibromyalgia and my hands (especially my left one) now hurt much, much more than my knees , if you can believe that . I am sooo frustrated. Nothing even slows down my hand pain. I am running low on meds and my doc is off until next wed. I dont know what I am going to do.   I personally dont understand the big commotion about Morphine. It honestly does not helpme. IV morphine helped in the hospital but pill form is a dud for me. Hydrocodone is like taking an asperin. I do have some demoral but it puts me to sleep and I still hurt. I dont know what else to try. I use ice and a TENS  unit but somedays (like today) nothing helps. I eat aleve like candy with no help. My stomach is going to start screaming at me soon. I have had my liver function tested and the drugs have not hurt it yet so that was good news.

Teresa, I have had good and bad nurses when in hospital. I think that you would be one of the best. I had one nurse post op on one surgery that did not speak much english and she ASKED ME  what medicine I was taking and when I was scheduled to have it again. I was in a lot of pain after that surgery so my mind was not very clear about such things. That has only happened once and it was horrible.  The orthopedic hospital that I use , they are really attentive. You never get any rest because they are constantly waking you up to ask how you are and check vitals. I know that it is good that they do it but shoot, when you get out of there, you are absolutely exhausted.

Helena, I was not offended if you meant me. I just dont see the hype about morphine, it doesnt help me. I so wish that it did.

I would write more bbut my hands are hurting terribly. I have to stop now.
Title: Re: Pain scale system
Post by: KatieO on June 02, 2006, 07:51:40 PM
One of the questions is, what pain med does work for knee pain, let alone the other issues we have. RSD is the toughest, along with fibromialgia (sp), I think. I also take Aleve and hydrocodone like nothing, but it is what I have. None of us can afford to go to sleep with drugs, except at night, which is nice. What about percoset? Is that as wimpy as hydrocodone? I don't know what is next up the list in usefulness without drowsiness. I know it is also very individual.
How are you today?
Title: Re: Pain scale system
Post by: knee deep in Goo on June 02, 2006, 09:26:24 PM
My dad happens to be a pharmacist.

I asked him once what was stronger than percocet. He advised Morphine.  I keep humming that song by Pink.

Pain medication should never be used as a sleep aid.  Ask your doctor for sleeping pills if you need to get to sleep.

Title: Re: Pain scale system
Post by: KatieO on June 02, 2006, 09:42:31 PM
I do take something else for sleep. I can't remember right now what it is. Though wouldn't pain meds keep one from waking up in pain at night? Wouldn't it be as amazing to be off meds as it would be to be painfree? Sweet thoughts that I can't imagine.

How are you today???
Title: Re: Pain scale system
Post by: knee deep in Goo on June 02, 2006, 11:06:07 PM
oh I am fine. Holding my own..  There is a big thunderstorm in Jersey now. . .I had my first orthovisc shot today.  Having some OA pain due to the funky weather.

I feel pretty positive about my action plan ..and my doctor mapped out what to expect..  A goal... we have.. Not to let this knee crap linger more than 2 years.  So I am doing the things I need to do .. Getting the pain control I need.  Getting stronger.. .. not as fast as I like at times.. But you know how that goes at least I have some piece of mind.

I am glad I have to see only one doctor who is getting to know me .and how I handle things.

Title: Re: Pain scale system
Post by: KatieO on June 03, 2006, 12:34:44 AM
A plan is a good thing, even if it seems like such a long range one. There are shorter term goals, like strengthening and getting pain under control is a wonderful goal. How old are you? What is the reasoning behind waiting two years?
I went to NH to my boyfriend's for today and tomorrow and was hoping to buy flowers and plant them for him, not that planting is really within my ability level but I do it anyway and just pay for it later. BUT it is chilly and rainy and I guess for all of us with joint issues, that is not fun. I get so antsy! I admit to doing some therapy shopping. I bought a skirt and top to wear to my daughter's graduation. It is hard to ice when it is cold out, too, but I must ice soon!
Title: Re: Pain scale system
Post by: knee deep in Goo on June 03, 2006, 02:13:41 AM
I am glad to say I am constantly seeking perfection on my short term goals. I have full range of motion. Pain control is currently under construction. OA medial Unloader brace- orthovisc shots/Mobic/pain patches/Pain Meds/Reducing Weight- Joined a pool/Completed Several months of PT- In other words I am doing all I can at the moment and feel its the correct choice for me.

When I talked with my doctor about Knee replacement. I advised I wanted that to be the treatment of last resort.  I just had an operation in January and really do not want to subject myself to a major surgery and plus the fact that there are some advancements that are on the road with Uni's and with knee care on the whole.. and the PKR would also provide 10 years before the TKR  and I would be up and running fast.  By all means if I felt that my progress detiorated and started to freak out.. He would do it.  But 2 years is a Smart goal.

I have reviewed my options with ACI, Oats and HTO's and feel that period of non weight bearing and time off work need and  the failure rate is great and is a risk I do not want to take. for 10 years prior to a TKR

Plus the fact I have OA in all compartments of my right knee.  The medial side being the worse. The joint is bone on bone.   The orthovisc shots will help ..Plus the OA unloader brace that I had custom made will be coming next week hopefully and this should replicate what an HTO would do.

My daily recovery blog is under the meniscus section --Really It is the recovery of Chrondroplasty with drilling (microfracture) and a partial meniscus removal.   Gone wild. :)  I have accepted that my battle with OA is not going to be a 123 quickie fix.  The past months really have been dealing with my own self center grief.. at times.  I am choosing right now to be as positive as possible and on this board I have found so many additional cheerleaders that helped this process be a bit more tolerable.

I smile alot and I am silly .. But my doctor knows that fine line where I am just using my coping skills and gives me what I need.  Hope..and support.

Title: Re: Pain scale system
Post by: Teresa_S on June 03, 2006, 05:11:03 AM
Hi, just wanted to clarify the post I made about converting the fentanyl to MS and then tapering or whatever. Fentanyl 25 mcg equals MS 135 mg, 50mcg fentanyl +135-224 mg MS, 75mcg fentanyl=225-314 mg MS, 100mcg fentanyl =315-404mg MS, 125 mcg fentanyl=405-494 mg MS, 150 mcg fentanyl=495-584 mg MS, and 175 mcg fentanyl =585-674 MS. I was glad to finally see it in a chart. Puts the patch in perspective, at least for me when I was wondering why the PCA MS did absolutely for me postop and nurses kept asking about the pain scale. Teresa
Title: Re: Pain scale system
Post by: KatieO on June 03, 2006, 09:17:40 PM
Dear KneeDeep,
I admire how you have a clear plan, and back up plans, and keep going. None of these are easy fixes, obviously. And we need this cheering section. We need to be able to cry and rant and not be looked down upon like we are wimps. I lose it fairly regularly, but I also carry on, and I have ways in my life where I feel I can make a real difference. If you walk around with an open heart, amazing things can appear. I am always watching for angel sightings! I don't know if I really believe in angels but it doesn't matter. Kindness shows up when you least expect it.
Take care!