"Some Discomfort" or Why can't doctors tell the truth about pain?

In My Humble Opinion
1

On Monday, I had extensive dental work under anethesia, including two mollars pulled. I asked my dentist, point blank, how much pain I would be in, and would I be okay to go to work on Tuesday. He said I’d be a little sore, and possibly experience “some discomfort”. I pressed him-- It was IMPORTANT that I go to work on Tuesday, that I needed to concentrate and get things done, and I need to be prepared for the level of pain I’ll be in. He says he’ll write me a prescription just in case.

It’s thursday. I’ve emptied a bottle of vicodin. After passing out at work from trying to make a go with just NSAIDs and having to be driven home by my boss (!), I left my bed for the first time this afternoon to have some mashed potatoes & stuffing at the table. (coping the past several days with severe nausea and dizziness, not to mention pain) It’s not dry socket-- it’s just a bad reaction to the procedure and anethesia. My face swelled up like a chipmunk-- but it’s healing well otherwise and this is not an abnormal reaction.

A few months ago, my best friend and minor surgery. She was also told she would experience “some discomfort” but would be fine to return to work the next day. In serious pain a few days later, she calls her doctor, convinced something must be seriously wrong-- only to be told that this is normal.

Two years back, I was in a car accident, and told by the ER doc that I had a sprained back, but to take some motrin and I’d be fine to go to work in the morning. The next day I was literally unable to move (hello, whiplash), and when I called in utter panic, I got, “Oh, yeah, that’s totally normal, here’s some muscle relaxants”

Why oh why oh why is it SO hard for doctors to say, “Yes, there’s a chance this will hurt a lot. You may want to give your workplace a heads up you might need a few days.”

“Some discomfort” is not an description that should ever require freakin’ narcotics and bed rest! Discomfort is a menstral cramps or a bruised elbow! It’s not being unable to open your mouth for two days! Or not (in my friends case) being about to sit for nearly a week. Why do medical professionals downplay pain to their patients like this. In either of my cases, or my friends case, if we’d just been warned, a day of taking it easy could have gone a long way.

Doctors of the dope, do you do this to your patients? Is “some discomfort” a code of some sort to mean serious pain? If a doc ever actually says, “serious pain”, is that code for “just kill yourself now, you won’t survive?”

Anyone ever had a doctor be honest with them?

Obsidian, who’s had enough vicodin for one lifetime and so is stuck awake, in pain, holding ice to her face at 1:40AM

PS. FWIW, I am a long time migraine sufferer, skilled in biofeedback, relaxation techniques, alternate therapies, and the management of severe pain, nausea, and attendant symptoms while still going about my life. Believe me when I tell you it has to be UGLY to force me to bed.

2

My theory is thus.

Tell someone that they’ll be in agony and (if they’re still willing to go through with the procedure) it’s more likely that they WILL be in agony. Sort of a reverse placebo effect.

Everyone is different, some people will feel only mild discomfort - like my mother who has had root canals without anaesthetic and gone back to work straight afterwards- and some people will be in excruciating pain.

More complicated reasons to do with opiate addiction, malingering and people taking days off work when they’re actually ok, because the doc told them to.
My menstrual cramps require 5 days of anti-emetics, opiate analgaesia and 2 days of bed-rest, one of my friends doesn’t take so much as an aspirin for hers. So even describing period pain as “mild discomfort” would be nowhere near the mark for either of us.

3

It just makes me sad that I need to do this weird dance of lies and mis-guessing with my doctor. I mean, shouldn’t you be able to have honesty with your doctor? It doubly annoys me because I feel that if I’d been advised to take a day or two and rest (and do my pain-management techniques) I might have gotten away w/out the vicodin. (But, again, I’d need to know what to expect for real) Pitching face first into my coworkers desk didn’t exactly aid the aching jaw.

I really want to round up and pit all the people who doctor shop for narcotics to get high, take a week off of work because the stub thier toe, or grossly exagerate the pain scale. Sometimes I think I’m the only person on the planet who thinks 10 = stab in the kidney/limb amputation level pain. Like my sister, who insists on ranking everything from cavities to a broken toe is a 9+. I’m sorry, but if you’re capable of articulating anything but primal screams, I’m doubtful it’s the worst pain you can imagine.

These people make life difficult for those of us with chronic pain-causing diseases. They apparently also make it hard for doctors to give a realistic assesment to their patients. I’m one of those people who can handle anything as long as I’m prepared for it. Worst-case-scenarios are my friend. But surprises just take my knees out.

For some reason, the move pissed I get, the less my mouth hurts. Adrenaline, perhaps? Only three hours left until dawn.

4

There is a lot to this statement, I believe. At the risk of sounding trite, pain is a very personal thing. The amount we can tolerate and the way it affects us varies, whether because of the way our personal nervous systems work, or macho posturing, or craving for sympathy and attention, or the phase of the moon. I hurt when someone describes their own pains very vividly - I had a friend who went into detail about some of her dental work, and I almost passed out! On the other hand, there have been many times when I look in the mirror to see a bruise or a cut, and for the life of me, I don’t recall acquiring it!

All of a sudden, I want to Google “pain” and see what the experts have to say. As for why some doctors use discomfort as a generic code word for a range of pains, I’m sure there’s a little mind gaming going on there.

5

The doctor who did my knee reconstruction after a football injury told me “it’ll hurt like hell and you won’t be able to walk for about a week.” He was right on both counts.

6

Not really sure how it fits in the thread, but my father probably died as a consequence of not being vocal enough about the pain he felt, resulting in the medical team not thinking his case was serious enough to warrant the medical attention he needed. It’s my sister-in-law screaming bloody murder on his behalf who managed to have the docs taking a closer look at him, but unfortunately too late to save him (he died from two undiagnosed internal bleedings lasting for two days while in an hospital bed).

My ex 's mother (also an hardened woman who wouldn’t complain unless she was being roasted alive) also died pretty much for the same reason in a nursing home, according to her pharmacist son who basically stated he was going to murder someone if an emergency team wasn’t called in immediatly, unfortunately too late in this case too.
So, maybe your sister is right, and in any case I would advise people never to be shy about saying they’re in pain, even if it means harassing all the medical team from dawn to nighfall and looking like a pussy.

7

I’m 43 years old, and I have lots of ear problems. I have an ENT that does NOT mince words, or tell you happy, little stories about how there might be some discomfort. Every time I need a Tympanostomy, he comes right out and tells me that (His exact words), “This is gonna hurt like hell. Don’t move, or we’ll have to do it again.” Short and sweet! He does this without any anesthesia (Only the little kids get to go to the hospital on an out-patient basis to get this procedure done. He makes the adults suffer through the pain, as it only takes about 30 seconds to do it.), as the injection of the medication to numb the area hurts nearly as much as the Tympanostomy itself, and, if you DO happen to flinch and move, yes. He WILL have to do it all over again, as I so sadly found out ONCE.

8

  1. I hope my PCP knows I’m neither a druggie nor a drama queen. Can’t he note that in my chart, so the specialist he refers me to is honest with me?

  2. Then say just that: It’s hard to say, because everyone’s different. Telling the patient he’ll feel some discomfort is just as much a half-truth as saying he’ll be in excruciating pain.

  3. That kind of makes sense, although the down side is that it damages the doctor-patient relationship, because the patient now thinks his doctor is a liar. “Some discomfort? That was the agony of the damned!” It also discourages people like clairobscur’s relatives from reporting key symptoms, because the last time it hurt that much, the doctor called it “some discomfort,” and they don’t want to be a baby.

9

I’m in nursing school, and we’ve been taught to never use the word “pain,” only “discomfort,” when telling the patient what to expect. The reasons are just as irishgirl said: everyone’s perception of pain is different, but if you tell someone he’ll be in pain, it’s a self-fulfilling prophecy.

It’s fine to ask people if they’re in pain, but it’s unadvisable to tell them to expect it. We just say “discomfort” and let them decide for themselves how much it hurts.

10

When I had to have surgery on my face the doc was up front and said, basically, I’m really sorry but the anesthetic going in is going to hurt really, really bad.

Despite what Licentious Ectomorph is being taught, it’s not always a self-fulfilling prophecy. Yeah, it hurt really bad, but because I was ready for it, it wasn’t as bad as I expected.

The same doc was also very conscientious about pain control. Warned me that wound cleaning was going to hurt like hell, but also told me how to get through it (pre-medicate a certain amount of time in advance, do this quick, do that immediately afterward, re-bandage then immediately do something to distract myself from the residual ache). Always asked if I felt my pain was under control, if I was able to sleep, eat, etc. or if the pain was interferring with that, and so on. Pain control isn’t always about eliminating pain, it’s sometimes about making you able to function while in pain.

It’s like I tell the doctors when they do have to hurt me - I’m going to make noise, I can’t seem to help myself, just ignore the whining/moaning/shrieking, get it done, get it over with.

It’s really condescending to lie to people when they’re going to find out the truth in about 30 seconds anyway. All it does is destroy trust.

11

My rule of thumb is that you can always remove the tens digit from someone’s pain score. If they describe their pain as “10/10”, it’s almost certainly zero. (I figure that if I’m bothering to ask and they’re able to answer, it isn’t 10/10.) If it’s 12/10, it’s probably closer to a 2. If you get all the way to 20/10, you’re back to zero.

I call it the PSM10 (Pain Score Mod 10).

12

My wife went in for surgery a couple years ago, and, because of the timing of a nurse’s strike, ended up in the pediatric ward. I went into her room to check up on her, and there was apparently a bit of a disagreement as to how much pain she was in. The nurses said they had asked her, on a scale of 1-10, how much pain she was feeling, and she said about a 6. So they prescribed aspirin.

:eek:

I pointed out to them that, in adult terms, 6 means she’s about to start screaming, but thinks she has a little control left, so how about we got some morphine in here?

They pointed to the chart on the wall which showed the various levels of pain for a children–a 6 was “stingy owie,” with little tears starting to leak out of the kids’ eyes… 10 was “hollering in pain.” I pointed out to the nurse that for grownups, a pain level of 10 was “go into shock and freaking die from the pain, so where’s my wife’s morphine which the doctor prescribed as her post-op painkiller before she even showed up this morning???”

13

When I had penile/scrotal surgery, the surgeon said I would experience “some discomfort.” I would hate to experience what he would consider agony if what I felt was “some discomfort.”

When I had my recent oral cancer surgery, the surgeon said I would experience “significant pain” and he was 100% correct. By and large, I prefer to have some idea of what to expect.

14

And if you describe something you know with more than 90% certainty will be painful as discomfort, you are doing a disservice to your patients. :dubious:

I strongly disagree with never using the word pain. I am as honest and open as possible with my patients as I can be. I’ll tell them that a given procedure may be uncomfortable, or it may be painful. Using euphemisms to try to influence patient behavior may be appropriate if you know the given patient very well, but it’s poor policy in general. IMNSHO.

And my descriptor to my patients for 10/10 pain is “pain so severe you rip the flesh off of your own arms with your own teeth to distract yourself from it”. That usually has them revising their pain scores downward a bit.

15

Part of my mother’s old job involved getting people with angina to run uphill on a treadmill until their pain became unmanageable. You’d be surprised at just how much further some people in “unbearable” pain were able to run with my mother screaming at them! This was for research purposes, I hasten to add, not because she felt like it.
I suppose different people have different tolerance for different types of pain. Like I said, my mother will deal with root canals without flinching, but I get my period pains from her, and she perfected that method (lying down, taking opiate analgaesia and anti-emetics) of coping. The woman who describes major dental work as “a bit stingy” used to take days off work with period pain.

16

Doc, speaking as a patient who’s been asked that question a couple of times, please don’t do that. Last April, I went in with some sort of GI problem - vomiting, diarrhea, and excruciating abdominal pain. I walked thirty yards from the car to the ER desk and threw up from the pain. Nurse asked me the 1-10 question, and I said “6”. I probably underestimated because I didn’t want to come off as a great big weenie looking to score some pain killers.

I’ve had my gallbladder out, and I woke up in less pain than that. I’ve also had my appendix and some scar tissue removed from a strangled bowel, and I had less pain than that episode. Even then, I don’t think the ER staff took me really seriously. Hey, it was great that I got a saline IV, an antiemetic, and some antibiotics, but more than anything, I could have used some pain relief. I never got it.

17

This is yet another thing where I’ve seen differences between US and Spain medical practices.

I’ve lived in the US about 5 years (Miami and Philly), most of the rest in Spain.

In the US, doctors tend to downplay things. It’s the same phenomenon as with hiring managers, who will say “this job involves about 50% travel” and it means “just put your stuff into storage NOW, cos once you sign up there won’t be time”. I think it’s because these people are asking you to go through something they would rather not go through themselves - those hiring managers who have been honest with me about travel time were road warriors too.

In Spain doctors are under instructions to NOT downplay things, both in the general Social Security system (which is universal, if one of you guys gets sick while in Spain you’re covered) and in private clinics. They figure that it’s better to be honest and give you a full explanation, so you know if you have to run to the ER or just lay low, and you know what the risks are. They’re less likely to get complaints, since you already knew beforehand.

18

I agree, it’s as if pain has become a dirty word, not to be used in polite company. I do know docs who have never, themselves experienced anything beyond “mild discomfort,” and have no concept of what real pain is, but they aren’t the rule.
I know that lying about pain to a child will cause them to never trust you, or probably any other healthcare professional ever again.

19

Oh, and they don’t tell you “you will be in pain”.

The words are “you may experience some discomfort, or it may actually hurt. If it hurts, these are the things you can take.”

They also say things like “about 2% of the patients need a second surgery, which is covered by the payment, you don’t pay again; in this clinic, that means we do a second surgery about every 2 weeks, since we operate about 25 patients per week.” They spell it out to make sure you understand.

20

Speaking as an MD who has been on the giving and receiving end of procedures, talk of “discomfort” by health professionals is a crock and the term should be excised from the medical vocabulary.

There may well be folk who believe that if you minimize the possibility of pain, the patient will experience less pain. There is probably also the factor that docs and nurses don’t like to think they cause pain, and it causes them less discomfort to use inaccurate phraseology.

Let’s face it - “discomfort” is when your underwear doesn’t fit right. “Pain” is what you feel during an invasive medical procedure.

“the injection of the medication to numb the area hurts nearly as much as the Tympanostomy itself…”

I believe this is another piece of crockery. When I was doing fine needle aspirations (sticking a narrow gauge needle into superficial lumps and masses to draw out material for cytologic evaluation), the party line among cytopathologists was to tell the patients that the extra stick beforehand for Lidocaine anesthetic would hurt as much as the aspirate itself. My opinion after doing a bunch of these procedures was that the local anesthetic was often quite helpful in calming apprehensive patients as well as reducing pain. Probably the major reasons for docs avoiding giving locals in this setting were actually 1) concerns about technical problems in getting a good sample from small lesions after giving the local, 2) wanting to avoid the small chance of an allergic response to the anesthetic, 3) time constraints, and 4) habit.

Pain is highly individual. If you tend to experience pain at a higher level than average, it does not make you a wimp and undeserving of pain prevention/relief. Don’t be afraid to make your wishes known to your doctor.