Monday Musings 12/19/22-surgery without pain is a fairy tale

As part of the pre-op checklist, I have to ask patients what their current pain level is.

Some people need a translation.

You wouldn’t think so, but there it is.

Through careful questioning, I have to ascertain the type of pain, where the pain is, what makes the pain worse, and the quality of the pain. This means is it stabbing, or throbbing (yes, those are 2 different kinds), duration of the pain, and so forth. And then I ask about the number on a scale of 0-10, where 0 is no pain and 10 is the worst pain ever.

Preop for an acute issue, I can anticipate an answer along the entire gamut. Some people really have limited pain, some have a score of 10 while scrolling on their phone or laughing with their family member, and others have a score of 10 while clutching the body part and practically screaming. I record what is reported.

And then I ask about the anticipated pain AFTER surgery. And what they would like their pain level to be then. I get a lot more blank faces with this question.

I preface this conversation by informing them that they will hurt, in some capacity, after surgery. Zero pain is not obtainable, especially when sharp objects like knife blades or suture needles are used.

What I want to know is what is a goal pain level that will allow them to be comfortable, while recovering. A goal number that the pain medicine will try to get them to.

Remember zero is not obtainable.

And five times out of 7, after getting the there will be pain, what is a good pain goal to shoot for explanation, some will smile at me and still say zero.

ugh

And some of the 5 that answer zero will bluster and try to excuse their pain goal.

Look.

No one wants to be in pain.

I get that.

I definitely don’t want patients to be in pain.

But zero pain is not a good goal immediately post-operatively. A week, maybe. Tonight, after surgery? Nope, not gonna happen.

Shall we begin again and you can pick a number that is attainable?

Three.

I knew you could do it.

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