Thursday, May 22, 2008

How much pain will there be?

Often I am asked about pain. I'll give you a couple of examples.

"Will the it hurt?"

This from a patient who wanted her earlobe repaired. She had missed out on a pair of diamond ear rings for Christmas, so now she had worked up the courage to have the repair done.

"I have to use a needle to put the numbing medicine in your earlobe. There will be a little pain with that, but you won't feel any pain with the actual repair. You may feel me gently move your ear as your cheek and the surrounding area won't be numb. You may also hear me cut the suture with the scissors as I will be working so near your ear."

"So you have to use scissors?!"

"Yes, I will use scissors for the suture. I will have to use a knife to cut the skin."

"But I won't feel you cut?"

"Correct. Your earlobe will be numb."


So I keep chatting with her as I get the local ready and do the injection. I finish and turn to busy myself with getting everything else set up for the procedure.

"You're done? That didn't hurt."

I smile and say, "Good. That's all the pain involved. You won't need anything other then ibuprofen when the numbing medication wears off."

Example Two

A young woman who wants a cosmetic breast procedure.

"How much pain will there be after surgery?"

I recheck her surgery history. None listed. No children yet.

"Have you ever had any cuts that needed stitches? Any broken bones? Pulled muscles?" I'm looking for something to compare the pain/soreness to.


"Well, the pain of the incision is often a burning, stinging kind of pain for the first several hours. Think paper cut. Then there will be a pain similar to a deep bruise. The first couple of days are the worst. Remember it will feel less painful, less sore each day."

She seems satisfied, but I am left wondering how I could better prepare her. When someone has had surgery before, I can use it as a reference point. The purposed surgery will have less, similar, or more pain involve. When the patient is female, has had children, and the surgery is breast implants -- patients have taught me that it feels very much like "when the milk first comes in--full and tight" initially. That often helps when discussing this question.

Anyone have any suggestions when it's the patient's first surgery and there seems to be no history of painful injury (past surgery, past injury, etc) to use as a reference point? I am always looking for better ways to communicate with my patients.


30 years from Darling said...

The problem is, everyone is different. My best friend is the type that the less pain she expects, the less she feels ..and the more I expect, the less I feel.
The surgeries that I've been told would be the most difficult, have been the easiest, and the ones that I've been told would be easy, were harder than ... well ...

My sinus, thymectomy and breast reduction were all ones I was told to expect pain, I got through all of those ok.
My gall bladder everyone told me how 'easy' it was now .. it was the WORST!!! Absolute worst of the surgeries I'd had. My bladder surgery ...oh geesh!

I'd much rather expect more pain, give me the horror stories ..and I can prepare. Then again, I had 2 kids by natural childbirth (no epi) and the youngest was over 9 lbs (and I knew it)and they were no where near as painful as most of my surgeries, so my reactions to pain aren't exactly normal.


rlbates said...

Thanks for the input, PK.

Anonymous said...

I have to say, after an earlobe repair (both ears)that didn't hurt, after coming home...holey moley...swollen ears and the pain was incredible. It's hard to gauge the pain since we are all so different. It's funny though how we all want the doc to tell us EXACTLY what we are in for as far as pain. As if you should know how we feel.

Nice site, I just sort of found you..

rlbates said...

Thank you, Noble Pig.

Anonymous said...

Yeah, pain is a rather subjective phenomenon, which is probably why it's hard to tell someone else how much a given procedure or experience will hurt. I don't have children, but I have some surgical experience that has taught me plenty. Although I'm inclined because of it to think: (1) the fear can be worse than the actual pain; (2)that the worst kind of pain is the unexpected kind; and (3) it's always interesting to hear stories from the "trenches" (like the docs and other health related professions) because there's such an enormous variety of ways people respond. Sometimes being "too quiet" about it is looked upon as skeptically as those who are die-hard complainers. (I'm one of the former, which sometimes wigs out health care folks!) Don't know how I'd do at the extremes, but I do know I've had a few migraines that were worse than anything that happened post-surgery. Can't even begin to imagine things like kidney stones or unmedicated labor.

rlbates said...

Thanks, Medrecgal.

Doctor David said...

Personally, I think your approach is dead on, especially the comparison to every day events, like a deep bruise or a papercut. It's tough to quantify pain, especially since everyone's perception of pain is different... so I usually take that approach and try to draw a comparison with something painful the patient has probably already experienced. For example, people always ask me how much pain they will experience after donating bone marrow.... I tell them that I've been told it feels like you've banged your hip into the corner of a coffee table or desk.

rlbates said...

Thanks, Dr David. It's just tough in patients who can't seem to help you find something to compare.

Ian Furst said...

I face the same problem removing wisdom teeth all the time - often they have never had local (so you have to find an analogy for that) and post op pain. I don't usually try to make a comparison other than to say that it'll hurt for the first 48 hours, we'll provide pain medication (which seems to satisfy the fear of po pain) and that if anything feels worse rather than better after 48 hours I want to hear from them (satisfies the fear of having to manage on their own). When i'm describing he procedure I use the line "the first day you'll be numb and will feel great. The next day you'll hate my guts". It's trite but it makes them laugh every time and get's the point across. BTW enjoy the blog. Ian.

rlbates said...

Thanks, Ian. I've told patients similar things. It just doesn't always seem enough to me though few come back and tell me that it was "lots worse" than they expected. So maybe I'm doing better than I think.