The Return To Work Blog

On A Scale of Zero to Ten

Posted by Sebastian Grasso on Dec 16, 2015 10:00:00 AM

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Morphine or Dilaudid?WindhamGroup_RTW_Child_Knee_Injury.jpg

I had the misfortune of visiting an even more misfortunate family member in the hospital.  It was a 6 day stint. The floor was for general patients. The room was shared.  The nursing activity was consistent,  they were courteous and friendly. 

During my repeated visits I noticed the RN’s and LNA’s spent a significant amount of time cleaning up after bowel movements.  I mentioned to one of the nurses in the room that it seems like half of their time is spent doing that type of cleanup.   She responded, “yes, and the other half is asking patients what their pain levels are and deciding whether to give them morphine or dilaudid”.  

The nurse then left and continued her rounds. Given my awareness of the opioid/narcotic abuse that exists in worker’s comp claims, I was shocked by the comment from that RN.   I had no doubts she was serious.  What is scary is that I was not as surprised at the ease of being provided with a potentially life changing drug but the rudimentary test utilized to determine whether the patients pain level warranted a dose.

Subjective PAIN LEVELS


A week later, I met with a business associate that is on the board of a local hospital. I decided to share my interaction with the nurse with him and gauge his reaction. His response was, “Scary isn’t it? That’s what goes on in every hospital”. He shared the challenges hospitals are faced with as a result of the general public’s sentiment that no one should have to endure pain when they’re injured or while being treated for an illness. He was also repulsed by this public sentiment and agreed that more needed to be done.

Please rate your pain on a scale of 0-10. Think about that. Could there be any question more subjective? defines pain as, “physical suffering or distress”. 

I wondered:

  1. When does an ache become pain?  
  2. How long does ‘pain’ need to last before someone should consider pain relief?
  3. How many Americans have been trained in how to rate their pain level?
  4. Do the professionals who are asking about pain levels give an example of a  pain level 5 versus a 10?

In my opinion, if you could verbalize that your pain level is a 10, then it’s not! It can’t be! Ten should be the equivalent of having all of your finger and toe nails ripped out at the same time while hot needles pierce your eyes.Pain_Scale.jpg

Look at this from a different perspective.  Take a small child vs. an MMA fighter. Both suffer a broken arm.  What will that child’s pain level be if asked?  Most likely a 10!  And how should we respond?  Pump morphine or dilaudid into them?   And by contrast, if that MMA fighter suffered a similar injury, do they even wince?   

Minutes & HoursRTW_delays_cost_money.jpg

Think about the spectrum of perceived pain levels in this industry and just how subjective they really are.  When employers put up barriers to returning to work, injured workers go into “benefit preservation mode” and the easiest way to preserve one’s weekly benefit is to be prescribed pain medications. The easiest way to be prescribed pain medications is go high on the pains scale. How can an impact be made before opioids are prescribed?  The key is early intervention.  How soon can you get the IW back to work? Return To Work needs to be measured in minutes and hours, NOT days and weeks.

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Topics: Pain Management

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