You put down what your doing and head into a Room 23A to answer the buzzer. Patty (patty the patient) is recovering from a fractured left ankle, ribs and right humerus post MVA. Patty wheeled past you in her wheelchair just 5 minutes ago with some friends in tow.

“I need my pain meds nurse.Its 8/10 and driving me crazy”. A friend jokes “I thought you said you weren’t going to be driving anywhere anytime soon”. Patty and her friends continue to joke and muck around as you leave the room.

Seriously you ask yourself how can someone be in soooooo much pain but show very little sign of being in pain. We are all unique and respond to situations including pain in our own way. Not appearing to respond as one would normally expect can at times influence how others judge or perceive the situation.

“I am in pain you just don’t know it cause I smile through the rain and refuse to show it

“The dingo took my baby” is a prime example of this. Some Australians judged Lindy Chamberlain negatively and with suspicion purely based on how she responded to the situation and appeared in the media. Her response was not considered normal by many at the time. Lindy was viewed with suspicion and labelled by many.

Pain is by its very nature subjective. Yes when pain is severe there are physical changes i.e. vital signs which are an objective measure. Irrespective of our thoughts of how much pain Patty is experiencing in this instance it is all about the patient. What the patient says the pain is what the nurse needs to treat.

Analgesia is one strategy to minimise pain however there are other alternatives that can by considered in collaboration with or as stand alone treatments. Resting, positioning, activity, stretching, thermal (ice or heat) and diversion such as listening to music and meditation are non pharmacological strategies for pain management.

Educating patients regards pain is also an important aspect of a nurses role in pain management. Not understanding why they have or still have pain increases anxiety. Anxiety exacerbates or heightens the pain. Having a good understanding of why the pain exists and knowing the plan for relieving that pain can reduce some of that anxiety.

Working with Patty in developing a plan of care around her pain management assists in giving her a much needed feeling of control over her pain. Patty is the expert when it comes to what has worked best for her in the past which must be respected in developing the plan.

Increasing medication is not always the answer. With each new medication or increase in dose the risk increases for drug interactions and unwelcome side effects. Getting the right management plan in place though is always the answer.