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I need help with this pain!

Posted by Ricky J. on 2/13/03 at 07:37 (108995)

The pain in my feet is so intense right now that It is making me cry. I had surgery on my left foot just over a month ago. The pain is so strong that the back of my calves are hurting. Every now and then it will feel like someone shocks the bottom of my foot with a hot 220 volt jolt. I will be sitting in a meeting or somewhere like lunch and get one of these jolts and almost jump out of my chair. I know people are thinking, what the hells wrong with that guy. My blood pressure use to be 120/80 before the TTS. Now it never under 155/95 with a idle pulse rate near 100 or better. I think that the only reason I sleep is because I am just tuckered out. I am currently on 2700 mg of neurontin a day. The doc wouldn't give me but two prrescripitons of Lorcets. I guess he is scared I might get addicted or something. I say let me get addicted if it will get rid of my pain, I will go to rehab after the pain is gone. Rehab can't be this bad. The only other thing that I have found that helps the pain is knocking back 12oz pain capsulses, but they frown at that at work. Does anyone have any suggestions?

Re: I need help with this pain!

Julie on 2/13/03 at 07:57 (108999)

This is just a thought, Ricky, but when did you go back to work? If you had surgery just over a month ago, you may be asking too much of yourself (and your feet) too soon. Could you back off a little and take some time out?

Re: I need help with this pain!

Ricky J. on 2/13/03 at 08:31 (109007)

I went back to work two days after surgery. I haven't had to stand up much at work since our lab is going through some repairs. Work has also slowed down here due to Columbia disaster. My feet hurt all the time, but sometimes worse than others.

Re: I need help with this pain!

lauriel on 2/13/03 at 12:31 (109063)

I agree with Julie, I think you need to take it easy, like maybe taking some time off work, keeping your foot elevated and ice,ice,ice. You went to work 2 days after and then you said you were hunting a week later. I cant believe your Dr let you do that. Its sounds like you may have done too much too fast and really aggrivated it. I am 2 months post surgery and basicly have done very little. (the first week I kept my foot elevated the whole time with 2 weeks off of work). Are you going through therapy at all? I am and my PT is guiding me on what I can and cant do which is not a whole lot but has helped a lot on getting more more mobile. I still ice every day during the week and on week-ends when I am more active, I ice several times during the day. YOu also need to see your Dr asap to let him know the situation
Laurie

Re: I need help with this pain!

Ricky J. on 2/13/03 at 12:51 (109067)

My doc did not say much of anything to me about post surgery. He said that I should be able to return to work in 2 to three days. He said for me not to put any weight on my foot for 30 days. He did not mention anything about me seeing a PT. I live about 100 miles from my doc, I don't know if that had anything to do with me seeing one of their PT's. I am not even scheduled to even see the doc until March 6th. I started putting weight on my foot at the 30 day mark. For a week I walk with the aid of my cructhes. This week I have been walking about a 1/3 of the day without crutches. My right foot has been carring the blunt of my weight for 5 weeks, and it's really screaming. I really hope this surgery works. I still have the other foot that has to be cut on.

Re: I need help with this pain!

Marty on 2/13/03 at 12:57 (109068)

I would push for some meds from your doctor. Try to take it as easy as you can and remember those zingers are put of the healing process but you need to get rest and ice as much as possible along with meds to help deal with the pain. If the doctor don't wont to give you anything trying your md.

Good luck,

Marty

Re: I need help with this pain!

lauriel on 2/13/03 at 13:31 (109072)

I highly advise you to get into your Dr asap and demand to get into PT. They should go hand in hand. It has helped me tremendously with the mobility I lost, and doing procedures to prevent scar tissue which is a big factor in why the surgery does fails. I just started my second month. (started one month post surgery). If I hadnt gone I dont think I would be walking yet (or very little) and possbily causing additional injury trying to do my own stretches and rehab. You want to make sure you go to someone who has had experience in this type of surgery. My PT is making the judgement call of when I am ready to stop. My last Dr appt I asked my Dr what I should be and not be doing and he said to rely on the PT.
Laurie

Re: I need help with this pain!

Ed Davis, DPM on 2/13/03 at 18:17 (109096)

Ricky:
No one should have to live with that type of pain. There are other things that can be done. First-- ask your doc to consider a referral to a pain clinic.

Neurontin is a good drug but patients become refractory to its effects after a while. The are alternatives to neurontin such a trileptal. Not to say one drug is better but that a change may be in order once a drug is no longer working. Sometimes trileptal works better for shooting pains.

Has a TENs unit been tried? It is very safe and can interrrupt pain impulses.
Ed

Re: I need help with this pain!

Ricky J. on 2/14/03 at 11:44 (109148)

I thought I could handle this pain by myself. It has finally broken me down. I decided that I could use some help. I have read from this board that pain management doctors could help. I called a local PM doc and ask what I needed to do to be seen. They said that I needed a verbal referal from my doc, so I called my doc's office. They said that they do not refer me to a PM doc until they have released me from their care. My wife on the other hand does not understand or help me that much with dealing with my pain. She has put up with my depression and the emotional roller coaster that I have been going through.

Re: I'm bringing out the Big Guns !!

BrianG on 2/14/03 at 15:27 (109183)

Hi Ricky,

I don't know if you have noticed, but I usually try to remind patients to discuss pain control with their doctors, before surgery. I have read too many stories like yours. Heck, I have been there!!!!

I cut and pasted the following for you. It is the JCAHO pain standards in the US. All accredited hospitals and doctors HAVE to folow this!! If you have a printer, print out the whole thing. Highlight what you think will help you, and present it to your doctor. If you have to do it over the phone, it's better than nothing. It will give you something to fall back on, should you decide to persue this once you are out of pain. The Lorcets are OK for acute pain, but you should be given the strongest ones, 10 / 650's. You should also have enough so that you can take them every 4 hours, thats all they are rated for. I hope this helps you, go for it!!!

Regards
BrianG

II: Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Pain Standards for 2001
Implementation of the Joint Commission Standards on Pain Management is among the significant patient care decisions leading health care in this new millenium. Credit goes to the Joint Commission and the University of Wisconsin-Madison Medical School for their two-year collaborative effort with funding provided by the Robert Wood Johnson Foundation. The approval of these standards in March 1999 makes pain assessment and management a high priority in the nation's health care system.
Working with a panel of pain experts, the Joint Commission developed new and revised standards and intent statements addressing pain management. Significant input was obtained from within the Joint Commission organization and through health care professionals, professional groups and associations, including the American Pain Society and consumer groups.
For the entire year of 2000, Joint Commission surveyors assessed compliance with the pain management standards through interviews with patients, families and clinical staff. Surveyors reviewed policies, procedures, protocols and practices for effective pain management. They reviewed clinical records, educational materials for patients, families and staff, patient rights or other statements of the organization's commitment to effective pain management and other evidence to demonstrate compliance.
Evaluating compliance to the new Pain Standards began in January 2001. What follows are the new and revised 'Standards' and 'Intents' taken from the six chapters in which they appear in the Joint Commission Standard Manuals for organizations providing ambulatory care, behavioral health care, home care, hospice, hospital and long term care. Additional information can be obtained from JCAHO's Web site at http://www.jcaho.org . The important chapters focus on the following:
Rights and Ethics
Assessment of Persons With Pain
Care of Persons With Pain
Education of Persons With Pain
Continuum of Care (Revised)
Improvement of Organization Performance (Revised)
Examples are provided as a means by which other organizations have demonstrated compliance but should not be considered a standard.
 
Objectives
These learning objectives will help you focus on expected learning outcomes. After you complete this section, you should be able to:
Describe the Joint Commission standards for pain management.
Describe the six chapters in which the pain standards appear.
Describe the intent of each standard.
Key Concepts
The Joint Commission Pain Standards are contained in The Rights and Ethics, Assessment of Patients, Care of Patients, Education of Patients, Continuum of Care, and Improving Organization Performance Chapters of the Joint Commission Standards Manual.
Both the Standard and its Intent are scored during on-site surveys of an organization's performance.
Some Examples of Implementation are provided. These are NOT standards nor are they required ways to meet a standard. They are only examples of how other organizations have successfully demonstrated compliance with a standard.
A. Rights and Ethics Chapter
Standards RI.1.2.7 and RI.1.2.8 apply to sick and terminally ill patients but dying patients have unique needs for respect and responsive care. A dying patient needs to have his/her pain managed aggressively and effectively. Therefore, it recognizes the right of individuals to appropriate assessment and management of pain. Pain is a typical part of the patient experience. If unrelieved, presents adverse physical and psychological effects. Clearly, health care organizations are committed to make explicit their service standards for pain management.
Examples of Implementation for the Rights and Ethics Chapter (RI.1.2.7)
The patient, family, or surrogate decision makers are involved in every aspect of the patient's care at the end of his or her life. The hospital uses a formal process to support this involvement. Policies and procedures guide clinicians in the appropriate format for medical record entries.
The hospital may use as its basis acute pain management guidelines that reflect the state of knowledge on pain management and are published by the Agency for Health Care Policy and Research.
Examples of Implementation for the Rights and Ethics Chapter (RI.1.2.8)
Pain is considered a fifth vital sign in the hospital's care of patients. Pain intensity ratings are recorded during the admission assessment along with temperature, pulse, respiration, and blood pressure.
Every patient is asked a screening question regarding pain on admission. Patients and families receive information verbally and in an electronic or printed format at the time of initial evaluation that effective pain relief is an important part of treatment.
Competency in pain assessment and treatment is determined during the orientation of all new clinical staff.
The following statement on pain management is posted in all patient care areas (patient rooms, clinic rooms, waiting rooms, etc.)
Statement on Pain Management
- All patients have a right to pain relief.
Institution:
- Inform patients at the time of their initial evaluation that relief of pain is
  an important part of their care and respond quickly to reports of pain.
- Ask patients on initial evaluation and as part of regular assessments about
  presence, quality, and intensity of pain and use the patient's self report as
  the primary indicator of pain.
- Work together with the patient and other health care providers to establish
  a goal for pain relief and develop and implement a plan to achieve that
  goal.
- Review and modify the plan of care for patients who have unrelieved pain.
The institution demonstrates its commitment to pain management by holding twice-annual staff awareness events regarding pain assessment and treatment. The institution supplies educational materials about pain to all patients. For outpatient surgery patients, information is mailed to patients prior to the day of surgery.
Any telephone follow-up (for example, outpatient surgery, short stay obstetrics, evaluation of discharge planning), includes asking the patient about their pain status.
B. Assessment of Patients Chapter
Standard PE.1.4 requires assessment of pain for all patients. If the patient identifies existence of pain, the nature and intensity must be determined. This standard indicates that the health care organization recognizes that pain is a common experience and that if untreated or unrelieved, has negative consequences. To meet the standard's intent, the organization incorporates comprehensive pain assessment into its procedures. Policies and procedures for assessment are developed and implemented with appropriate follow-up of care. Competency and training of staff is the responsibility of the organization.
Examples of Implementation for the Assessment of Patients Chapter (PE.1.4)
All patients at admission are asked the following screening or general question about the presence of pain: Do you have pain now? Have you had pain in the last several months? If the patient responds 'yes' to either question, additional assessment data are obtained:
pain intensity (use a pain intensity rating scale appropriate for the patient population; pain intensity is obtained for pain at present, at worst, and at best or least; if at all possible, the pain rating scale is consistently used in the organization and between disciplines)
location (ask the patient to mark on a diagram or point to the site of pain)
quality, patterns of radiation, if any, character (elicit and record the patient's own words whenever possible)
onset, duration, variations and patterns
alleviating and aggravating factors
present pain management regimen and effectiveness
pain management history (including a medication history, presence of common barriers to reporting pain and using analgesics, past interventions and response, manner of expressing pain)
effects of pain (impact on daily life, function, sleep, appetite, relationships with others, emotions, concentration, etc.)
the patient/client's pain goal (including pain intensity and goals related to function, activities, quality of life)
physical exam/observation of the site of pain
Patient/clients often have more than one site of pain. An assessment system or tools with space to record data on each site is provided on the assessment sheet.
A hospital may need to use more than one pain intensity measure, depending on their patient/client population. For example, a hospital serving both children and adults selects a scale to be used with each of those patient populations. Assessment of cognitively impaired patients may also require assessment of behavioral factors signaling pain or discomfort.
Staff are educated about pain assessment and treatment including the barriers to reporting pain and using analgesics. Staff encourage the reporting of pain when a patient/client and/or family member demonstrates reluctance to discuss pain, denies pain when pain is likely to be present (for example, post-operative, trauma, burns, cardiac emergencies), or does not follow through with prescribed treatments.
Pain intensity scales are enlarged and displayed in all areas where assessments are conducted. For organizations using clinical pathways, pain assessment is incorporated in some way, into every appropriate clinical pathway.
An organization selects pain intensity measures to insure consistency across departments; for example, the 0-10 scale, Wong Baker FACES Pain Rating Scale (smile-frown), and the Verbal descriptor scale. Adult patients/clients are encouraged to use the 0-10 scale. If they cannot understand or are unwilling to use it, the smile-frown or the verbal scale is used.
A unit caring for persons with Alzheimer's disease developed a pain scale for each resident based on their long-standing knowledge of their residents and their knowledge of the common pain syndromes in elderly persons.
A pediatric hospital includes, in its introductory information for parents, information about pain and pain assessment, including parents' role in interpreting behavioral changes of their child that may indicate pain or discomfort.
C. Care of Patients Chapter
Standard TX.3.3 and TX.5.4 instructs the organization to establish policies and procedures in support of appropriate prescribing or ordering of effective pain medications and with the intent of monitoring continuously the patient during the post-procedure period. The health care provider treats the symptoms and chooses the appropriate medication and modality of care, e.g., patient-controlled analgesia (PCA), spinal/epidural or intravenous administration of medications, etc.
Examples of Evidence of Performance for the Care of Patients Chapter (TX.3.3)
Before initiating patient-controlled analgesia (PCA) for surgical patients, an interdisciplinary team of physicians, pharmacists and nurses reviewed the literature on PCA, drafted policies, procedures, and standing orders, obtained approval from the pharmacy and therapeutics committee and medical staff, oriented all staff, and conducted a pilot test on the general surgery patient care unit.
A patient rehabilitation plan determines goals, services and interventions needed to help him/her function with as much independence and choice previously. Decisions are based on regular reassessment and reliable measures of patient needs, strengths, symptoms, behavioral patterns, and goal achievement. The patient and clinician agree on care choices.
 
D. Education of Patients Chapter
Standard PF.3.4 asserts that patients, residents and families are educated about effective pain management. The implication here is that the organization is responsible to help patients, residents and clients understand the importance of pain management in the treatment process and to be sensitive of other influences due to culture and other belief systems impacting on concepts of pain management. Balanced and accurate information on the patient's pain medications must be available including addressing any apparent misconceptions.
Examples of Evidence of Performance for the Education of Patients Chapter (PF.3.4)
Progress notes
Policies and procedures definition of responsibilities for patient or family
Clinical staff interviews
Referral and consultation notes
Examples of patient and family educational materials
E. Continuum of Care Chapter
Standard CC.6.1 concerns the discharge process and addresses the patient 's continuing need for symptom management before leaving the institution. Pain is considered a symptom and to be managed.
Example of Evidence of Performance for the Continuum of Care Chapter (CC.6.1)
A discharge plan meeting the patient's health care needs and services, e.g., physical, emotional, symptom management, housekeeping, transportation, etc.
F. Improving Organization Performance Chapter
Standard PI.3.1 mandates the organization collect data to monitor its pain management performance. This information is incorporated into the organization's performance measurement and improvement program for pain management.
Example of Evidence of Performance for the Organization Performance Chapter (PI.3.1)
Organizations have developed data collection systems that are based on their mission and scope of care and services provided. It is important to be able to benchmark performance both internally and externally. Computers are making this task easier as software packages have been developed to help record, collate and measure the essential elements to allow for performance evaluation. Patient satisfaction surveys, focus groups and using performance measures from acceptable databases are possible performance aids.
Summary
The new JCAHO Pain Standards for 2001 provide important criteria for evaluating health care providers on their facility and staff. These important initiatives prioritize on patients right to appropriate effective pain management and assessment, education and training needs of everyone concerned and the safe use of analgesics and other pain control interventions

Re: Thanks, Brian

Sharon W on 2/14/03 at 16:12 (109187)

Thanks for posting this. I agree that pain meds after surgery are a VERY important thing to discuss with your surgeon, BEFORE the surgery. I say that partly because pain IS such an important consideration, and partly because it gives a clue about how responsive the surgeon is likely to be with respect to all your other needs once the cutting has been done and he has earned his surgery fee.

I know I've said this before but I think it bears repeating once again: it's VERY important to discuss pain medications and ALL OTHER ASPECTS of your after-care with your surgeon, BEFORE he cuts! I believe that good after-care (the plan for healing and recovery -- things like physical therapy, wearing a splint or cast, using crutches or a wheelchair, when you'll return to work, how often you will see your Dr., how to notify him/her in case of complications, etc.) is every bit as important to your ultimate chances of success as the skill your doctor has in doing the surgery itself.

Sharon