Pain and Vital Signs

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philslat

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Can a patients pain be accurately guaged by their vital signs ?
 
120/80 BP = 5/10 on the pain scale

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Fleury14 Can a patients vital signs remain within normal limits if they are in severe pain

One would expect elevated resps, pulse and BP for example
 
So the traditional thinking is that pain causes sympathetic stimulation, which then causes tachycardia and hypertension.

That is generally true. But you can't really rely on it because there are so many other things that influence HR and BP. Beta blockers and antihypertensive drugs can blunt or completely mask increases in these VS. Stress and anxiety can cause significant increases even when no pain is present.

Someone tells you that they are in a lot of pain, but their BP is 130/90 and their HR is 84. Does that mean they aren't in pain? How do you know that a normal BP and HR for them isn't 112/65 and 57? What if they take metoprolol and lisinopril? How does that weigh in on this?
 
Pain is a very subjective experience, influenced by genetics and culture. Unless there is anything to suggest otherwise, taking the patient's word for it is not a bad idea. Sometimes we need to have a little blind faith.
 
Just to build on Highglyder's comment, I don't know of a way to accurately gauge pain. The best we can do with something like the Borg scale is compare a patient's pain to what it had been.
 
mgr22 said:
Just to build on Highglyder's comment, I don't know of a way to accurately gauge pain. The best we can do with something like the Borg scale is compare a patient's pain to what it had been.
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Too many variables. Anxiety plays a large role in vital signs. Treat what your allowed to. Looking at the splintered end of bone through a leg, sure. Treat the patient, not the vitals, unless they're compromised internally. They'll get plenty of candy at the receiving facility.


"Cooler than a cucumber in a bowl of hot sauce."
 
LocNar said:
Too many variables. Anxiety plays a large role in vital signs. Treat what your allowed to. Looking at the splintered end of bone through a leg, sure. Treat the patient, not the vitals, unless they're compromised internally. They'll get plenty of candy at the receiving facility.


"Cooler than a cucumber in a bowl of hot sauce."
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I'm sorry, but this makes no sense and serves only to muddy the waters.

The right answer is to ask them, reassure them if necessary that pain management is safe and acceptable, and if they consent, manage it as effectively as you can.
 
I believe that rocket is right on the money here. I've had people with angulated fractures who've refused pain management and people with nothing wrong that I could see and totally normal vital signs, writhing around on the stretcher. After reassurance and informed consent, treat what you can treat and let God sort em out.
 
"Is your pain bearable right now?"

"Would you like something for it"

We neither create nor treat dependence issues in EM. Withholding does no one any good.
 
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