I look at it from the perspective if I was the patient. If I was in any pain I don't want to feel a thing. And having the unfortunate event of breaking a femur I am glad I had an ALS crew who were very liberal with pain management.
I'm not sure you really meant "not feel
a thing", so I'm not picking on you at all, just using this statement as an example of something that we hear all the time, and is actually quite problematic. Many people DO mean they don't want to feel a thing.
The expectation that pain should never exist at all is unrealistic, unreasonable, and ultimately even counterproductive to the overarching goals of our healthcare system. Unfortunately, this expectation has been heavily reinforced since the 1990's, to the point that a patient's satisfaction with their care (which is highly subjective and variable and dependent on many individual factors, of course) is dependent largely if not mostly on their perception of how well their pain was managed. Give patients enough of "that one that starts with a D" and they are satisfied with their care. Don't give them enough and they aren't satisfied. Little else matters to many people. Except of course how long they have to wait to get "that one that starts with a D".
For a couple decades now patients have been told that they are
entitled to be pain free, and if that requires a large supply of potent opioids, then they have a
right to those drugs. Accordingly, doctors and facilities have been punished for trying to take a more moderate and reasonable approach to analgesia. We are all familiar with where this has led us. It has in at least some cases shifted the focus from areas of care that are more important, it has exposed a huge part of the population to doses of opioids that were not necessary or safe, and it has seriously skewed many people's perceptions of what constitutes quality medical care. Now in an effort to combat the problems caused by this approach, the pendulum is beginning to swing back in the opposite direction, and that won't be a good thing either.
The reality is that pain is a normal physiologic response (and experience) to injury or illness. It is just one of the many unpleasant facts of life that everyone will go through. If you have surgery or suffer a traumatic injury, it is going to hurt. The only way to make it not hurt at all is to expose you to large doses of powerful chemicals that can have untoward effects on your physiology and your psychology. Yes, there are problems with not managing pain. But no one is suggesting that we not manage pain. Part of managing pain properly is having a realistic expectation of it.
What does this have to do with EMS? Am I saying we shouldn't treat pain? It really doesn't have a
whole lot to do with EMS, because for the most part we aren't talking about problems arising from the very early phases of managing an acute injury, in which case we should of course treat severe pain. But many folks in EMS now weren't around in the days before everyone was on opioids, and seem to have the same misperceptions about pain and what is reasonable for patients to experience. All the comments you see on this and other EMS forums to the effect of "there's no reason patients should be in pain at all" reflect a misunderstanding of effective pain management and in at least a small way, contributes to the larger problem.
