pain threshold

[zzyzx]

I had a patient last night with a mid-shaft femur fracture who had only a minor complaint of pain. Granted she was drunk, but still, I couldn't believe it. I felt the broken bone and put a traction splint on, but until I saw the ER x-ray, I just couldn't believe that she could really have just broken the biggest bone in her body and not have hardly any pain. The last time I had a guy with a broken femur, he was a 400-pound biker who was cussing about every little bump in the road on the way to the hospital.

[AZCEP]

This is why when you assess a patient for pain you have to use objective and subjective information to decide how to treat them. How does the patient rate the pain? What are their vital signs at that pain rating? Do they look more uncomfortable than they are telling you?

All things that are learned with experience, I suppose.

[brentoli]

Can you tell us what her vitals were? Maybe the intoxication was affecting it. Or maybe she just didn't know what was going on.

What was the cause of the injury? Femurs don't just break. Was there indication of a head injury or altered mental status?

[Yummymedic05]

I've had patient's with minor abrasions that were crying for pain medication telling me its the worse pain they've been in. I've also had patient's with major trauama like you've described and not giving much mind to the injury/pain at all. I would think it depends on the person. I've broken bones (never my femur knock on wood) and never shed a tear. I have a high pain tolerance to where others do not.

[JakeEMTP]

We had a patient with a separated shoulder. They were administered 100mcg of Fentanyl. They were putting on a brave face until we reached the truck ( didn't want their buddies to see them cry).I have also witnessed someone being extricated from a vehicle with a femur fx without any pain control and handle it well. I can only speculate, but I'd guess the ETOH had some effect on your patients pain level.

As others have said, everyone's pain threshold is different. Patient assessment is the key to know what's really going on.

[AnthonyM83]

Some people just really know how to disconnect from the pain, too, even if sober.

Some just learn it on their own and some have formal training on it.

[Richard B the EMT]

I speak from some pain experience.

When I tore my meniscus, I was getting what I jokingly describe as electrocution therapy, actually Electric Muscle Stimulation, where an electrical current is actually put through the injury site.

I was supposed to be getting a low voltage, cycling up and down, but due to some malfunction, I was not getting any "juice". The tech started top leave to find the senior tech, when the machine gave me the full voltage without the usual "ramping up", and I believe I levitated for a few seconds between the cot and the ceiling!

A few weeks later, I guess due to my acclimation to the voltage, and higher voltage being given at the later time, I fell asleep when the therapy was being administered.

When I had the burst aneurism in my leg, I told the responding EMS crews the pain was, "on a one to ten scale, with ten being the worst pain you've ever had," that I was at an 8 point 7. It was so bad, when I finally relented and accepted the morphine in the hospital, it didn't even make a dent in the pain.

Figure it as kind of like a low blood pressure. Some folks, 80/50 is normal, others, would be fainting. Everyone is an individual, and there (sometimes) is no cookie cutter approach to pain tolerance, either.

[Richard B the EMT]

Also, as Spock would say: "The Mind Rules! There IS NO PAIN!"

This, as comment to Anthony's posting.