David,
You bring up some interesting points. Assessment of pain and function are not easy compared to temperature, heart rate, or blood pressure. One objective measure I use is the patient's weight. The pain medication allows them to improve their daily function and activity and this should work towards being able to have some weight loss and conditioning.
Ask this,"How is the patient's life better on narcotics than not?"Feeling better just doesn't cut it. Example, 2 obese people are are sitting on a couch watching Opera, One has been prescribed narcotics and the other has not. What's the difference? Answer-One is taking narcotics and the other one and is not.
Maybe all the needle jockey's don't prescribe narcotics because it's too difficult.
The numeric pain score is unique to reach patient. I don't use it to compare 1 patient to another. Everybody's pain response depends on multiple variables such as age, race, sex, ethnicity,
family and social upbringing, and prior pain experiences.
Some patients present with pain complaints and on exam there are no abnormalities. That's why I also like getting plain old x-rays sometimes. When you see the railroad spike in their chest, you can understand why they might have some pain.Some endocrine and metabolic abnormalities can cause diffuse pain and boy are they hard to pick up.
Also if the pain seeking behaviors improved with treatment or disappear altogether, then you must be on the RIGHT track.
Again, treating pain is not easy.
Nate
