Adequate pain relief

Whilst on my cardiopulmonary prac I was treating a 65 year old gentleman who was a day one post Whipples procedure. He hadn't been out of bed yet and my supervisor came with me to provide assistance. Before we began I read through his notes to gain some idea of his PMHx and had a look at his CXR which was clear. The pain team had seen him just a few minutes earlier and I had read in the notes that he was 0/10 pain at rest and 2/10 pain with movement.

I introduced us both and told the patient we were going to get him up for a walk which caused him to begin yelling at us and telling us we were 'crazy'. We tried to explain that it was normal for people to get up the first day after their surgery but he didn't believe us. Finally he consented to sitting out in the chair. We began a two maximal assistance transfer to sit him over the edge of the bed but once we began he started screaming in agony and crying. Upon enquiry he said he was 11/10 pain. We called over another physio and were able to get him back into bed.

He told us (not very politely) to go away and said we could never come back. He seemed to associate physiotherapy with pain, and thought that we were causing him pain. As much as we tried to reinforce that his pain relief should have been enough to enable him to get out of bed we were unsuccessful. My supervisor liased with the pain team and explained what had happened, asking them to reinforce that physio is important and shouldn't be as painful as it was for him. This experience taught me that you can't always trust everything that you read in the notes. I was unaware before this that the pain score with movement reported by the pain team didn't require the patient to move and then report a score. Thus, it wasn't an accurate representation of what the patient really felt when he moved, causing major problems when he did move. Also, I learnt how important the very first treatment session is with a patient, and how easily impressions can be formed, whether positive or negative. In future I will explain to the patient before we begin that the pain relief should be enough to allow him to get out of bed, as he wasn't very receptive to this concept (or anything we said) after the fact.