<A pain scale isn't needed
when you see the client breastfeeding because most clients cannot hide
their pain.  Pain scales may work well when pain medications are used to
relieve that pain.  But for those of us who cannot dispense pain meds,>

To belabor a point:

I don't think the value of a pain scale is only in relation to pain meds.
It is simply one proven communication tool, an amplifier for meaning,
with relief as the end goal.

Semantics is so tricky at times. I find so often that what a mother says
does not reflect accurately  what's actually going on, because her
understanding, her interpretation, and her choice of words therefore, is
limited. And when I explore the situation more with her, I feel the need
of more terminology to place myself closer mentally to her particular
physical reality at that moment.

I discussed this last evening with one of my oldest and dearest LC
friends, who knows me and my way of thinking. She says that when phone
triage is the only option,  she simply asks the patient to define her
pain as "Is it  'squinch your eyes and take a deep breath pain', or is it
'clench your teeth and curl your toes' pain?"

That often makes a difference in determining a cause and selecting an
intervention. NONE of it should be ignored, but unless appropriate
interpretation and/or interventions are selected, the pain is thereby
prolonged, and often, continuation of breastfeeding itself endangered. So
many HCP's have not yet learned how to make a distinction between the
many variations of pain and their probable causes (e.g. thrush).

I see this as a window of opportunity to reach the busy hospital  or
office nurse or pediatrician or OB or FP doc, etc. many of whom have
probably never experienced this sensation personally or thought it
through to the degree that some LC's have. They seldom have the luxury of
the time or the insight it takes to do the detective work, or the people
to whom to refer.

I see the scale as having potential value as a communication breakthrough
(and heaven knows, we LC's are really trying to bridge the gap with the
larger HC community). I believe that by introducing it into OUR
literature as a communication tool that WE can learn to understand and
apply WHEN AND IF we choose, we can capitalize on what many of them have
already incorporated into their thinking.

By using a system that has already been widely written about in other
specialty literature, and adopted as valid in other health care fields,
we "accept them where they are" and adopt a more multidisciplinary
approach. It's a version of "If you can't beat 'em, join'em", I suppose,
but if we can improve overall care for mothers and babies, it's worth my
distilling my thoughts and writing about.

Enough said here. I promise.

K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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