Sometimes as I’m interviewing a patient their eyes become big. They turn their heads, distracted, and cry out in pain. I sit still, unaffected, waiting for the episode to pass, as it eventually always does.
Kidney stone pain? Needles? Setting a broken arm? No, these patient’s suffer the torment of the automatic cuff inflating to check their blood pressure.
Even though they might think otherwise, these people have low pain tolerance (LPT). This is useful information, as it immediately becomes far less likely that anything is seriously wrong.
Note: while this test has excellent specificity for LPT, the clinican should recognize that the sensitivity is lacking.
April 11, 2008 at 7:43 pm
Boy, thank goodness I’ve never been your patient! I have a very strong but admittedly irrational fear of tourniquets, and the blood pressure cuff makes me almost pass out. Not because it’s painful, but how would you know that? Anything cutting off my circulation makes me queasy. I may be in a tiny minority but I would sure hate to watch my doctor roll eyes at me with my ‘LPT.’ Since I have had three major surgeries, I have had serial blood draws and BPs quite a lot but my doctors and nurses fortunately have been very understanding, since THERE’S NOTHING I CAN DO ABOUT IT. I know it may be a pain for you, but a little more compassionate attitude from you might make everyone more comfortable. Generally I have enjoyed your blog but that was a little too snide on a subject I feel strongly about.
April 11, 2008 at 8:58 pm
Eden Mackay said “I have a very strong but admittedly irrational fear of tourniquets, and the blood pressure cuff makes me almost pass out.”
The bad news is that your doctors are feigning compassion. I assure you that they are mocking you behind your back.
The really bad news is that they were too weak-willed (undoubtedly beaten by the current climate of medicine) to educate you as to when and where to address your “irrational” medically-unrecognized fear.
I assure you that even more doctors are laughing at you now: Not so much for the fear, but the tragic sickness you share with much of the entitled and immodest society which has bestowed validity to opinion, regardless of merit. Thoroughly deluded, you reach for sanctimony to reply to a physician on a blog.
The responsibilities of being a good patient are lost on you. That is one of probably many responsibilities that are undervalued in your life.
Good Luck, FWM
April 11, 2008 at 9:21 pm
The last time I went to my Dr’s, I was getting my BP tested,the automated machine malfunctioned and just kept inflating…and inflating…and inflating. Now that hurt! I didn’t say anything, but the nurse noticed me gritting my teeth. There ended up being a ring of bruising around my arm. Ouch! =)
Your entry reminded me of that story. You have a very entertaining blog!
April 12, 2008 at 6:39 am
LOL….
Gonna use that one!
Oh,y the way, you LPT folks, if my 88 year old patient with the broken hip doesn’t complain, neith should you.
April 12, 2008 at 7:20 am
WOW some people can have REALLY low pain tolerance I guess…
April 12, 2008 at 11:58 am
It’s all relative. If you’ve got a worse pain somewhere else, you won’t notice the cuff. It’s a good trick!! Worked for me when I had a ruptured ovarian cyst – the nurses catheterized me and I didn’t feel a thing. Genius.
April 12, 2008 at 12:03 pm
We see this all time where I work, and most the time I just put on my sympathetic face and move on.
Now put the cuff on your calf and have someone kink the line until it pumps up to 250 plus…now that’s mildly painful…not that we have nothing better to do then put BP cuffs in weird places. ahem.
-Kim
April 12, 2008 at 12:43 pm
niiiice..I think i will be hanging here alot..
April 12, 2008 at 1:24 pm
Oh, for heaven’s sake. If you have high blood pressure, the cuff inflates higher, and it can hurt. Hurts more if your arm is fat instead of muscular, too. Those of you with normal blood pressure or skinny arms probably don’t know because it doesn’t hurt if your blood pressure is normal or if you don’t have a lot of fat on your arm.
I’ve had the cuff malfunction, too. It DOES start to hurt when it gets up over 180 or so.
My BP this morning was 95/61. It didn’t hurt a bit, because the cuff only inflated to 143.
April 12, 2008 at 2:45 pm
I love it. And, as anyone who has actually worked in an ER will tell you, LPT is a completely real phenomenon (first diagnosed here by 10/10, but nevertheless real).
Yes, I’m sure that if the cuff is inflating to 250 it probably hurts for a few seconds. And, if it were to stay like that for many minutes I’m sure it would hurt even more. But come on, if that’s the most painful thing you’ve got to complain about while in the ER (which, by the way, is a necessary VITAL sign that is actually pretty important) then you may have been better served by going to your family doctor the next day instead.
April 12, 2008 at 3:05 pm
Eden Mackay now has a rational fear of responding to medical blogs.
April 12, 2008 at 5:15 pm
I don’t have a LPT, but I have a low tolerance for medical personnel who publicly tells a group of people, identified by a similar reaction, that they are laughable and deserving of ridicule.
Repress yourself.
April 12, 2008 at 8:16 pm
I have a deficiency in my ability to repress my laughter at LPT ninnies and their supporters.
HAHAHAHAHA.
Sorry.
April 12, 2008 at 8:29 pm
Advice for anyone having their BP measured by a “Dinomapp” : HOLD STILL. If you move the extremity the cuff is on even the tiniest bit, the cuff will keep squeezing and squeezing until your hand (or foot) turns purple and falls off!!!
April 12, 2008 at 11:45 pm
i love this post!
April 13, 2008 at 3:34 am
LPT? Be very careful. I generalised once,and put patients of Mediterranean roots into the LPT category. Left a Portugese mother in labour and went and had a coffee.When I returned the baby had been born in the bed.
Experience as a MD will teach you NEVER to do this.
April 13, 2008 at 10:39 pm
“The trick is not to mind that it hurts.”
An ex-boyfriend told me that once. I punched him, the muppet.
April 14, 2008 at 1:48 am
I don’t know which I’m enjoying more, the post or the comment thread!
April 14, 2008 at 2:25 pm
Hmmm. Glad I’m not your patient too. I hate the bp cuffs.
And the last bp cuff I had (during labor–one of those automated ones) actually broke superficial blood vessels in my arm. That frickin’ hurt and I had red streaks for weeks.
For the record, I can handle multiple IV sticks without a problem (although I like a break around try #5).
A little off topic, I now wonder, after reading all these ER blogs, if everyone thinks I’m an addict because my veins are so bad? I dunno. The anesthesiologist gave up trying to get enough blood to do a blood type during labor.
M
April 16, 2008 at 2:23 pm
That’s hilarious. My wife always complains about the blood pressure cuff. She even nicknamed it the ‘evil cuff o’ death’ while she was pregnant. I bet she’ll punch me after she reads this too.
April 17, 2008 at 12:53 pm
[...] got a chuckle out of Ten’s LPT post, but the comments were even more surprising. It’s called satire, folks. Chill out a [...]
April 21, 2008 at 7:40 pm
you are so right…if the BPcuff is painful, then you don’t even know what real pain is
April 22, 2008 at 9:38 pm
What does it mean when you feel no pain as the cuff is inflating, but you feel a sharp pain in your arm as the cuff is deflating?
April 24, 2008 at 10:11 pm
Oh, good grief.
May 4, 2008 at 2:41 pm
You all are missing the point here. I waited until all the name-callers and self-appointed martyrs finished their condemnation reflexes on the proper behavior to a level of pain as if they would somehow instinctively know such a thing.
The whole point of education is to exceed that level. To learn what it is that your instincts didn’t tell you.
I have stage 4 hypertension and if you think it doesn’t hurt, you are the uneducated. I’ve also had 2 children, multiple surgeries, and have endured my allotment of pain without undue screaming.
The point I’m trying to make is that some patients are attempting to tell you not merely that it hurts, and cut it out, but that the pain represents a sense of urgency that medical personnel need to listen and respond to as information. Not whining, not measly whimpering fools, but medical information that professionals need to listen to and take into account without bothering to pretend to themselves that they know the entire human experience well enough to judge the patient.
The failure here does not lie in the patients failure to suck up pain, but the medical personnel’s failure to suck up information.
June 18, 2008 at 11:53 am
The BP cuff doesn’t hurt me, persay, just makes me slightly light headed and queasy. I too have an irrational fear of anything that cuts my circulation off. The thing I’m most afraid of is a tourniquet.
This fear is so annoying. I’ve tried to get over it, but I can’t. I know the doctors and nurses laugh at and scrutinize me, and I accept that, but it doesn’t change my phobia. It really angers me because I’d like to have normal visits to my doctor without being frightened that she’s going to take my blood. I’ve actually avoided going to the doctor because I knew it was inevitable.
Does anyone know how I can get over this fear? I’d really like to be cured of this. I don’t want to be a ninny anymore.
June 18, 2008 at 11:57 am
The BP cuff doesn’t hurt me, persay, just makes me slightly light headed and queasy. I too have an irrational fear of anything that cuts my circulation off. The thing I’m most afraid of is a tourniquet. I’ve passed out several times while being prepped to have my blood drawn.
This fear is so annoying. I’ve tried to get over it, but I can’t, I don’t know how. I know the doctors and nurses laugh at and scrutinize me, and I accept that, but it doesn’t change my phobia. This fear really angers me because I’d like to have normal visits to my doctor without being frightened that she’s going to take my blood. I’ve actually avoided going to the doctor because I knew it was inevitable.
Does anyone know how I can get over this fear? I’d really like to be cured of this. I don’t want to be a ninny anymore. I’d like to start having children, but I keep putting it off cause I know they’ll be drawing my blood on a regular basis.
Please help.
October 18, 2008 at 11:44 pm
Being a man of science myself, I would recommend caution when attempting to diagnose LPT with just a single measure such as the “blood pressure test”. How much peer-reviewed research has been done into this apparent correlation? Can you give me a numerical confidence interval for the specificity of this measure? Has observer bias been factored out? Have all other possible variables been eliminated? Where are the randomized, double-blind trials?
(Note to L.G. — You might want to find a psychologist who specializes in something called “cognitive behavioral therapy”. There is sound research to support its effectiveness for many anxiety disorders.)
December 20, 2008 at 9:17 pm
What LG should seek out is something called systematic desensitization. Its used for most phobias, and I am sure can be adapted for a phobia of BP cuffs. I know about this because I am a clinical psychology graduate student. Basically, you would be exposed to wearing a bp cuff inflated to gradual degrees, and during this exposure your anxiety would go down over time, and you would come to associate less anxiety with the bp cuff. This is fairly inexpensive and very effective. I would reccomend looking into it.
March 8, 2009 at 11:35 am
LOL! I love it! One of my fave 10/10 posts!
March 9, 2009 at 10:27 am
I would have to agree that if the most of your worries is the BP cuff that is going “so high” you will immediately be laughed out of the ER or office.
March 10, 2009 at 1:09 am
Really?????
Umm Now let’s put the “unbearable pain” of the blood pressure cuff in relation to the 25/10 pain rating that you just gave for your headache,bellypain,ankle pain………
All while talking on your cell phone, eating cheetos, and sipping a soda.
This while your 3 friends who came in with you advise me what a HIGH pain tolerance you have……
The comments above are as funny as the original article. It is obvious how many have actually WORKED in an ER.
March 12, 2009 at 6:37 pm
I think it’s hilarious, and yes I work in an ED. If people are more worried about their blood pressure cuff, friends, food, cell phones, text messaging, something to drink, etc. Then it really doesn’t hurt that bad
June 8, 2009 at 10:11 pm
I came across this site when I was trying to find out if my “problem” was an actual “phobia” or not. I do not have a decidedly low pain tolerance, in fact, I find nothing about BP cuffs or the like “painful” whatsoever. Being fairly young, I’ve had limited personal experience in hospitals (thankfully). The only thing I have to go on is the fact that, when anything cuts off my circulation in any way, I can only stand it for a brief moment before I start hyperventilating. Over time I’ve been able to “control” it a bit, but if it goes on for longer than just a few moments, I tend to have a panic attack. This is the only thing in my life that’s ever caused this, and it’s particularly odd because in general I’m a fairly laid back person. I can’t handle something as simple as a rubberband just on my wrist… I even can’t wear my wedding ring if it’s hot enough outside for me to feel like my finger may swell up. It’s ridiculous and I feel like the only person on the planet like this. Outside of having to go into therapy for the rest of my life, can anyone tell me what this affliction is, and how I can finally be rid of it? I would appreciate ANY response, as long as you’re not just telling me I’m “overexaggerating” like so many others have throughout my entire life. Thanks!