Deer in the headlights pain assessments

[rn/writer, RN]

Getting a patient to use the numerical pain scale should be easy, right? Pick a number from one to ten with one being just a little bothersome and ten being the worst pain you have ever felt or imagined. Seems pretty straighforward to me.

But my patients sometimes look at me as if I've asked them to add the square roots of their children's birth dates and round to the nearest hundredth.

They stare at me and scrunch up their faces as if this is a scary pop quiz and they don't want to get it wrong. After a ten or fifteen seconds of agonizing, I get answers like, "Not quite a four and a half," or, "sort of a six," or, "somewhere between a two and a seven."

We all know about the 10/10 folks who want every prn measure available the second they can have it. But this other group seems really cowed by the complexity of the question. I've seen the same expression on people who have just been told they have to do a dozen algebra story problems. I feel for them. I really do. Sometimes I have even said, "Don't put yourself into a tizzy over this," and reassured them that they aren't being graded. Not even on a curve.

When I offer the pain faces as an alternative, I'm not sure if the face they pick matches their actual medical discomfort or if they are expressing the psychological intimidation they feel about having to choose the exactly appropriate not-so-smiley face.

It's not a big deal. We work it out and they get the meds they need. I'm just periodically amazed/amused at the overwhelming burden picking a pain face or number seems to put on some patients. Makes me wish I could offer them some light sedation before putting them through the ordeal.

[DookieMeisterRN]

It makes me think that this group of people must be so co-dependent that they've totally stopped validating their own feelings or even recognize them because they've been so wrapped up taking care of someone else. Not healthy at all.

[rn/writer, RN]

I wonder if it has something to do with freaking out because numbers are involved. There are an awful lot of people who don't like anything connected with math. So, even though there isn't any calculating required, just the mere mention of numbers is enough to make them uncomfortable.

But then you'd think they'd respond better to the pain faces, and they don't.

Maybe I should give them a ten-minute warning so they can work through the emotions first.

[DookieMeisterRN]

Those people that have a hard time assigning a number to their pain I just ask for a descriptive word and see where it corresponds to the faces scale. No point in traumatizing them any further by asking for something that clearly they can't handle.

[classicdame, MSN, EdD]

patients cannot respond because the scale is too subjective. They are wondering what you WANT them to say, or what is the best answer that will get me some meds. The scale is totally up to interpretation and yours may not be the same as the patient's. As I see it, the number is just there to gauge whether or not your interventions are working. So it does not matter if you start at 5 or 10. What matters is did it come down. Remember, you are asking them to assess their own pain. THEIR perception, not yours.

[sapphire18]

LOL! So true:yeah:

[Been there,done that, ASN, RN]

A prime example of why bureaucracy does not work ..

when working with people and people in pain.

Of course they are confused... they are in pain and looking to you for relief.. not give them a number!

I merely ask if this pain is any different.. and,would you llike something for pain?

Then there are those that are always 10/10... but that is another thread.

[redhead_NURSE98!, ADN, BSN]

I swear I think some of them think that if they don't give a high enough number we're not going to give them the pain medication.

[GitanoRN, BSN, MSN, RN]

unquestionably, i go through the same situation every time i use the pain scale. however, what really irritates me is when i come back & they are on their cell laughing with their friends, and the moment they see me they act like they are in this horrible pain :flamesonb

[wooh, BSN, RN]

They are wondering what you WANT them to say, or what is the best answer that will get me some meds.

Sounds like how I always feel when I go for an eye exam. "Which one is clearer, 1 [click] or 2?" And I always wonder if I got it "right.":lol2:

All that matters is, "Did it come down?" which could easily be ascertained by, after the pain med should have worked, asking, "Did it come down?"

[AnonRNC]

:) You write a nice story. :)

Unfortunately, I am one of those patients. I can tell you quite certainly that labor was a 9. But after that, it's confusing. For example, I once sliced open a finger and needed stitches. It hurt like a 7, but it was only a finger, so it was really only like a 4. I guess need a way to curve down painful, but small things.

[cayenne06, MSN, CNM]

:) You write a nice story. :)

Unfortunately, I am one of those patients. I can tell you quite certainly that labor was a 9. But after that, it's confusing. For example, I once sliced open a finger and needed stitches. It hurt like a 7, but it was only a finger, so it was really only like a 4. I guess need a way to curve down painful, but small things.

Yes, as a patient I have always disliked the pain scale. It is way too subjective! I know it is the best we have, but I find it annoying nonetheless.