Do you think the pain scale is accurate?

BlueEyedRN · Sep 20, 2006

I have a little different slant to this issue. Since it has been decided that assessing the pain of EVERY patient is paramount, we have added a variation of the pain scale to our neonates. Now, call me crazy, but unless the neonate has had surgery, had a traumatic delivery with a lot of bruising, etc. for example,would you expect for a typical say 34 wk infant now 2 weeks old to have "pain"???? I mean, growing pains maybe (hehe) but pain???
any thoughts on this???
I think they took a good idea a little too far...
topkat

I don't get what you mean. Reflux, gas, circumcision, shots, blood draws. Isn't this why we have the FLACC scale?

scribblerpnp · Sep 20, 2006

"I've been living with this pain for 14 months, and it has increased steadily since my last surgery. The way he phrased the question was, "with zero being absolutely no pain, and 10 being the worst pain imaginable, what's your pain right now? And what is your average pain on a 'normal' day? What is the level of pain that makes it impossible to carry out basic ADLs? What is the level of pain that you believe would allow you to do the things you want to do?"

I've not heard it phrased this way before, and I liked it- my answers were 7.5/6.5/9/3. For a chronic pain patient, the fact that they may have drastically changed their lives because of pain often overlooked in the pain assessment. Thus, at 6.5, I'm able to drive to work, walk from my car to the elevator, and that's about it- but that's how I function daily since the pain got so bad. I can't drive at 9, and at 3, I would be able to hike, shop, etc. Personally, I don't know that I can even imagine a pain-free state, as it's been so long since i was pain-free; I also think that most chronics don't really expect to get to 0, realistically."

Where I work, this is a common way to assess chronic pain. It is included in our assessment paperwork on the computer. If the pt answers "yes" to chronic pain, we automatically get these questions plus about 10 more that ask the pt to decribe their pain, aleviating factors, occurences, etc. It really does help put their current pain in perspective, if they the are not med-seeking and honset.

BlueEyedRN · Sep 20, 2006

OK this is MHO, but does it really matter if it is a 10 or a 3 if the patient needs to be treated pain, isn't knowing they are in pain enough and treat it? Maybe it is different for chronic pain, I work on a surgical floor, and I don't like having them rate it if they hurt give them pain meds are we going to say nope not high enough on the scale can't have any. my scale it hurts, tolerable, no pain, see how simple :)

Exactly. The pain scale isn't supposed to be accurate. It's just supposed to be a way for the patient to say, "it hurts like hell, please help me." It's subjective and the numbers mean nothing except what the patient says the mean. When I have a patient laying there watching TV who says that his pain is a ten, I'm not going to think he's stupid because I've given birth and my ten was a lot worse than his ten. I'm going to try to do what I can to control that pain. I really don't think we should say "worst pain imaginable like having my arm torn off." Or course it doesn't hurt like that (unless their arm has been torn off). You can't try to set the scale as some universal measure. I like the pain scale just because it helps patients think about how bad it is and what they need and so helps them to be more proactive in their own care. Plus it gives me something to chart.

Tweety, BSN, RN · Sep 20, 2006

But is that a fair assessment? Kidney stones are the worst pain I have ever had, but they weren't "you wish we would take you out back and shoot you to get it over with" bad. So, if I rate my pain at a 6 because it isn't "you wish we would take you out back and shoot you to get it over with" bad, I get toradol, when what I really need is morphine?

Gee, I don't want to work with you. A six will get you morhphine where I work. :)

But you're right, and have some valid concerns for accuracy, people's perceptions of pain change with their life experiences.

The reasons we're so keen on the pain scale, JACHO, etc. is not to decide if a patients in pain and what he needs, but primarily for followup. This is where we've let people down in the past. We've always been free with the pain medicine, but we never cared if it worked or not. The pain scale is a great gage of effectiveness. "You said a 6 30 minutes ago, what is is now?" This holds us accountable for calling for more pain medicine or other interventions (rather than the 'sorry your pain meds not due for 3.5 hours"), or we know it's working just fine.

RunnerRN, BSN, RN · Sep 20, 2006

I love when a woman will come in and say "10/10 - it is so much worse than my labor!" The next (appropriate) question is "did you have an epidural?" But of course that will never be asked!!! I know people have pain, and pain is the big reason people come to the ER (chest pn, abd pn, HA, etc etc) but if every drug seeker who came in rating 10/10 and smiling was given morphine(HA who am I kidding...Dilaudid), our WR would be even more backed up than it already is.

Not trying to turn it into a drug seeker thread. I do think the pain scale is good for what it needs to be - a way for the patient to communicate his/her pain, AND if the interventions have helped. It really does help if someone can say their back pn went from a 6 to a 3 after a little Toradol.

Pain scale pet peeve?! "0-10? My pain is a 15." That drives me insane. You don't get extra points for going over 10....you don't get into a room faster for being 15/10 instead of 10/10.

Also, I love the NIPS and FLACC scales. I think they give you a pretty accurate idea of if the kid is in pain - or at the very least is really unhappy!

Agnus · Sep 20, 2006

I've been reading some other threads and talking with some of my coworkers lately and it makes me wonder how accurate the 0-10 pain scale is. I've heard nurses describe '10' as being the worst pain you could possibly imagine or the pain you would feel when you have your arm ripped off...is that fair? I've had migraines that were the worst pain I have ever had, but not the worst pain I could imagine...so does that make them only a '6' on the standard pain scale? Was I wrong to rate the pain at an '8' or '9'? I had a kidney stone that made my worst migraine seem pretty mild...does that mean that next time I get a migraine, I can only rate it at a '3' or '4'?
I've never been comfortable with the 0-10 scale...people's pain tolerance is so different and what is a '3' to me might be what a '10' is to someone else. I think I like the Wong-Baker Faces Scale better...it seems easier to pick out a face that describes how you feel rather than trying to put a number on something.
I know both are just tools, but it seems to me there should be a better system...if anyone wants to invent a machine that could determine the actual level of pain, I would be happy to try it out.
:)

I've only read the original post.

Heck no, to your question. I do not know how to rate pain based on that scale. I think it is false and arbatrary and is used in manipulative ways by both patients and nurses and doctors.

I believe it has nothing to do with so called pain tollerance. It has more to do with pain perception. It is possible to be in pain and preceive it as something else. (personal experience)

I beieve the scale is used more in terms of what am I going to have to say to get adequate pain relief, or to avoid being over medicated, etc.

I get a better picture if the patient describes thier pain in more discriptive terms. The pain scale was suposed to give an "objective" measurement to pain but the truth is there is NOTHING objecive about it. it is not only subjective but the least accurate measure of pain in my opinion.

Many patients even after explaining the scale to them stare at you blankly. I understand why. I would too.

But good ol JAHCO in its infinite wisdom had declared that this is the standard and now everybody, insurance, lawyers, everybody expects us to use it faithfully even though it does not work.

A discriptive statement by the patient coupled by objecive observations of s/s by the nurse go much further in determining pain.

Agnus · Sep 20, 2006

Scribblerrn, I think that is very good asking specific questions about how the pain limits your activity. That probably gives the most accurate picture.

In fact I experienced those questions from my chiropractor after an injury. And you know I gave better more accurate answers to those questions than anything else. I also helped clarify for me just how bad my pain was.

fgoff · Sep 20, 2006

I've always asked the question differently "Please rate your pain now: 0 no pain -10 the worse that this pain has been?" I've not asked the patient to compare the pain to other painful episodes???? Did this still meet the standard intent of pain assessment????

Agnus · Sep 20, 2006

scriblerrn, now that you mention it, I was asked very specific questions about how the pain effected various activities, after an injury a few months ago by my chiropractor. Not only are they objective ( I can't stand for more than 5 minutes." "I cant pull a tee shirt over my head. I cant shower but can do such and such. etc) but they also clarified for me how bad my pain was and how much it improved.

Now that is what we should be asking. I loved the pediactric patient who was hunched over and moved very gingerly to go to the BR after abd surgery tell me she had no pain. and said it was "just a little sore" when confronted directly about the signs of pain she displaied .Then the adult across the hall who was also my pt. who whinned her pain was constantly a 10 yet walked out to smoke.

Wanted to slap her up side the head.

TazziRN, RN · Sep 20, 2006

Well, the pain scale is meant to state the pt's pain, not yours, so yes, a 3 for you could be a 10 for someone else. I used to not find it accurate unless I used the faces, but I found a way that seems to work for me. If someone comes in with a headache I ask "With zero being no pain and ten being 'someone is hitting me on the head with a hammer', where is your pain level?"

Tweety, BSN, RN · Sep 20, 2006

I've always asked the question differently "Please rate your pain now: 0 no pain -10 the worse that this pain has been?" I've not asked the patient to compare the pain to other painful episodes???? Did this still meet the standard intent of pain assessment????

In my opinion, no.

On admission we ask them "what's the best it's felt, and what's the worst". So we can get a feel of what to do and what works and what doesn't. And that's a good idea.

Asking some to rate the worst their pain based only on this experience isn't necessarily a good idea. Someone who just had a bunion removal is going to say it's a 10 because it's hurting the worst it's every hurt, but in reality it's really only just a mild pain that a tylenol would fix. Not a good example I know.

It's all subjective and inaccurate. It's just a tool. Working in trauma I'm amazed at the differences in people in their response to pain. For example I get a lot of femur fractures which is a horrible acute pain, two days later one guy is still a 10/10 and refuses to move and and another is a 2/10 going home.

topkat, ADN, RN · Sep 20, 2006

I don't get what you mean. Reflux, gas, circumcision, shots, blood draws. Isn't this why we have the FLACC scale?

yeah, but they do a pain assessment every 24 hours??? doesn't that seem a little over the top??? maybe I'm wrong, but I just don't see it as needed that often for a neonate. and we do use a modified version of the FLACC scale BTW...topkat