Pain Scales

Nurses General Nursing

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Specializes in Emergency Dept, Pediatric Trauma.

I apologize if this has already being posted, I'm days old in this forum...

Pain Scales are used by us constantly, Pediatric Emergency/Trauma Center, yet we get those flat affect, normal vitals, stating they are in a 10 out of 10 pain.

pain is whatever you say it is, but I'm also going to note all the various actions that paint a factual picture of how well you handle that pain...

I'm sure someone here has already posted Hyperbole & a half's pain scale, but I just love it so... and since it's original posting I've used 'being mauled by a bear' when explaining the scale to some.Photo+18.jpg

Brosh's interpretation of the Wong Baker scale:::

0: Haha! I'm not wearing any pants!

2: Awesome! Someone just offered me a free hot dog!

4: Huh. I never knew that about giraffes.

6: I'm sorry about your cat, but can we talk about something else now? I'm bored.

8: The ice cream I bought barely has any cookie dough chunks in it. This is not what I expected and I am disappointed.

10:You hurt my feelings and now I'm crying!

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Brosh's explanation of the more extreme Pain Scale is as follows:::

0: Hi. I am not experiencing any pain at all. I don't know why I'm even here.

1: I am completely unsure whether I am experiencing pain or itching or maybe I just have a bad taste in my mouth.

2: I probably just need a Band Aid.

3: This is distressing. I don't want this to be happening to me at all.

4: My pain is not f*ck!ng around.

5: Why is this happening to me??

6: Ow. Okay, my pain is super legit now.

7: I see Jesus coming for me and I'm scared.

8: I am experiencing a disturbing amount of pain. I might actually be dying. Please help.

9: I am almost definitely dying.

10: I am actively being mauled by a bear.

11: Blood is going to explode out of my face at any moment.

Too Serious For Numbers: You probably have ebola. It appears that you may also be suffering from Stigmata and/or pinkeye.

curious what other's do w/ the cool calm and collected who may or may not be actively eating McDonald's, or who may or may not be crushing candy, or playing xbox in the waiting room...

[Original blog posting:::Hyperbole and a Half: Boyfriend Doesn't Have Ebola. Probably. ]

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Specializes in psych, addictions, hospice, education.

As someone who experiences pain that's at least +4 out of 10 continuously, I say you can't tell what pain a person is experiencing by what you see. You can't even tell by vital signs if the person's body has adjusted to long-term pain. No one can tell I'm in pain most of the time, until it's to the point that blood is about to burst out of my face, taking my eyes with it. My pulse, resps, and bp also stay stable, on the low side. I don't know what they are at the blood-bursting stage, because no one is going to touch me at that point, to take some ridiculous vital signs!

Don't judge by what you see. Talk to the person...

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Specializes in Emergency Dept, Pediatric Trauma.

I'm sorry for your chronic pain condition and understand why you wouldn't find humor in my post.

Yes there are some who suffer such chronic pain that they acclimate to it and are conditioned to it so much so that nonverbal pain indicators and vital signs all appear normal. I'm sorry if you think based on my post that I don't talk to clients based on their behaviors that is certainly not the case

However it is more than widely accepted to note nonverbal pain indicators or lack there of, including vital signs, & pt's behavior

All the best

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Specializes in Critical Care, Education.

I enjoyed your humorous interpretations of the Pain Scales very much. Thanks for giving me a mid day giggle.

We need to be very careful with the way we interpret non-verbal cues because they are culturally bound. Some cultures find it perfectly acceptable to act out with extreme behavior in a public setting -- others, not so much. They could be in extremis, but maintain a stoic expression at all times. Best practice? Just believe the patient.

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Specializes in Emergency.

I have been known to incorporate the bear mauling into my pain question... Kids seem to get it.

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curious what other's do w/ the cool calm and collected who may or may not be actively eating McDonald's, or who may or may not be crushing candy, or playing xbox in the waiting room...

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You should do the same things you do with patients who aren't playing X-Box or eating McDonald's. You should treat their pain at the level they say it is. You stated early on in your post that you know that pain is subjective. Stick with that. Avoid the temptation to add a "but..." afterward.

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Specializes in Emergency Dept, Pediatric Trauma.

Good insight, I document what they say, I document what the parents say, in addition I also document what I see. We utilize the FLACC scale in addition to what is reported, like i said it all paints the picture, sorry if you don't agree w/ that

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Subjective and objective findings are the part of any good assessment.

FWIW, in my ER, a pt's pain rating doesn't have much effect on their treatment. The docs don't read them.

If we actually gave narcotics based on numerical pain scores, and word got out, we would have to hire a whole lot more staff.

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Specializes in Cardiac, Home Health, Primary Care.

I also love the funny type pain scales. I know pain is subjective and I know some learn to deal with it.

I also know some know what to say to get pain meds. There are times a patient says their pain is "15/10" that I want to smash their finger with a hammer and ask if the pain is worse....my bet is it is.

I definitely see where you're coming from. I definitely see where the other PP's are coming from. I'm just overly critical of certain patients because I've had close relationships with drug abusers and have zero patience for it if I can help it. BUT I always know pain is subjective and I'd never withhold pain meds because I was overly critical of the situation. I may roll my eyes when they call but I'd care for them just the same.

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There are a ton of threads on pain treatment on this site. If you truly want to know what some of us do when a patient is calm, eating, and states their pain is 10/10, then use the search function. Search

I do love the funny pain scales, though. I usually ask my patients to rate their pain from 0-10 on the OMG! scale. 0 = OMG! What a great day! 5 = OMG! This hurts and I need some pain medicine. 10 = OMG! KILL ME NOW!!!

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https://allnurses.com/nurse-colleague-patient/pain-seekers-973476.html

Here's a recent thread on pain management that I enjoyed.

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Specializes in Family practice, emergency.
Subjective and objective findings are the part of any good assessment.

FWIW, in my ER, a pt's pain rating doesn't have much effect on their treatment. The docs don't read them.

If we actually gave narcotics based on numerical pain scores, and word got out, we would have to hire a whole lot more staff.

THIS. Femur poking out? Let me get that fentanyl for ya. Car accident 8 years ago? Sorry, not my top priority. I don't question that you're in pain, it just doesn't make me move as fast.

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