Pain Management Pain Scale

I have always used the 1 to 10 pain scale as a nurse and as a patient.
As a nurse, I find that some patients are resistant and I have to explain the rationale behind it. Once they understand that it's for consistency and takes out the equation of healthcare professionals interpreting (or misinterpreting) their pain, they are usually very cooperative.

As a patient, I did find it annoying sometimes, so I think nurses should be aware that this annoyance can happen and be prepared for it. If I sense that this may happen, I used to say to the patient something like, "it's that pain scale time again," or something to lighten the mood a bit, rather than just launching in to the pain rating question.

If I could, I would use the Face Scale to determine what the patient's pain score is instead of using their self-report.


"No, you don't have a 10/10 pain. This is what a 10/10 looks like." [points at end of scale]


http://www.anes.ucla.edu/pain/FacesScale1.jpg



Another thing I like about this tool is the descriptions used for the different ratings. A 10/10 is "worst pain imaginable" and "requires bedrest". Lower pain ratings have descriptions like "interferes with concentration" or "interferes with basic needs".

I used facial scales when people can point to the face that most resembles their pain, for children or patients who can't talk. I would never judge a patient's pain by how *I* see their facial expression. I am in a lot of pain a lot of the time, but you could never tell by the way I look because I've learned to mask it very well.

[wipes dust off thread]


I know that when it comes down to it, the patient's subjective score is the best indicator we have about the quality and quantity of their pain, but in some cases, it is not very useful.


For a scale to be useful, the parameters of what the endpoints mean needs to be understood by the patient. If it isn't, or if the patient knowingly over- / under-reports their pain, then the pain scale fails to be a useful tool.

It might be out-of-the box a bit, but I like to relate the pain scale to the PRE [perceived rate of exertion] scale that I used as a personal trainer. With the PRE scale, a 10/10 was a level of effort that the client could only sustain for 10-20 seconds - after that, they had to slow down or change what they were doing. Now using this analogy to the pain scale, a 10/10 would be a level of pain that could not be tolerated for long - the patient would have to respond in some manner to decrease it. Granted this perspective works better for acute pain...

A famous acupuncturists intentionally positioned his office so that he could see patients walking in from the parking lot. In addition to a bunch of esoteric 5 Element stuff this supposedly tells him, it also allows him to see how much the patient's pain actually affects them when they think nobody is watching them.


Back to the topic. It might be a failing of mine to desire that all patients understand the mechanics of the pain scale in order for them to report a more accurate measure of their pain, but from my perspective, it is hard to show improvement via their reported score if the endpoints aren't the same. A 5/10 one day might not correlate to a 5/10 the next. Thus, I like to use objective measures such as the facial scale to help corroborate what I am being told.