Quote from clemmm78
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.