Anyone else frustrated by the pain scale??

[gomerblog]

I can't stand when I get the 10 out of 10 pain patient and they are just looking at me. Ahh, yeah if you were really 10 out of 10 pain you should be rolling on the ground!!

[THELIVINGWORST, ASN, RN]

Although dealing with drug seekers is frustration, pain is whatever the patient says is is

[BloomNurseRN, ASN, BSN, RN]

Not really. I had a patient who had been in a motorcycle accident, which of course included extensive injuries. She regularly was able to lay calmly in bed (I saw her prior to surgery, as her back surgery was scheduled for later in the day), fairly relaxed from my perspective but when asked about her pain she called it a 10/10. Given that she had numerous broken bones, already had one surgery for her broken arm, and had multiple broken discs in her thoracic spine, I had no doubt of her pain level. Everyone deals with pain differently and reacts differently.

I can also remember labor with my daughter. I was able to stay relaxed and calm through contractions when I was on my hands and knees but it was definitely 10/10 pain. To someone else I might have looked like I was barely have a contraction.

My point is that pain is pain and we have to go by what our patients tell us, not judge them.

[ambitiousBSN]

I would always wonder what could possibly be 10/10 when they're laughing, joking, etc. during assessment and/or vitals, but pain is pain- and whatever the patient says, goes.

[mbkgen]

I agree with Bloomgirl118, everybody reacts to pain differently. Some shout while others remain calm.

[HouTx, BSN, MSN, EdD]

PPs are absolutely correct - pain is whatever the patient says it is. I do understand that many nurses - particularly those in ED - tend to discount the claims of patients who have been characterized with "drug seeking behavior". But their assessment of patients on long-term opioids or other pain meds may not take into account the phenomenon of Hyperalgesia.. It is well documented that long term pain meds may actually LOWER the pain threshold and increase suffering. Here is a link to the info Opioid induced hyperalgesia: clinical... [Pain Physician. 2009 May-Jun] - PubMed - NCBI

[mclennan, BSN, RN]

I am extremely stoic about pain. It probably has something to do with my ethnic heritage, I dunno. But I have a bunch of stones in my left kidney and pass a boulder or two once or twice a year, usually resulting in an ER visit. I am very quiet and still, very calm. My pain will be 20/10 and I don't make faces, grimace, cry, howl or scream. I have a very flat effect when in that kind of extreme pain. I sometimes will even smile. People who know me well say I get very quiet and hang my head, that's the only sign I give of being in pain. It was like this when I was in an accident and broke my collarbone and shattered my left hand, too. So yeah. Pain is the most subjective thing in the world. Not everyone pulls theatrics.

[CalRNtoBe2013]

One of my very first clinical instructors used to say, "pain is perception and perception is reality". That has stuck in my head the whole way through NS. it has helped me stay non-judgmental about how a patient experiences pain.

[melizerd, ASN, RN]

Your 10 and my 10 are not the same so the "worst" pain I've ever felt isn't necessarily enough to make me "act" like you think I should in pain. Especially in someone with chronic pain visual cues are completely unreliable, even vitals don't change for chronic pain but that doesn't mean it isn't what the patient says it is.

My brother broke his femur, that was a 10... but I haven't ever broke a bone, so my 10 is tiny compared to him... Because pain from one person to another has nothing to do with the last person, or the next person. It's very individual.

I have no problem with people telling me pain is an 8,9,10 and still being able to talk to me, or read a book etc, distraction can help. It is what they say it is.

[MrChicagoRN, RN]

Ever go to a fast food place where a small soda is 8oz & a large is 20oz, then go somewhere else where a small is 16, the large is 32oz?

I give my patients a frame of reference:

"How would you rate your pain on a scale of 1-10, with 1 being little or no pain, 5 is moderate pain, and 10 is the worst pain you've ever had...or could imagine".

At least then we're talking the same language.

[lovinlife11]

Ever go to a fast food place where a small soda is 8oz & a large is 20oz, then go somewhere else where a small is 16, the large is 32oz?

I give my patients a frame of reference:

"How would you rate your pain on a scale of 1-10, with 1 being little or no pain, 5 is moderate pain, and 10 is the worst pain you've ever had...or could imagine".

At least then we're talking the same language.

Love this comparison!!

[emtb2rn, BSN, RN, EMT-B]

While pain is what the patient say it is, this is the real pain scale chart. We have a copy hanging in the doc's dictation room.