how to ask patient for pain scale score correctly?

tewdles, RN · Sep 4, 2012

If the patient is cognitively able you assess for a numeric level of pain...1/10. If they are not able to quantify using a number you may use the faces or you may use other verbage; like quantifying it by "a little pain" (1-3) "moderate pain" (4-6) or "a lot of pain" (7-10). As well there are tools, like the PAINAD, for use with adult patients who are unable to verbalize their level of discomfort.

In my line of work it is also important to document the type of pain (ie: visceral vs. neuropathy for instance), the location, the frequency and duration of the pain, and the history of pain (is this new or chronic?). Additionally, for patients who can speak to us, who are cognitively intact, it is important to understand what their goals are relative to discomfort. What level of pain is acceptable to them? In the hospice setting we will treat the pain of a patient at 4 or higher UNLESS the patient has identified a different goal or target for the POC.

Sometimes elderly patients do not equate "aches" with "pain". Sometimes we can see evidence of discomfort but the patient is saying "no". When we change our language we can occasionally get to a better understanding of the patients experience with pain.

Pain is on the radar for most health care settings, so documentation is a VERY IMPORTANT piece of your role.

Good luck.

Always_Learning, BSN, RN · Sep 4, 2012

well,you know sometimes there's kind of patient felt uneasy being questioned for the pain score.
sometimes i get scolded because asking for score.

I'm not sure why you or the patient would feel uneasy about assigning a pain rating, but if so, you can always educate the patient on the purpose behind pain ratings: they enable us to tell if subsequent pain relief measures were (in the eyes of the patient) effective or non-effective. Not sure why you would be scolded, but asking the patient about their perception of pain (not ours) is generally a good thing.

That Guy, BSN, RN, EMT-B · Sep 4, 2012

It is whatever they say it is. I say 10 is getting squeezed out like a tube of toothpaste as a steam roller is running over you.

And yet they still say their pain is a 10.......sigh

tewdles, RN · Sep 4, 2012

It is whatever they say it is. I say 10 is getting squeezed out like a tube of toothpaste as a steam roller is running over you.
And yet they still say their pain is a 10.......sigh

Of course, it is their (the patient's) pain experience that we are trying to assess, not ours...

wannabecnl · Sep 5, 2012

I must have asked this question at least a thousand times as a student in the PACU; we did 15-minute assessments and had to reassess for analgesia effectiveness, so it was a frequent discussion. With 6-10 patients per shift over 15 weeks, I think I had about six patients total who just could not get the analogy; the rest were fine. We did have to use the FLACC scoring system when patients came out of the OR too disoriented to answer questions. Generally, if they were sleeping peacefully, with no grimacing or guarding, we scored them a 0 and documented that they were asleep.

I like the idea of using Wong-Baker faces with people when the 0-10 scale just isn't working for them. We use it in pedi recovery more than with adults.

However you end up wording this question, be sure you ask it and document what they tell you. As another poster said, the Joint Commission is VERY big on pain management, and nurses are supposed to assess, treat, and reevaluate pain regularly and within specific time frames depending on the department and type of analgesic. And don't forget to document, document, document! If I have a patient who is reporting 10/10 pain but has a resp rate of 5, no way are they getting any opioids until they wake up some more! But I have to document that decision and continue to assess them.

wannabecnl · Sep 5, 2012

And for a little humor, check this out. To focus on pain assessment, fast forward to 4:20, but the whole thing is pretty funny.

http://www.youtube.com/watch?v=cP4zgb9H3Cg

schroeders_piano, RN · Sep 5, 2012

With me it was dependent upon how many times I had seen them in the ER that month. If it was their 20th visit for HA, backache, abd pain, etc. I would say, "On a scale of 0-10 with 0 being no pain and 10 feeling like you were ran over by a semi truck and then lit on fire, how would you rate your pain?"

If they responded "15" or whatever number above 10, I would say to them, "I'm sorry sir/madam, but 15 does not fall between 0-10."

Honestly, I think the whole 0-10 numerical pain scale is ridiculous. A lot of people don't understand it. And then there are people like myself, who could have tears running down their face and not able to stand up straight because they hurt so bad that would still rate their pain as a "1 or 2".

I worked in an ER that used a behavioral/non-verbal pain scale for adults and it worked a lot better than a numerical scale.

emtb2rn, BSN, RN, EMT-B · Sep 5, 2012

I often uae the classic "on a scale of 0 to 10, with 0 being no pain and 10 is you're being mauled by a bear, how would you rate your pain?". I also document what the pt is doing/how they appear to go along with the rating. So, pain rated at 10/10 with "pt resting on stretcher, watching tv, talking with friend, nad"

MrsNurseMom · Sep 5, 2012

well,actually in our center pain scale score just been practiced and i'm still a young baby in getting pain scale score..and i even do not know / not confident in asking patient that in pain for their pain score.sometimes i get scolded because of asking for 'how much pain does he/she suffered'...
can you'll guys give me some 'nice' way of getting pain scale score?because i know you'll expert in this..
thanx![/quote
I establish a 'common scale' with my pts so that we understand each other and I can treat their pain appropriately. Here is the basic form I use to explain the pain scale when I take on a new (to me) pt. "I want to understand what your level of pain is and what you find tolerable so that I can give you the best possible care and relief of your pain. You've probably been asked many times what your level of pain is 0-10 but I'd like to make sure we understand each other. 0 pain means no pain, 1, 2 or 3 is a level of pain that you'd take a couple of tylenol or ibuprofen for and/or lay down for a bit and it would resolve. Many people find a pain level of 1 or 2 and even 3 tolerable. A pain level of 4 or 5 would lead you to make an appointment to be seen by your doctor/dentist/massage therapist in the near future. A pain level of 4 is appropriate for prn pain medications on our unit. If you're having a pain level of 5 or above after prn medications that warrants a call to the provider to look at modifying orders for more effective pain relief. A pain level of 6 means it is impossible to rest and a 6 might lead you to urgent care, a level of 7 would likely result in a trip to urgent care or the emergency room. People describe pain that is 8, 9 or 10 as similar to childbirth, kidney stones, colitis or a severe migraine. Pain at this level will often cause a person to breath in a rapid, shallow manner, but not always. Your heart rate and blood pressure may be elevated, but not always, so I want to be able to correctly assess you to give you enough medication and other measures to relief your pain without over medicating you. A pain level of 8, 9 or 10 is intolerable to most everyone and interferes with rest, healing, emotional health and physical therapy. Our goal is to help you recover from your surgery/injury/illness and appropriate pain management is part of that process." I don't read this or recite the whole thing - this is an overview and I touch on some points with each pt and describe the levels to each pt. I hope this helps someone, it has really helped me to understand my pt's pain.

Meriwhen, ASN, BSN, MSN, RN · Sep 5, 2012

"0 being no pain and 10 being the worst possible, what would you rate your pain right now?" Whatever number they give is the answer.

If they can't decide on a number or say things like, "it's not too bad, it hurts somewhat, I'm dying, etc.", then I'll use that plus what signs I see and guide them a bit towards a number, or at least a mild/moderate/severe range. Sometimes people really don't know how to answer that question. I know I didn't before nursing school. No matter how bad the pain was, my answer never went above 3 or 4.

If they still can't or won't rate, then it goes in the chart as "patient unable to rate pain d/t (whatever), patient verbalizing/exhibiting (whatever)...." We even have an "unable to rate" pain option on the scale in the computer charting, with room for an explanatory note.

dudette10, MSN, RN · Sep 5, 2012

Being a recent patient in pain, it is sort of difficult to use a pain scale. With movement, I had rated my pain as an 8, but at one point, I had a flare of pain that just kept throbbing. You know, the kind of flaring that is similar to putting your hand under hot water. You remove your hand, and you wait for the "flare" before the pain goes away all together. At that point I felt this flaring pain, I also thought, "My previous 8 was too high compared to this," but 10 was the only number left for me.

That said, as a nurse, you do the best you can. A lot of PPs have given the answer I give during pain assessments: 0 is no pain, 10 is the worst possible pain ever. If they seem hesitant to give you a number for whatever reason (I think it's because *they* think I won't medicate them properly), I say, "You have a variety of pain meds available to you, and the number you give me helps us pick the right one together to manage your pain. You have X, Y, and Z available. Can you give me a number and let me know which pain med you would like to use at this time?"

7feetunder · Sep 5, 2012

I asked "can you please rate your pain for me? if 0 was no pain and 10 the worst you ever had, where would you put your pain right now?"
our clinical site has pain rating charts in each room velcro'ed with other lang's (Mandarin and Russian I think) on it, as well as the Wang-Baker Faces pain scale. I once pulled it off for a mildly demented patient because she could not answer 0-10. She pointed to the appropriate face and I put it back on the wall.

thanx!

this is very helpful for me