Do you think the pain scale is accurate?

  1. I've been reading some other threads and talking with some of my coworkers lately and it makes me wonder how accurate the 0-10 pain scale is. I've heard nurses describe '10' as being the worst pain you could possibly imagine or the pain you would feel when you have your arm ripped off...is that fair? I've had migraines that were the worst pain I have ever had, but not the worst pain I could imagine...so does that make them only a '6' on the standard pain scale? Was I wrong to rate the pain at an '8' or '9'? I had a kidney stone that made my worst migraine seem pretty mild...does that mean that next time I get a migraine, I can only rate it at a '3' or '4'?

    I've never been comfortable with the 0-10 scale...people's pain tolerance is so different and what is a '3' to me might be what a '10' is to someone else. I think I like the Wong-Baker Faces Scale better...it seems easier to pick out a face that describes how you feel rather than trying to put a number on something.

    I know both are just tools, but it seems to me there should be a better system...if anyone wants to invent a machine that could determine the actual level of pain, I would be happy to try it out.

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    30 Comments

  3. by   bagladyrn
    I think the pain scale is more accurate for chronic pain - where the patient can rate the current pain in comparison to pain they have experienced before. I don't think it is accurate for all situations - particularly in OB where I work. Most of my young women in labor with their first have NO referent for pain - many healthy young women have not experienced severe pain in the past, so when they come in, in early labor,they relay their pain as a "10" while able to walk,talk, smile and breathe normally, with a uterus that is soft to the touch. (It's hard at times not to tell them "Hon, there is no "20"). Therefore, you are not getting an accurate assessment of their pain. It is "the worst pain they have ever experienced", but not an indicator of anything abnormal, and treating it at that point with narcotics would be inappropriate.
  4. by   CHATSDALE
    we had a post a while back where this guy had epididymititis [sp] and he was in lot of pain er not sympathic
    he was not happy with them putting the pain scale in front of him and then acting like he was a druggy
  5. by   2bNurseguru
    Quote from bagladyrn
    I think the pain scale is more accurate for chronic pain - where the patient can rate the current pain in comparison to pain they have experienced before. I don't think it is accurate for all situations - particularly in OB where I work. Most of my young women in labor with their first have NO referent for pain - many healthy young women have not experienced severe pain in the past, so when they come in, in early labor,they relay their pain as a "10" while able to walk,talk, smile and breathe normally, with a uterus that is soft to the touch. (It's hard at times not to tell them "Hon, there is no "20"). Therefore, you are not getting an accurate assessment of their pain. It is "the worst pain they have ever experienced", but not an indicator of anything abnormal, and treating it at that point with narcotics would be inappropriate.
    I was one of those women 2 years ago. I thought I was experiencing the worst pain and when the Doc came to check me out, she said that since I was smiling there was no way I would have ben close to delivery, so the next time she came in I wore a face of someone in severe pain. I fully dilated by then but she just hadn't checked me out correctly the first time due to my facial expression. I gues it all depends on your level of tolerance. I can withstand the worst kind of pain and still manage to wear a smile.
  6. by   rach_nc_03
    Just had a personal experience with this today- I met with a new surgeon, who is going to perform a second surgery on my hip (1st, by a different doc, didn't fix the problem). I've been living with this pain for 14 months, and it has increased steadily since my last surgery. The way he phrased the question was, "with zero being absolutely no pain, and 10 being the worst pain imaginable, what's your pain right now? And what is your average pain on a 'normal' day? What is the level of pain that makes it impossible to carry out basic ADLs? What is the level of pain that you believe would allow you to do the things you want to do?"

    I've not heard it phrased this way before, and I liked it- my answers were 7.5/6.5/9/3. For a chronic pain patient, the fact that they may have drastically changed their lives because of pain often overlooked in the pain assessment. Thus, at 6.5, I'm able to drive to work, walk from my car to the elevator, and that's about it- but that's how I function daily since the pain got so bad. I can't drive at 9, and at 3, I would be able to hike, shop, etc. Personally, I don't know that I can even imagine a pain-free state, as it's been so long since i was pain-free; I also think that most chronics don't really expect to get to 0, realistically.

    On the other hand, I've been told by people who have experienced 10/10 acute pain from kidney stones, SAH, migraine, etc. that nothing else could ever come close to *that* level of pain. For them, a broken arm may rate a 7 or 8, but for someone else, it could be an 11 (hee hee, spinal tap reference).

    I've also talked to patients who thought the faces scale was insulting. I've seen one on a health risk assessment that was a series of stick people walking- they ranged from walking upright and smiling at 0 to stooping a little at 4, using a cane at 6, and crouched down crying at 10. The whole thing fascinates me- really, I think there's no way to assess pain accurately with a rating scale- I think adding the patient's subjective descriptors helps a lot, but isn't always feasible.
  7. by   topkat
    I have a little different slant to this issue. Since it has been decided that assessing the pain of EVERY patient is paramount, we have added a variation of the pain scale to our neonates. Now, call me crazy, but unless the neonate has had surgery, had a traumatic delivery with a lot of bruising, etc. for example,would you expect for a typical say 34 wk infant now 2 weeks old to have "pain"???? I mean, growing pains maybe (hehe) but pain???

    any thoughts on this???

    I think they took a good idea a little too far...

    topkat
  8. by   niccikatie
    I think the true value of the pain scale lies in the comparison values. It's really not about the number, it's about getting the number to a tolerable place. I think, just like learning styles, everyone will react differently to different scales. The goal should always be to get the pt to a tolerable level of pain.
  9. by   clee1
    I always ask the pt to rate their pain/illness on the 1-10 scale: one = well/great and 10 = "you wish we would take you out back and shoot you to get it over with".

    I find that I get fairly reliable ratings that way.
  10. by   flashpoint
    Quote from clee1
    I always ask the pt to rate their pain/illness on the 1-10 scale: one = well/great and 10 = "you wish we would take you out back and shoot you to get it over with".

    I find that I get fairly reliable ratings that way.
    But is that a fair assessment? Kidney stones are the worst pain I have ever had, but they weren't "you wish we would take you out back and shoot you to get it over with" bad. So, if I rate my pain at a 6 because it isn't "you wish we would take you out back and shoot you to get it over with" bad, I get toradol, when what I really need is morphine?
  11. by   clee1
    Quote from cotjockey
    But is that a fair assessment? Kidney stones are the worst pain I have ever had, but they weren't "you wish we would take you out back and shoot you to get it over with" bad. So, if I rate my pain at a 6 because it isn't "you wish we would take you out back and shoot you to get it over with" bad, I get toradol, when what I really need is morphine?
    Maybe... and maybe not. I've had kidney stones - I agree that thy are NO fun, and the pain is intense. Some folks, for various reasons, just don't perceive pain as intensely as others

    Our Docs are pretty sharp; subjective pain reported level or no. They Rx based on clinical findings and lab/xray. Also, they're not bashful about a second or even third round of analgesics to relieve pain.

    My pain scale question does have two advantages: 1) I have never yet failed to elicit a laugh from my pts after asking it that way, thus relaxing the pt somewhat and getting more complete/accurate information on other portions of the Hx; and 2) I generally get a more realistic number from those with less than super-intense pain.

    Also, I've had my fair share of people answer my question with scores of "11" or "32". After all, we aren't really going to take them out back and shoot them, are we?
  12. by   EDValerieRN
    I read on here once that someone said this:

    Zero is no pain at all, and 10 is Jesus hanging on the cross. What is your pain?

    I like that one.
  13. by   jmgrn65
    OK this is MHO, but does it really matter if it is a 10 or a 3 if the patient needs to be treated pain, isn't knowing they are in pain enough and treat it? Maybe it is different for chronic pain, I work on a surgical floor, and I don't like having them rate it if they hurt give them pain meds are we going to say nope not high enough on the scale can't have any. my scale it hurts, tolerable, no pain, see how simple
  14. by   BlueEyedRN
    Quote from topkat
    I have a little different slant to this issue. Since it has been decided that assessing the pain of EVERY patient is paramount, we have added a variation of the pain scale to our neonates. Now, call me crazy, but unless the neonate has had surgery, had a traumatic delivery with a lot of bruising, etc. for example,would you expect for a typical say 34 wk infant now 2 weeks old to have "pain"???? I mean, growing pains maybe (hehe) but pain???

    any thoughts on this???

    I think they took a good idea a little too far...

    topkat
    I don't get what you mean. Reflux, gas, circumcision, shots, blood draws. Isn't this why we have the FLACC scale?

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