Pain Scale

Nurses General Nursing

Published

What pain scale do you use for your patients? Do you feel that it is a good tool? We need to find something that assesses pain better than the smiley faces and frowny faces.

Specializes in 15 years in ICU, 22 years in PACU.

I work in PACU where the 0-10 pain scale doesn't always make sense to the recently anesthetized mind. Yes, I do have another "pain scale" It's called the small, medium, large or super-size pain scale and most folks can easily quantify their pain to give me a starting point.

I also do not use the term "tolerable pain". That implies you have to remain in pain as much as you can tolerate to bear. An icky place to be. I use, "Is your pain manageable?" In working with an outpatient, I get to the "Goldilocks" zone of enough pain medicine to enable you to cough and breath without conking you back out so you can go home. With an inpatient, I "titrate to apnea." My record for pain medication in a 2 hour PACU stay is 63mg of Dilaudid IV and the patient was still able to take his own Opana.

A couple of my well-used phrases are "It takes what it takes" and "I'm not going to rehabilitate anyone in an hour"

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More often than not...verbal communication is the best measure of pain...esp. with younger children.

The child wants to get it right..to them it's just another anxiety producing 'test' they have to pass and not really high on their priority list.

Charades, simple explanations, a little humor and acting out the faces helps the child to relax and focus, in a non-threatening manner.

I don't think which test you use is as important as how well the child is prepared and understands why you are asking the questions as well as how it is presented.

Pain is a combination of the nurse's objective observation and the pt's subjective comments..but most important, when all is said and done.... pain is what the patient says it is. Therefore we have to help the patient articulate it as best we can.

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Specializes in PACU, ED.

Great post Mavrick. For inpatients I also tirarte to apnea and then put on NC and call it good. I explain to my patients that oxygen trumps pain meds and I must keep them safe. I will chart their pain as reported but then add narrative to describe the clinical picture. A sleeping pt, resp 12, requiring O2 to maintain sats does not get additional narcotics.

I choose and use a scale appropriate for my patient; FLACC, faces, or 0-10.

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Specializes in Nephrology, Cardiology, ER, ICU.

Got a recent personal experience. Had major abd surgery recently and was asked "what's your pain level and what do you want it to be?"

Well, my frame of reference is that I have had no experience with major surgery, am normally healthy, active and I don't think I'd like pain.

So...my sweet brand new nurse just off orientation was crushed - I'm sure she had many other pts to see and all she wanted was a number from me. So - we settled on a 3-4.

My pain was very well controlled but I felt coming up with a number was more stressful than just saying "I hurt, can I have something please?"

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Specializes in PACU.
I work in PACU where the 0-10 pain scale doesn't always make sense to the recently anesthetized mind. Yes, I do have another "pain scale" It's called the small, medium, large or super-size pain scale and most folks can easily quantify their pain to give me a starting point.

I also do not use the term "tolerable pain". That implies you have to remain in pain as much as you can tolerate to bear. An icky place to be. I use, "Is your pain manageable?" In working with an outpatient, I get to the "Goldilocks" zone of enough pain medicine to enable you to cough and breath without conking you back out so you can go home. With an inpatient, I "titrate to apnea." My record for pain medication in a 2 hour PACU stay is 63mg of Dilaudid IV and the patient was still able to take his own Opana.

A couple of my well-used phrases are "It takes what it takes" and "I'm not going to rehabilitate anyone in an hour"

I work PACU also. I use CPOT for adults and FLACC for those under the age of 18. When patient is awake enough I will ask for a rating on 0-10 scale, knowing that it often does not make sense for a patient just coming out of anesthesia. Many times I've had patients rate their pain a 6, and ten minutes later tell me it's so much better now, more like an 8. See the problem is they can't even remember what they said 5 minutes ago. So I will chart their verbal response but continue to chart a CPOT as well. IF they are able to tolerate pain medication (resp, BP, O2 sats) I will give it.

Great post Mavrick. For inpatients I also tirarte to apnea and then put on NC and call it good. I explain to my patients that oxygen trumps pain meds and I must keep them safe. I will chart their pain as reported but then add narrative to describe the clinical picture. A sleeping pt, resp 12, requiring O2 to maintain sats does not get additional narcotics.

I choose and use a scale appropriate for my patient; FLACC, faces, or 0-10.

Inpatient I am much more generous with the pain medication. Same day surgeries I have to take into account some people may go home before all the pain meds "catch up" with them, so I'd rather get them switched to orals ASAP (we do not give orals in our PACU).

I have apologized to many patients that I can tell are in severe pain, but are just not holding an airway or oxygenation well enough for me to continue to treat. I tell them if I have to choose I will always choose breathing, and have many chronic pain patients tell me they'd choose relief over breathing. I can sympathize with their desire for relief, will place a CPAP if I think that will keep them breathing and allow for better pain control.

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I HATE the pain scales that we have, especially the most common one I've had to use "0-10". Hell, I don't think I could even accurately rate it. How about mild-"yeah, I have some discomfort but I can deal with it. A Tylenol wouldn't hurt (assuming the liver isn't shot). Moderate- "look, I'm hurting a lot. Get me something stronger" (like a prescription pill), or severe- "I just woke up missing a leg, bring on the good stuff" (preferably IV).

The only thing that annoys me more is the admissions pain assessment questionnaire. "Does the pain make you more irritable than normal?"....nope. Not at all. Everything's just peachy!

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