Pain Scale

SouthpawRN · Jul 30, 2017

I don't like the faces one because most kids having pain or even having to go to the hospital are not going to be smiling. I think pain starts at around the 4 mark with the flat mouth. that should be 2 or even 0.

5228shamrock · Jul 30, 2017

I don't like the faces either. I find that most people rate their pain high with this scale. We often get folks who say their pain is 8 or 10, but they have full ROM, no objective findings, and are laughing.

macawake, MSN · Jul 30, 2017

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.

Personally, I think that faces pain scales work fine for the intended patient populations, and the research I've looked at seem to support that they are valid and reliable. Have you looked at the available research on pain scales?

Pain scales might not be perfect but since we actually don't have a reliable way to objectively "measure" how much pain a patient is experiencing, they are in my opinion a useful tool.

Who are your patients OP? Pediatric (younger or older?), adults, patients with dementia?

There are different faces pain scales. From reading your and soutthpaw's posts, I suspect you're using Wong-Baker's scale or something similar?

Instructions for Use - Wong-Baker FACES Foundation

Personally, I use FPS-R when the use of a scale with faces is appropriate.

Faces Pain Scale - Revised Home - IASP

With both scales it's important that you ask the question/give instructions the correct way when you show the scales to your patients.

I personally prefer the FPS-R since it doesn't show happy and sad faces, but shows a more neutral baseline one which changes to express an increasing amount of discomfort/pain.

I guess it's possible/conceivable that the faces with feelings/affect like happiness and sadness might be a confounding factor that affects how pain intensity is reported by the patient (but that's just me speculating).

I don't like the faces either. I find that most people rate their pain high with this scale. We often get folks who say their pain is 8 or 10, but they have full ROM, no objective findings, and are laughing.

Now I'm really curious about who your patients are. My experience is of course only anecdotal and I don't normally work pediatrics, but I have done so on occasion and I've found the faces pain scales useful. If the child rated a high "number" when I've assessed them, they almost always rated a lower number (less pain) a while after I'd administered pain medications.

JKL33 · Jul 30, 2017

I don't like the faces one because most kids having pain or even having to go to the hospital are not going to be smiling. I think pain starts at around the 4 mark with the flat mouth. that should be 2 or even 0.

Guess what! Kids use the faces scale completely purely in my experiences. It never fails to amaze me in the ED because they are so consistent with it. Anytime they are well enough to endure looking at the pain scale, they point out a face that is exactly what you think they might say. I'm just slightly fascinated with this phenomenon. It restores humanity in my mind just a little every single time.

5228shamrock · Jul 30, 2017

I agree that the faces work remarkably well with children. I do not work with children. I'm also not trying to second guess someone else's pain. I work in occupational health. I often see people who tell the nursing staff that their pain is 8 or 10 all day, every day. But when they are observed working, they are smiling, laughing, joking with friends and performing their job without any issues. What is observed and what is reported just doesn't match. It's hard to know how to proceed with contradictory information.

chare · Jul 30, 2017

I don't like the faces either. I find that most people rate their pain high with this scale. We often get folks who say their pain is 8 or 10, but they have full ROM, no objective findings, and are laughing.

If your patient is able to self report pain, why aren't you using the numeric scale?

And whether they have "full ROM, no objective findings, and are laughing" has no significance, as the patient's pain is what they report.

5228shamrock · Jul 30, 2017

So thanks for the comments but I'm really just asking what pain scale everyone uses, in hopes that I can find one that better meets our needs. I'm not really interested in explaining our current company policies, or why my statements are pertinent to occupational health. I was hoping to find some helpful information.

JKL33 · Jul 30, 2017

I use numeric and faces. Faces work well for children in my experience. Numeric works very well for some adults but is only as useful as each individual patient uses it appropriately. I just choose to proceed with the idea that something is very wrong whether or not it is what I personally would call debilitating.

In my experience you can simply document all findings in a non-judgmental way. IMO you aren't going to find a pain scale that works the way you're talking about. It's a subjective measurement and the results thus will always be subjective.

macawake, MSN · Jul 30, 2017

So thanks for the comments but I'm really just asking what pain scale everyone uses, in hopes that I can find one that better meets our needs. I'm not really interested in explaining our current company policies, or why my statements are pertinent to occupational health. I was hoping to find some helpful information.

As a matter of fact it would have been helpful if you'd mentioned what your patient population is in your original post. You might have received answers more relevant to your query. Generally speaking, if you want helpful information it's helpful if you provide the pertinent information.. But, since you're not interested in doing that...

I'm also not trying to second guess someone else's pain.

If that's not what you're doing, then what are you doing?

Because it seems to me that you don't believe that your patients really are experiencing the pain level that they report?

I often see people who tell the nursing staff that their pain is 8 or 10 all day, every day. But when they are observed working, they are smiling, laughing, joking with friends and performing their job without any issues. What is observed and what is reported just doesn't match. It's hard to know how to proceed with contradictory information.

OP, smiling, laughing and joking doesn't automatically rule out pain, not even severe pain. Since you aren't willing to share more details about your patient population, I don't see how I can help you any further. But I do agree with Chare, it's odd to use the faces scales when the patients are capable of labeling their pain with a number between 0 and 10.

You said that patients tell "the nursing staff". What's your role? Are you part of the nursing staff?

Ruby Vee, BSN · Jul 30, 2017

I agree that the faces work remarkably well with children. I do not work with children. I'm also not trying to second guess someone else's pain. I work in occupational health. I often see people who tell the nursing staff that their pain is 8 or 10 all day, every day. But when they are observed working, they are smiling, laughing, joking with friends and performing their job without any issues. What is observed and what is reported just doesn't match. It's hard to know how to proceed with contradictory information.

Where I've worked, we've always used the 1-10 scale. Many folks will promptly give you a number (usually a number >10) but others seem confused by the whole idea. When I became a patient, I understood. Assigning your pain a number between 1 and 10 is difficult. I like the Wong-Baker Faces scale when I'm a patient. It's simple, it works well and I don't find it at all insulting.

Sour Lemon · Jul 30, 2017

It doesn't matter what the scale is. Some people will always exaggerate. I tend to scale "backwards" ...I ask them if they need dilaudid IV or a single percocet 5/325. If it's dilaudid, I assign their pain 8-10. If it's percocet, I assign it a six. I'm not concerned with accuracy when it comes to an eight verses a nine or a two verses a three. I just want to hurry up and finish so I can go to lunch.