How do you all like the pain scale???

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I confess, I hate the pain scale. It's alright for some folks who like to quantify everything, but with many people I find that it is an annoying way to communicate. I hate this mandated, cookie cutter type of interaction. It reminds me of going to Safeway and having them all say the same lines to you everytime. I think the pain scale is overrated and utterly annoying.

Specializes in NICU, Infection Control.

The N-PASS seems like it is a better scale, but it's not being used where I've worked. I'd really love to try it. It's the PIPP scale I have a problem with. @ the time it was implemented, it was the only scale that took the gestational age into account--and that is very significant. OK, time has passed, and new scales are available, I'm just not seeing them implemented.

That's my complaint.

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What about people that constantly rate thier pain really high. even after pain meds...isn't the dr supposed to do something about it? what if he doesn't ....or cant (max dose already ordered)...what would you do in that situation...because then it looks like the pain is not being treated at all...pain management is always one of those kind of confusing areas...please don't get me wrong...I have no problem giving pain meds when ordered but well I'm just gonna leave that one alone...

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Specializes in Med-Surg.
What about people that constantly rate thier pain really high. even after pain meds...isn't the dr supposed to do something about it? what if he doesn't ....or cant (max dose already ordered)...what would you do in that situation...because then it looks like the pain is not being treated at all...pain management is always one of those kind of confusing areas...please don't get me wrong...I have no problem giving pain meds when ordered but well I'm just gonna leave that one alone...

JACHO expects to see documentation of alternatives such as relaxation techniques, repositioning, distraction, etc. But there should also be documentation that the physician was notified of poor pain control. If the pain meds are maxed out, time to try something else more effective.

I also document if the pain level is acceptable to the patient. Sometimes a 5 can be an acceptable level the patient can live with if you or you collegues on the prior shift have done all they can and the patient verbalizes this.

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Specializes in cardiac ICU.
What about people that constantly rate thier pain really high. even after pain meds...isn't the dr supposed to do something about it? what if he doesn't ....or cant (max dose already ordered)...what would you do in that situation...because then it looks like the pain is not being treated at all...pain management is always one of those kind of confusing areas...please don't get me wrong...I have no problem giving pain meds when ordered but well I'm just gonna leave that one alone...

When you say "max dose", what do you mean? It's worth remembering that opioids have no maximum dose, as long as you are careful to ensure that pt. is getting appropriate tx for constipation, as it is the only side effect that the pt's system will not adjust to. It may be that the dose is simply insufficient.

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It's worth remembering that opioids have no maximum dose, as long as you are careful to ensure that pt. is getting appropriate tx for constipation, as it is the only side effect that the pt's system will not adjust to.

HUH? You are saying constipation is the only side effect of chronic high dosage opioid use??? :p

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we had a thread on this back in the summer that was started with a health care worker who was a patient at the time...he was completely dissatisfied with scale

i was a patient once with a kidney stone....that kind of pain could not be rated with a scale....they kept giving me iv pain meds..w/o relief...when stone passe all that demerol hit me and they could not wake me up...i think they thought i was going to die...my friend said they kept coming in every 15 minutes to take vs...i don't die easily...went home in two days

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Specializes in Utilization Management.
personally I like it because it gives a way to try to rate something that is highly subjective. It gives a more tangible symptom to deal with and shows that relief measures have worked.
In general, I use the pain scale. But sometimes I have a confused postop patient and I'll use the "Patient exhibits s/s of pain AEB facial grimacing, elevated BP, restlessness, or crying out."

For the suspected pain med abuser, I'll write, "Pt rates substernal chest pain at 10 out of 10, and states that Nitroglycerin 'doesn't do a thing, so give me Demerol.' Pt's vital signs are stable, EKG reflects NSR and no change to baseline EKG. Pt also offered Mylanta as Pt was earlier observed having Taco Bell food for supper, brought in by S.O. Pt refused Mylanta, stating 'I hate the taste of it and it doesn't do anything for me either, but I could use some Phenergan.'"

So I just kinda write what I see--whatever the heck it is. :rolleyes:

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Specializes in Emergency Room.

there is nothing more annoying than triaging someone with "stomach aches" who is eating a big bag of doritos and drinking a 20 oz pepsi. "how would you rate your pain ma'am from 1-10, 10 is the worst you ever had, like having a baby and 1-2 is like a tiny pinch"

"oh, its definitely a 10" saying this while licking fingers.

yes, i hate the pain scale most of the time. i find it more uselful in people that have history of chronic pain.

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Specializes in ER.

About the only time I find the pain scale useful is in someone with an acute onset of pain like a kidney stone, burn, MI..etc. Then you can evaluate how your pain meds are doing. It doesn't really matter what the number is to start with, it only matters if it is getting worse or better with your meds. It gives you something to quantify if what you are doing is working.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

I use the numbered pain scale and the OPQRST...and looking at body language. Since I work with mainly elderly, there are many stigmas about their pain...so I have to use all the tricks to try to establish a good pain quantification from them.

Onset/Origin What were you doing when the pain began? Did your stomach begin to hurt immediately after you fell (somatic) or several hours later after you vomited (visceral)? Somatic pain usually comes on abruptly while visceral pain more gradually.

Provokes What makes the pain worse or better? Does your chest hurt each time you take a breath and move your intercostals muscles (somatic) or is it made worse with exertion and anxiety (visceral)?

Quality What does the pain feel like? Is it sharp like a stabbing pain (somatic) or dull like a throbbing ache or pressure (visceral)?

Referred/Region Where does it hurt? Is you pain only in your shoulder you injured, (somatic) or does the pain radiate from your abdomen into your back (visceral)?

Severity Compaired to the worse pain you have ever felt...how would you rate this? What was your worse pain? (Numeric scale works in here too!).

Time How long have you had this pain? Has it been there only since the injury (somatic) or for many months (neuropathic)?

I really like the OPQRST! In addition to the rating numeric scale recognized most in charting, and quotes or assessments on movement, body language, and general conversation about the pain..one can make a pretty good solid assessment!

Just using the numeric pain scale is like using a Tylenol to solve all issues..it simply isn't enough, and doesn't work for all people :).

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I have mixed feelings about the pain scale. I think it can work if you have an awake, oriented and cooperative patient. A patient who is ticked off in general, confused or just psycho is not a good one to use a scale. I prefer to ask them if it hurts a little, medium(so so) or very much. THIS always gets me a response. The scale I can get a rational resly maybe 60% of the time. I work post anesthesia so of course some patients are too sedated to grasp the 0 to 10 concept. But they CAN say it 'hurts ALOT". I think we have to use the best assesment we can for each individual patient. One size does not fit all.

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I think it is ridiculous. Most of our patients don't understand, no matter how you explain it. I overheard a co-worker explain it like this one day, "A zero is pain free, one is mild pain that you can tolerate with no problem, and a ten is like someone cut your arm off." :uhoh3: How the heck are they gonna know what that feels like unless that's actually happened to them? My brother who is diabetic, had to go into the ER with an infected cat bite to his hand. When the nurse asked him where was his pain on the scale, he was like "You are kidding right?" He felt insulted, and for most educated people, I can understand how this would be very simplistic in an almost demeaning sense. My favorite is the laboring patients who are talking and smiling and rate their pain as an "8". :rotfl: It just doesn't work in most cases IMO.

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