How Would You Rate Your Pain????

How would you rate your pain???? As nurses, how many times have we asked that? Have you ever really thought about what you are asking and what the answer might mean? Have you ever had to give an answer to that question yourself? Just what does it mean to you? If you've even been forced to use a pain scale, you may have noticed some of its inadequacies.

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How Would You Rate Your Pain????

I was with a friend recently who was awaiting a craniotomy. We were in the OR holding area when the nurse came in and asked him "How would you rate your pain on a scale of zero to ten with zero being no pain and ten being the worst possible pain you could imagine?"

Now my friend has a sense of humor, however at this moment he was definitely not trying to be funny when he tried to give his answer. He was very perplexed.

"What do you mean? How would I rate my pain? I am not having any pain right now. Why are you asking me that now?" he asked.

She showed him the pain chart. You know the one. With all the little faces.

The nurse explained that they would be asking him that after surgery so they wanted to know the number he would give the level of pain he was having pre-operatively. That way they would have a baseline for his pain, making it easier to find appropriate treatment to manage the pain.

Now I don't know about you....but that would be confusing for me too had I not been a nurse. I might think the pain I am or am not having right now has no affect on the pain I probably will be having post-operatively.

We all know that pain is subjective, which makes it difficult for anyone but you to know how you feel. What I might rate as a 5, someone else may rate as a 7 or 3.

The subjectivity of pain may also make it difficult for doctors and nurses to determine whether or not pain medications are effectively treating your pain.

Pain scales are meant to provide a more objective method to measure pain and let the healthcare team know the severity of the symptoms. When asked how they rate their pain on a scale of zero to ten, with ten being the worst possible pain they can imagine, most people will base their answer on the type of pain they have experienced throughout their lifetime. Some people have had the good fortune to not have experienced severe pain. Their point of reference will be quite different from someone who has experienced natural childbirth, kidney stones, nerve damage, etc.

Some people are used to living with chronic pain of a daily basis. If they say their pain is only a 6 or 7, it doesn't mean they are not hurting. Also, just because they are trying to be optimistic and are laughing and joking doesn't mean they are not hurting.

Some people worry that if they don't give the answer that appropriately reflects their pain, they will not get the proper treatment. Therefore, some patients may tend to rank their pain higher than it really is just to assure they will get medication. (Of course we know patients who purposely create or magnify their pain in order to get pain meds. But that is an entire topic all of its own.)

The friend I mentioned at the beginning of this article told me about a video which is a very humorous depiction of one comedian's experience with the pain rating scale. It is quite amusing. Enjoy!!

Emergency Room Humor

After watching this video, I am afraid I might have to stifle a laugh or a smile when asking this question. We all know that pain is no laughing matter. It is real and is difficult to measure.

Viktor Frankl made this statement in his book, Mans Search for Meaning, which aptly portrays the effect of pain and suffering:

Quote
"To draw an analogy: a man's suffering is similar to the behavior of gas. If a certain quantity of gas is pumped into an empty chamber, it will fill the chamber completely and evenly, no matter how big the chamber. Thus suffering completely fills the human soul and conscious mind, no matter whether the suffering is great or little. Therefore the "size" of human suffering is absolutely relative."

To read more articles, such as When Nurses Cry, and I am Afraid. Please Pray for Me, go to my AN blog: Body, Mind, and Soul

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tnbutterfly - Mary

About tnbutterfly - Mary, BSN

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I just wonder- why do people thinka 6 or 7 isn't that bad? If one is really using the pain scale as "10 is the worst pain you can possibly imagine" then I think a 6 or 7 would be pretty bad too. This is why I dislike the numerical scale. It leads to gross exaggeration and leaves no room for subjective data such as the nursing assessment and objective data such as change in vitals/RASS scale.Cute article though- good way to bring up some of those points!

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Specializes in Gerontology.

I hate rating pain. (I actually hate rating anything!).

I have pain. Make it go away. That is all.

After my last surgery, things were just starting to hurt. I know my body, I know my needs. take something now, and everything will be fine. Wait, and it will be bad.

So in Recovery, I asked for something just when the twinges started. I had a student nurse, she asked me to rate it. Now, if I answered truthfully "2" because in my experience that is what is was, using the pain scale rational. However, I knew that if I said "2" I might be some Tylenol, if I was lucky. So I said "7" and got the Oxycodone.

Now - before I am accused of being a drug seeker, the only time I take oxycodone is during the first 24 hours post-op, after that, I take extra Tylenol and use an ice pack. I don't like the way narcotics make me feels. Plus, they last forever in my body. However, I also knew that I had to get through dressing, a trip home, etc so I knew I needed some stronger on board.

So, do pain scales really work? I have my doubts.

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I always explain what the pain scale means concretely, not with silly terms like "the worst". Seriously, I think that's stupid. If the worst pain you ever felt was from a stubbed toe, how accurate can this scale be?

I explain that to me 0 means no pain at all, 1-2 means minor aches and pains, 3-4 means more than aches and pains but bearable, 5-6 means you're hurting more than you can tolerate and need pain medicine, 7-8 means the pain is severe, 9 means total agony, 10 means you would rather be dead than feel this way. I tend to get a lot of 5s and 6s and a lot of funny looks. However, when patients are called for survey purposes after they are released, my patients usually give an "excellent" rating on pain management.

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Specializes in Gerontology.
I always explain what the pain scale means concretely, not with silly terms like "the worst". Seriously, I think that's stupid. If the worst pain you ever felt was from a stubbed toe, how accurate can this scale be?

I explain that to me 0 means no pain at all, 1-2 means minor aches and pains, 3-4 means more than aches and pains but bearable, 5-6 means you're hurting more than you can tolerate and need pain medicine, 7-8 means the pain is severe, 9 means total agony, 10 means you would rather be dead than feel this way. I tend to get a lot of 5s and 6s and a lot of funny looks. However, when patients are called for survey purposes after they are released, my patients usually give an "excellent" rating on pain management.

I like this. This make sense! I am going to have to steal this from you.

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I like this. This make sense! I am going to have to steal this from you.

I'm stealing it too, shoulda got a patent!!!

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Specializes in ICU + Infection Prevention.

No discussion of pain ratings is complete without Hyperbole and a Half's modified pain scale:

Hyperbole and a Half: Boyfriend Doesn't Have Ebola. Probably.

painfaces0-6.png

painfaces7-12.png

The real fun part is the accompanying descriptions.

Hyperbole and a Half: Boyfriend Doesn't Have Ebola. Probably.

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I agree with some posters here that the "1-10" pain scale can be pretty inaccurate. I say this as a sufferer of chronic LBP. I have the same pain now sometimes as I had when it was at it's absolute peak. The difference is, because it's been with me for approx. 10 years, I rated it as a 5 during my VA check up, since in this time I've been able to work around the pain to get things done (plus the eval was done during the summer, when the pain lessens to a more manageable level (not manageable, lol just MORE manageable). But it's the same pain I always had. Anyway, the VA used that "5" as an excuse to cut my disability in half lol.

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Specializes in Adult/Ped Emergency and Trauma.

I have found that men are not to responsive to the rating system anyway. I mean, we kinda feel we might get judged, except the time I had that kidney stone, I rated mine 12 on the 1-10 scale, which wasn't appreciated:)

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How about asking patients to rate their "emotional pain" on a scale of 1-10.

I feel so silly every time I have to ask that, and I usually give a little disclaimer along with it.

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Specializes in LTC, assisted living, med-surg, psych.

I hate the 'faces' scale.......it's demeaning when you're dealing with adults. Not really a fan of the 0-10 scale either, especially when working with the elderly---a lot of times they really can't put a number on their discomfort. For that matter, neither can I; kidney-stone pain is the gold standard against which I compare every other kind of pain, and that is a 10 and then some! Nothing else compares, not post-op pain, not chronic arthritis pain, not even childbirth (although that last one was probably a 9.5). OTOH, I hurt every day of my life, yet I probably wouldn't rate it as more than a 3 while someone else might rate it as a 5 or 6. It's all relative.....and thus, not very accurate. :sneaky:

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How about asking patients to rate their "emotional pain" on a scale of 1-10.

I feel so silly every time I have to ask that, and I usually give a little disclaimer along with it.

I'm a man... I have NO emotional pain ;)

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