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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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."
