theory for new pain scale

Specialties Pain

Published

Maybe I am opening a can of worms, but here goes:

I have been reading many of the postings on pain control and management. I am pretty new to all of this, but have a theory that would be a little less subjective.

Instead of having 0-10, which everyone feels is different, i.e. many people seem to think that you could not possible sleep with a 10/10 but when a patient is awakened after being given a narcotic will insist that the pain is still a 10/10...

OK, does the pain keep you from:

walking

talking

laughing

breathing

eating

sleeping

working

reading

and so on, depending on where the pain is...also, evaluate exactly what the limitations are..sometimes people have stated that they are a 10/10, but have no limitations to the above. So, if the pain is not interferring with normal function, I personally would not rate it a 10/10. However, I do try not to judge someone who does because this is a very subjective scale, as it is intended to be. Mine is more objective, and I think it is a little easier to measure if pain is relieved. Of course, it does not meet jacho requirements and is not approved in the facility where I work, but just food for thought.

Of course, there will still be cases that it is more difficult than others to evaluate pain, but I guess I just notice many people saying, "How can she have a 10/10 pain? she is eating chips, drinking soda, and talking on the phone." So, to many people, she is still able to function, so that was the goal for her. But, importantly, could she do this before the medications?

Specializes in Neuro Critical Care.

I have had patients in the past say that it is hard to judge their pain level based on a 1-10 scale. Personally I don't like the 1-10 scale but it is what we have. If a patient is unable to place a "pain level" I like to ask them if this is the worst pain they have ever had, is it tolerable but uncomfotable.....and document what they say. One of the facilites I worked in used a FLAAC scale for unresponsive patients which worked really well-unfortunately I can't remember what it stood for.

Although I sometimes questions people's pain level I have never judged or not given pain medicine. I have never been in chronic pain so I don't know what it is like. I do wish we had something better than the 1-10 scale but don't have any solutions. People can function with pain, they adapt to it. That doesn't mean their quality of life is what it should be, they have just gotten used to it.

I guess what I am trying to say is that there should be a more objective way to document the pain instead of only what the patient is saying...

Quickily, I know, this is how they percieve it, so this is how it is....

However, sometimes there are noticeable improvements and the patients deny them...Sometimes, I just want to be able to say..you couldn't eat all day because you were in so much pain..now you are eating pizza, so it must be better?? Or is this just an insane approach that would be totally inappropriate?? Or you walked all hunched over and now you are walking upright, so are you sure your pain is no better??

I am not trying to say they should not ever get more medication, or even that they shouldn't get another dose now, but it seems that they may be just a little better by just observing them before and after...not vitals, just body language, affect, anxiety, etc...

Just a thought...

Basically what you're saying is that if the pain is not stoping you from being mobile, your pain isn't *that* bad.

The WORST pain I have ever had in my life has been dental pain. Forget post-op knee surgery, or a fracture reduction. I thought I was going to die!

As of now, pain can only be judged by the patients perception. Ever heard someone say that they have a low tolerance to pain? No test can account for this. Or take a FMS patient. Their pain level is greatly intesified. A paper cut can seem like a laparotomy to them.

I appreciate your attempt to come up with a new way to judge pain. This is something I think about every day.

Bellehill, the questions you ask are part of a VERY GOOD comprehensive pain assessment. They're ALL important when trying to assess a patients pain, their perception of it, and its location. BRAVO!

Dave, who wonders when in the heck people will understand that just because you can eat some Dortios, doesn't mean you're not in pain.

Specializes in ED staff.

This is one of the things I struggle with everyday. I am a triage nurse, of course one of my questions is rate your level of pain for me on a scale of 0-10. I am always amazed at how people rate their pain. As the OP stated, how can someone rate their pain a 10 while they are smiling and laughing, eating, drinking, chasing their 3 year old and then picking him up with no difficulty? I observe this behavior while they are in the waiting are and then they sit in my office and tell me their low back pain is a ten. I write down what they tell me, but I also write down what I have observed them doing. I myself have had intense pain, I've had 2 kids, kidney stones, gall stones and appendicitis. The only pain I would classify as a ten is childbirth or the kidney stone. When I had these things I was definitely not smiling or laughing, I was doubled over, vomiting because it hurt so bad. I try not to be judgemental, I really do, like I said this is a struggle for me. I can only fall back on the old addage, actions speak much more loudly than words.

Specializes in NICU, Infection Control.

I hear what you're all saying--we need more concrete pain measuring tools. The same is true in NICU. The Newborn pain scale is pretty good, but the Premature Pain Scale is very difficult to use--it's meant to assess pain before and after some painful intervention, it takes a long time to do, and I have found that it's really not good for post-op pain. Since there is only one scale that includes Gestational Age (which is very significant), that's the one I'm stuck with. :o

Where are the research types when we need them?

I still believe that using a pain scale only is a mistake. PAin is an assessment and we can all be fooled by the 10/10 who can eat, oh lets say Doritos(Dave:) ). I live with a chronic pain from IBD and am "used to it". When I went to the ER one time recently, I rated my pain as 5/10. My mom yelled "5! Whaddya mean 5!, you are in alot of pain". Well,for me a 3 is more than usual and a 2 is livible with no meds. So I HATE the pain scales. On the other hand, my menstrual cramps have been as bad as labor pains, and I would rate them as a 9 at times! So screw the pain scale on that level.

I just ask my patients, is it hurting ALOT, SOMEWHAT, a LITTLE or BARELY. Then I say we use a scale here....a 0-2 is barely, a 3-5 is a little or somewhat, and so on. They get this and the chart shows proper numerical documentation. Working in post-op recovery, I love saying to the delerious patient "Can you please rate your pain, no no stay on the gurney sir, I am your nurse...no, coach class has not boarded yet..."

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