Pain scale is missing a key element

[ThatPoshGirl]

I don't like the question, "On a scale of 0 - 10 with ten being the worst pain you have ever experience..." The problem is that no one ever seems to ask what IS the worst pain the pt has ever experienced. I spent three hours in an ER with my ovary twisted and no pain killers because two different MDs insisted I was "just constipated" and over reacting because I was an adolescent. So if I say something is a 5 it means it is half way to that, and that's actually pretty bad. I wonder how it is possible to properly assess a pt.s pain level without knowing what ten actually means to them.

[deeDawntee, RN]

Yea everybody it is a flawed system. because those that have much experience with pain will rate it a "10" in order to be treated seriously, even though it is obvious that they are no where near a 10. I heard a neurologist describe a 10 as pain so bad you had to crawl on your hands and knees to the ED and then were in so much distress you could barely talk... he made it a very rare occurence. But then it made a rating of a 6 or 7 also be considered severe pain but one was more functional while experiencing that pain. This is really where most of patients with severe pain fall unless there are extenuating experiencing, like severe trauma etc.

What I always tell people is that what is important is that it will give us a way to gage how well we are doing getting your pain under control. In my facility a pain level of 4 or below is normally considered acceptable for most people (and i often also explain this to my patients as well.) So, since JCAHO considers this documentation as one of their key measures, we just try to do our best to indicate that we are really working with the patient's own experience of their pain and relieving their suffering as long as their safety is maintained. I think if you look at it as a JCAHO standard and at best a subjective measurement, that is the best anyone can expect us to do.

We are also forced to us a "non-verbal" pain scale in much the same way, in that case we use indicators like grimacing, diaphoresis, and vital sign changes to indicate pain, give it a rating, and then look for a reduction in these signs after the pain meds have been given-- and again give it a rating from our own perspective.

It is another one of those things that we spend 4 times more charting about than actually taking care of for our patients!

[kmoonshine, RN]

I'll ask the patient to rate their pain "from 0-10, 10 being the worst pain you could imagine". If they say "10" and they're sitting upright, talking, smiling, and the pain rating doesnt fit the clinical observation, I'll clarify by saying "So if 10 is the amount of pain comparable to being hit by a semi-truck, would you still rate your pain as a 10?" 99% of the time, they say "Oh no, not that bad...probably a 5 then".

Some nurses I've worked with say "rate your pain: 0 is no pain, 10 is the worst pain ever, like being hit by a Mack Truck".

[djc1981]

I think I suffer from the "disease to please" in that I don't want people to think I'm stretching the truth. I had to go to the ER with gallstones -- the worst pain I'd ever felt. I couldn't stand, sit, or anything without being doubled over and nearly crying out in pain. Yet, I still couldn't say "10" for some reason. Through gasps I said, "Uh, a 8 or 9". Guess some people are just like that!

[SheriLynnRN]

I saw a pain scale that made sense to me posted on the wall at the Air Force base clinic where I get my GYN care. It's based on level of functioning...ie pain is present but able to perform activities of daily living..etc etc. According to that scale, no one could ever SAY that their pain was presently a 10/10, because a 10 means "You are unconscious due to pain." Sounds pretty crystal clear to me.. :)

[JBudd, MSN]

I use "10 being rolling around on the floor screaming". I've had people look me straight in the eye after that, sitting calmly on the chair and say "11".

The one I believed when he said 10 after that, also said "I feel like that!".

[Turd.Ferguson]

I had one person tell me he had a papercut which was a "10."

Kinda on the same subject....

People whose every headache is a migraine, but a couple of Tylenols took care of it.

[Babs0512]

We've all had patients who, no matter what we do for them, or give them, their pain is still a "10". They can be very frustrating.

I just make sure I document the VS - typically HR and BP will be increased with severe pain as will be respiration's (I said "typically", I realize nothing is carved in stone) Most patients will be restless, or diaphoretic as well. You often see facial grimacing, guarding and /or moaning, etc... you get the point.

So, if after I've give 10mg Morphine and 1 mg dilaudid, and AFTER I WAKE THE PATIENT and ASK THEM their pain level, and they slurr "10". I make note of the fact that they are no longer restless, their BP and HR has come down, and they were resting comfortably before I woke them, OH, and I had to put them on O2 because their sats dropped - AND I document they stated "10".

I also document the patient who after pain meds, states pain is no better, but they are now telling me jokes, or talking on their cell -

These are all reasons to "take an educated guess" that their pain MIGHT be better than it was!

[Dolce, RN]

I say "the worst pain you can imagine experiencing", not necessarily "the worst pain you have ever experienced".

I say that too. And when a stony faced patient (who appears to be in no acute distress and appears to have no good reason for being in severe pain) answers "10" I then give the second description. "Zero is no pain, ten is a lion ripping your arm off." Doesn't always get them to give a more "accurate" number though.