Pain Scale

Everytime we give a pain med we do the 0-10 scale and then we recheck in 30mins.

I have used 0-10...it doesn't matter which scale you use as long as you remember to use the same scale with that patient. I have seen people that use 0-10 and then 0-5 ,forgetting what they used before.

You asked about using 1-10 pain scales (VAS) in your documentation. I understand this topic is mostly academic research information we are discussing and not intended as policy, but yes, there is in fact something else that is also used.

For example, we need to consider the cognitive impaired pt population may require a completely different pain assessment approach. Visual analogue scales may not be especially reliable considering 60% of older adults typically experience chronic pain. (inflammation, swelling, arthritis etc.)

Research also indicates that pt's experiencing mild to moderate cognitive impairment can complete VAS pain assessment scales for the pain they are experiencing around 83% of the time. Such research also discovered such manifestations of pain can even be the result of delusional thoughts, fears or behaviors. They don't necessarily need to be non verbal, disabled, or even particularly old in terms of age. For example, pt's with a hx of drug and alcohol abuse may also exhibit similar difficulty focusing and maintaining attention when queried about their scale of pain.

... but like the original post stated, "our documentation might lead reviewers to think our patients don't have much pain."

For those it may benefit, there's a good article about this subject here:

http://www.pharmacytimes.com/issue/pharmacy/2007/2007-01/2007-01-6171

My Best.

I have been in the ER recently in severe pain, which was different from the chronic pain I have had for a long time. It doesn't help just to ask how much, but where!!

Also when I had my stents placed, I never really had chest pain, but everyone wanted to know how much pain I had. I felt forced to ascribe a number for something that didn't have a quality that I could reduce to a number.

But 1-10 seems to be the universal field.

When I provide an intervention,such as medication, I ask the patient to rate their pain on a scale of 0 being no pain, and 10 (or 5) being the worst pain they could be in; for most patients this explanation seems be relatable to. If I'm asking a patient to rate a pain it is only because I will ask the person to rerate their pain; if the rating has increased or the pain is still uncontrolled it's a cue that I need to look further into pain control.

Interesting point on the scale. I am a Spanish and English speaker. I was floated to a hall that had a Spanish only speaker. Having c/o pain that was thought to be flank pain, so he had a U/A, C&S done, not finding any problems. When I got there, I spoke to him and asked him about it. He told me that they asked him through an interpreter how much pain he had, using a 0/10 scale. The interesting thing is that, he told me that his pain was not in the back but in the front at the ribs by the RUQ, mainly when he was turned and when he C&DB and that he did not know what 10 felt like so he couldn't give an accurate answer. I reported it and it turns out he had fractured ribs. Pain is subjective to the individual regardless of 0/5 or 0/10. Everything else about the pain can help more in treating it properly.

0-10. If the patient is unable to use the scale I document signs and symptoms of pain. (eg. grimaces, moaning with turning etc)

Tait

0-10 but the hospital i work in also uses the facial grading scales in pediatric and case sensitivities.

Do you use the pain scale in your documentation? Do you use a pain scale of 0-10, or something else?

We have been using 0-5 for awhile and our patients are used to a 0-10 from other facilities. It's confusing for patients, and if 0-10 is really the normal, our documentation might lead reviewers to think our patients don't have much pain. Just curious. Thanks.

The standard in hospice is to use the 1-10 scale with a comprehensive pain assessment in which we differentiate between locations and types of pain. For example, if the patient has abd pain and hip pain there will be an assessment for each pain which includes the typical stuff (where exactly, how deep, type, quality, duration, frequency, worst vs best, what works, what they have tried, are they willing to try new stuff, etc).

For patients who are cognitively impaired it is necessary to use another tool...most hospices that I am aware of use the PAINAD, which was developed for use in the adult dementia population. PAINAD DESCRIPTORS The PAINAD is also reported in a 0-10/10 format.

Even if you continue to use 0-5 scale, it should be documented in the 0-5/5 fashion rather than as a single number. In other words you might document that "patient reports pain 3/5 at this time, aching in lower back which is chronic for this patient..." This prevents any reader of the chart from misinterpreting the pain of "3" as mild rather than the much higher level in the 0/5 scale.

Thank you for taking this interest in assessing and relieving the pain of your patients...good luck