Pain Scale

[makes needs known]

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.

[dudette10, MSN, RN]

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.

I clicked on the PAINAD descriptors link, and I don't see the scoring method on that document. How is it scored?

[tewdles, RN]

I clicked on the PAINAD descriptors link, and I don't see the scoring method on that document. How is it scored?

Sorry....what I posted was descriptors to help you decide where the patient fits in the categories of the tool. The idea is to observe the patient for at least 2 minutes and then rate them in the areas of the PAINAD. The numbers are added together to give you a 0-10/10 pain rating. You must interact with the patient to determine if they are consolable. Here is the actual tool...PAINAD TOOL

[meandragonbrett]

We use 0-10 for verbal and lucid patients. Then we also have a non-verbal pain scale that's used for folks who are intubated/sedated/paralyzed/non-verbal that runs from 0-8 based on several different objective assessment.

[SWS RN, ASN, RN]

Have always used the 1/10 scale in the hospital, as well as the face chart for peds.

THe main flaw that I see is the patients perception of the pain.(or drug seeking behavior) In using the 1/10 scale I have had countless patients tell me their pain is a 10...this is while they are sitting up in bed, eating, talking on the phone and watching TV. So the scales are obviously not reliable...and we are not stupid.

I am with the other posters....check for vitals and other physical signs of pain, rather than relying on scale.

I would also chart in the past that "the pt states his pain is a 1/10. Pt is sitting in bed, vss, rr wnl, no grimacing noted......eating," or what ever is applicable at the time. Hard to justify a 10 pain when pt does not have any outward signs or alteration in vital signs no matter how stoic they can be.

s

[LevitateMe, RN]

We just talked about this in class a few weeks ago, my teacher says 1-10 is the norm but since some facilities use 1-5, you do have to be consistent. One way she said to document to avoid forgetting or the next nurse not knowing what you used is to document like "pt. Complains of pain of 3/10." Or 3/5.......

[tewdles, RN]

It is perfectly acceptable to report the patient's pain exactly the way the patient describes it, as well as to add the assessment of the nurse. However, it is important to remember that patients with chronic pain are compensated and may very well not have the same physical findings on exam of a patient experiencing acute pain.

In my line of work it is entirely possible to have 2 patients, each with pain of 8-10/10 by report with two completely different physical presentations. We must be careful not to undermedicate a person who has excellent ability to cope with long term discomfort simply because we do not believe him/her....

[SWS RN, ASN, RN]

Oh, I agree...I would still medicate. Pain is what the patient says it is...it just doesn't always look that way.

s

[CJMR]

It's so weird how different people have different pain tolerances. I've been told by multiple healthcare workers that my pain tolerance is unusually high. A few nurses have asked me if I've ever experienced pain that was 10/10 and when. That usually clears things right up.

A couple months ago I broke my arm and had a 1" x 1/2" chunk of skin ripped off in an accident. I went to the ER and rated my pain as 2/10 and turned down pain meds. They were so surprised when the x-rays came back showing a fracture. But my 10/10 pain is when I got run over by a truck.

I'm a student now but I think when I get out into the field I may ask my patients what their 10/10 pain consists of just to give me an idea of where they are coming from.

[Crash_Cart]

I don't feel the 1-10 pain scale is an accurate pain assessment analysis strategy.

It makes the nursing profession appear very "simplified" and without scope.

Just my 2 cents.

[tewdles, RN]

I don't feel the 1-10 pain scale is an accurate pain assessment analysis strategy.

It makes the nursing profession appear very "simplified" and without scope.

Just my 2 cents.

Hmmm, the pain scale is part of a pain assessment...not the whole ball of wax....

I wonder how it appears "simplified" and "without scope"... and I wonder what we would use to document patient pain in it's absence?

[LNFNP18, MSN, NP]

I would say the 0-10 pain scale is a big part of my charting. I also use the faces pain scale for people who may be unable to tell me a number, or young children/babies (they have charts for this that you can use for reference... I just draw a picture of the face that corresponds with them and then the number that goes with that face). If you are doing any sort of pain intervention or assessment then the pain scale is a must. I agree that it can be confusing with the 0-5 scale if the patients are used to 0-10, and also anyone looking back at the documentation in the future who is used to 0-10.

[LNFNP18, MSN, NP]

Hmmm, the pain scale is part of a pain assessment...not the whole ball of wax....

I wonder how it appears "simplified" and "without scope"... and I wonder what we would use to document patient pain in it's absence?

I agree! If we are not asking the patient to rate their own pain, then I can only guess that we would be rating their pain based on how they are reacting to it? However, that is not accurate (in my opinion)... people react differently to pain and have different idea's of pain. Someone can be acting very calm and "not in a lot of pain" but in reality may be in a lot of pain. How would we know if we don't ask? Pain is subjective. Which is why we ask the patients to rate their own pain.