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.

[LNFNP18, MSN, NP]

Oh yes, I also do always make it a habit to put what the scale was out of.... for example I would never just say pt rated pain at a 5, I would say pt rated pain 5/10.

[invernessfl]

I use the 0-10 but the facial grading scales is actually a verified research tool

[tewdles, RN]

Yes...the faces scale is very useful for developmentally delayed adults and children...

[SWS RN, ASN, RN]

Everyone...STOP what you are doing right now and go to this link.....

THe title is "boyfriend doesn't have ebola" but check out the site....in this chapter she has

The Better Pain Scale

Enjoy!

Then stick around and read some of the other blogs. Hilarious...I double dog dare you to be in a bad

mood while reading Allies stuff.

http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html

Hugs and Giggles to all, and tell all of your friends about Hyperbole...just a little plug

s

[talaxandra]

That's very annoying, SWS - I just searched for that so I could post it here and you beat me to the punch! My favourite hyperboleandahalf post is the alot :)

I agree with all of you who say that the 1-10 (or 1-5) scale is a part of the pain assessment, along with a description of the pain, location (including radiation),duration, novelty (have you had this kind of pain before, when? what helped?), associated symptoms (eg breathlessness or air hunger, nausea, photophobia), visual assessment (eg facial expression), observation of demeanour (sitting up chatting, eye squeezed closed, difficulty talking) and vital signs.

With all these elements together you should have a near-complete picture that helps you to determine whether the best intervention is analgesia versus indigestion medication, medical review vs emergency call, massage vs a warm cloth etc.

I find the most useful aspect of using the VAS takes advantage of its subjectivity, when I ask the patient post intervention how their pain is now. I can then more accurately domcument the effectiveness of interventions, and more strongly support recommendations to, for example, increase the dose or frequency of analgesics.

I also use the score, particularly as past of pre-procedure teaching, to familiarise patients with the idea that our aim won't necessarily be to have them be painfree, but instead to reduce their pain to a level where they can move, and a level that is tolerable for them. By thinking ahead of time what kind of score would be okay for them to work within, and giving them permission for this to change when they're tired or nauseated or it's night, they seem to feel as though they have more control in what is often a frightening and powerless time.

[SWS RN, ASN, RN]

Talax,

SO glad you are a fan of Allies too....I also love the alot a lot!

I was just happy when I found her site, I thought I was the only one in the world who thought like that.

I guess there are more of us.

s

[Crash_Cart]

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?

It's simplified because but I think it's possible to actually measure and monitor pain using technology. It's without scope because we simply ask a question instead of actually measuring it.

Similarly, we don't ask the patient if they feel like they might have an elevated temperature and what they think such temperature range it might be. We use technology to actually measure it.

For example, it's often understood that sweat glands respond, heart rate and BP increases when pain is present. Could it be possible to actually measure and "document" pain intensity in this or a similar way instead of using such current pain scale approach?

Other research articles:

http://timesofindia.indiatimes.com/Home/Science/Now-a-way-to-measure-pain/articleshow/4627737.cms

http://www.healthcentral.com/chronic-pain/c/5949/75928/researchers

http://www.timesonline.co.uk/tol/news/uk/health/article6446494.ece

My Best,

[talaxandra]

fMRI scanning may show bioelectric evidence of pain, but it's hardly a practical way of assessing patients, quite aside from the huge number of MRI scanners the average hospital would need :)

As another member has pointed out previously in this thread, vital signs only change with acute pain, so using those techniques would demonstrate that chronic pain patients don't really have pain.

In my experience there's also no correlation between pain intensity and increase in vital signs, quite aside from the fact that there are other factors at play. I, for example, have a baseline BP of 110/70 - several years ago I had elective orthodontic surgery. Preop, when I was painfree but more stressed than I realised, my BP was 160/95; postop, when I had some pain but reacted to the GA, my SBP was almost 90 after 1L of N/Saline bolused over 20 minutes.

Substituting technological assessment for the process I described earlier wouldn't help with assessing pain for many patients; not only post-op, but (off the top of my head) also septic, hypoglycemic, febrile, anxious, physically fit and naturally sweaty patients.

I for one think we increasingly rely on what our equipment tells us over what our patients and our assessment of them tell us. If my patient reports pain and spikes his BP, I believe he's got pain. If he tells me he has pain and his BP is the same as it was an hour ago, I don't believe him less.

I just rememebred an incident from several years ago - a patient was being weaned of his GTN infusion because there'd been ongoing issues with maintaining his BP. For some reason now lost in the mists of time, this was being done overnight. His nurse, who was not particularly experienced but none the less cocky for that, left the desk to respond to his buzzer. When she came back to the desk ten or so minutes later I asked her what he wanted.

"He said he had chest pain," she replied, "but I checked his obs and they were fine, so I told him he didn't, then checked on my other patients."

And by then he was pale and grey, with crushing, radiating pain, but still not hypertensive, a state not helped by the bump in his GTN the evolving MI required.

[talaxandra]

Posts combined

[Crash_Cart]

In my experience there's also no correlation between pain intensity and increase in vital signs,

Would you mind if I and the New England Journal of Medicine would respectfully disagree?

My Best.

[talaxandra]

Not at all - I never mind learning new things. So there's data supporting a logarithmic progression in vital sign increase that correlates to the degree of pain being experienced? Fascinating. Is it universally applicable (eg a 10% increase in systolic pressure reflects a 10% increase in pain) or individualised to each person? And did the researchers account for acute pain in people with chronic background pain? Because my experience has been that sometimes their vitals don't seem to change even then.

[Batman25]

We use a scale of 1-10. I like that patients when they are capable can tell us the pain level they feel they are experiencing. People have different tolerances to pain and I am mindful of that. I also make sure those with high tolerances don't feel they need to suffer through it.