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.

[nursel56]

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

According to all 3 of the "research articles" posted, you send the patient for an MRI when he complains of pain, where a snapshot in time supposedly is totally accurate in describing a dynamic process scanned by an fMRI in the study. The theory is that pain "seems to" increase blood flow "roughly" proportional to the patient's pain, subjectively defined. Circular argument. Plus. . geez how many MRI machines would you need for that?

To be more accurate than the real-time query or observance of pain, every other reason for that type of increased blood flow to the brain has to be ruled out. Since there isn't a link to how this study was done, who knows how they screened for variables. Like, maybe the patient is p*ssed off about having to have an MRI before he can get his Vicodin, and the brain is responding to that stimulus in the same or a similar way.

Anyway. . . funny blog post wars!! . . .it's on!!. . .if you are humor impaired, best to skip this. . .

Scalpel or Sword?: Scalpel's Helpful New Pain Scale

[SWS RN, ASN, RN]

Thanks so much for the link....LOVED IT!

I have to agree with Scalpel, I don't think there is a 10. It's so often misused. I am tired of asking a patient who is eating, watching the TV, talking on the phone and laughing what there pain level is only to be told it is a 10.

No way, no how.

Don't want to get into the fray with the MRI debate....let's do a $2,000 test to see if this guy is in pain?

I do also believe that chronic pain does not exhibit the physiological signs that acute pain does, yet it is pain all the same.

Bascially, I use signs and symptoms to assess and also whatever the patient says it is....then I medicate.

Taught that pain is whatever the patient says it is.....except for a 10!:)

s

[tewdles, RN]

I actually think that some people are conditioned by their exposure to the health care system to inflate their pain reports...as if they feel that they won't actually get medicated if they tell me that their pain is 4-6/10 rather than 10/10. I am pretty sure that I had pain 10/10 with the rapid labor and forceps delivery (without anesthetic) of my second child. I am pretty sure that the patient who had an open wound involving her entire perineum and then fell and broke her clavicle really had pain 10/10...but I could be wrong. At any rate, I medicate until they tell me their pain is at a tolerable level, which is appropriate in my line of work.

Clearly, MRIs and other expensive and poorly accessible testing is not the answer to the age old question of "how much pain do you have?"...already we have poor, underinsured, and uninsured citizens who have difficulty acquiring the medical and nursing care they need...this would pretty much see to it that those folks live in misery with poorly controlled pain because we can't "prove it" with technology. Let's not even consider how this practice would impact the cost of providing basic care to the masses.

So, for me (dealing daily with people experiencing very real physical, emotional, and spiritual pain) I will continue my "simplified" and "without scope" practice of asking the patient their level of pain (on a scale of 1-10 when possible), conducting a comprehensive pain assessment, making appropriate referrals to MSW and spiritual care, and medicating accordingly.

[nursel56]

Agree 100%, Tewdles. I can totally understand why there is this research into having a way to assess pain (as the 5th vital sign) as we do the other 4, and it probably would be helpful in patients who are cognitively impaired, unable to speak or in peds, etc. I did a little more reading on the MRI research. Even if some day there would be an efficient way to observe dynamic brain activity as an objective measure of the subjective experience of pain, the models produced won't be able to tell you what you need to do before treating the pain, as even the author of the studies referred to in the popular press articles linked to by Patient Care Asst, Irene Tracey, seems to agree. For all the benefits of such a model described here,

.Chronic Pain - Researchers Find Way to Measure Pain -- it could as easily be used to deny treatment of pain.

I couldn't find the exact study, but several others quite similar by researchers at Oxford, it appears they use a uniform method of triggering pain, "thermal stimulus", which I think means they burn the subject in some fashion, then use the functional MRI to map areas of the brain showing increased activity.

A related study by Tracey did show that distraction generally decreased the perception pain, but that concept is already well accepted. If anyone is interested in this field of study, here is a great overview by Dr. Tracey from 2008 including some of the complexities associated with pain models developed by using the fMRI.

http://physiologyonline.physiology.org/cgi/content/full/23/6/371