Pain Scale

JKL33 · Jul 30, 2017

It doesn't matter what the scale is. Some people will always exaggerate. I tend to scale "backwards" ...I ask them if they need dilaudid IV or a single percocet 5/325. If it's dilaudid, I assign their pain 8-10. If it's percocet, I assign it a six. I'm not concerned with accuracy when it comes to an eight verses a nine or a two verses a three. I just want to hurry up and finish so I can go to lunch.

:nono: Come on now...you know someone's going to be righteously "miffed" that you just wrote that.

Can't help it...I was just sitting here deep in thought about the whole pain scale dilemma and how we don't have very effective conversations about pain and it struck me pretty funny...

Good one...

5228shamrock · Jul 30, 2017

Sour Lemon- you made me laugh! Our scale has both faces and numbers on it, but I find that folks can't really come up with an answer on the spot. I don't care if their pain is 2 or 8, but I need them to report it accurately so I know how to treat them. I just want to make sure that they understand the scale correctly. And it does happen that people report pain of 10, and say that they can barely comb their hair because their shoulder hurts so bad, and that they can't raise their arm hardly at all- but then they are seen 10 minutes later working, lifting 30 pounds over their head and joking around with their coworkers, with no problems moving their arm. I'm just saying that the two things just don't match and it makes it difficult to know how to proceed with treatment.

Julius Seizure · Jul 30, 2017

I agree that the faces work remarkably well with children. I do not work with children. I'm also not trying to second guess someone else's pain. I work in occupational health. I often see people who tell the nursing staff that their pain is 8 or 10 all day, every day. But when they are observed working, they are smiling, laughing, joking with friends and performing their job without any issues. What is observed and what is reported just doesn't match. It's hard to know how to proceed with contradictory information.

Where I've worked, we've always used the 1-10 scale. Many folks will promptly give you a number (usually a number >10) but others seem confused by the whole idea. When I became a patient, I understood. Assigning your pain a number between 1 and 10 is difficult. I like the Wong-Baker Faces scale when I'm a patient. It's simple, it works well and I don't find it at all insulting.

I wasn't aware that FACES and similar...."face-based" pain scales were validated for use with any population besides pediatrics. I've only ever seen numerical scales used with adults. Guess I should read up on that. No reason an adult couldn't use FACES, I've just never heard of it.

5228shamrock · Jul 31, 2017

The faces allow us to communicate with non-English speaking people who might not understand the English numbers, even though we have it translated in multiple languages.

DowntheRiver · Jul 31, 2017

I laugh when I'm in pain FYI, particularly when my abdomen is palpated. It's not like a cackle, and you can tell it greatly differs from my normal laugh. I didn't even pick up on it until I had my gallbladder out and a physician noted it in my chart...

JKL33 · Jul 31, 2017

And it does happen that people report pain of 10, and say that they can barely comb their hair because their shoulder hurts so bad, and that they can't raise their arm hardly at all- but then they are seen 10 minutes later working, lifting 30 pounds over their head and joking around with their coworkers, with no problems moving their arm. I'm just saying that the two things just don't match and it makes it difficult to know how to proceed with treatment.

This is reality sometimes and IMO we don't have enough honest conversations about it.

I've always appreciated the fact that in the ED one of our go-to manuals (from a government entity nonetheless) mentions this to enough of an extent to at least acknowledge it. Granted, this manual is used for the purposes of learning to triage/sort through great numbers of people. But I find that it is on point with regard to this. I don't know how we as a country can keep carping about overprescription and overuse of main medications without addressing this aspect a little more head-on.

https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/esi/esihandbk.pdf

page 12.

**canoehead, BSN, RN** · Jul 31, 2017

I start out with the assumptions that the patients pain is what they say it is. But their behavior can contradict what they say. If they start out at 10/10, I medicate accordingly. Then after an hour I think they look more relaxed, and they are able to chat with their visitor, but they still say 10/10. Well...maybe, but I'm starting to wonder if it isn't at least a little better. Then their visitor leaves, they go to sleep, and are sedated enough to require oxygen. They ask for more meds when I do vitals, and still, they're 10/10. Now I just don't believe them. I'm going to medicate to behavior, not pain scale.

5228shamrock · Jul 31, 2017

Well said, JKL33. Thanks for sharing.

Ruby Vee, BSN · Jul 31, 2017

I wasn't aware that FACES and similar...."face-based" pain scales were validated for use with any population besides pediatrics. I've only ever seen numerical scales used with adults. Guess I should read up on that. No reason an adult couldn't use FACES, I've just never heard of it.

They used the faces scale in the perioperative area each time I've had surgery. It's an adult OR -- the children's OR is in a different building, so it's not as if they picked up the laminated piece of paper from the kid in the next cubicle -- they were planning to use it on adults. I just found it so much easier to look at the faces -- I feel worse than that one, but I'm not as bad as that one, so I'll pick the one in between. I could remember which face I chose more easily that I could remember whether I rated my pain at a "7" or an "8", so when the nurse asked me to rate my pain after the medication, I could more accurately report on that. The scale had numbers above the faces, so maybe an all purpose pain scale? I don't know. I just know that asking me to rate my pain on a 1-10 scale was, despite the fact that I've used that scale for decades as a nurse, stressful to me as a patient. The faces scale was so much easier and less stressful.

Ruby Vee, BSN · Jul 31, 2017

I start out with the assumptions that the patients pain is what they say it is. But their behavior can contradict what they say. If they start out at 10/10, I medicate accordingly. Then after an hour I think they look more relaxed, and they are able to chat with their visitor, but they still say 10/10. Well...maybe, but I'm starting to wonder if it isn't at least a little better. Then their visitor leaves, they go to sleep, and are sedated enough to require oxygen. They ask for more meds when I do vitals, and still, they're 10/10. Now I just don't believe them. I'm going to medicate to behavior, not pain scale.

I always use the behavior pain scale in addition to the numeric one. They tell me their pain is 10/10 and they need dilaudid, but the behavioral scale rates them about a 3 . . . or the opposite problem. Some folks (including me) tend to rate their 9/10 pain a lot lower than it is because they figure they should be "able to handle it." When they tell me their pain is a 4 and the behavior scale gives me an 8, I talk to the providers about pain control. Unfortunately, the behavior pain scale doesn't help me to rate my OWN pain.

Susie2310 · Jul 31, 2017

I just know that asking me to rate my pain on a 1-10 scale was, despite the fact that I've used that scale for decades as a nurse, stressful to me as a patient.

This has been my experience too. On one occasion, when I had severe pain and was shaking and diaphoretic, I confidently rated my pain level as a 10 as I couldn't and still can't imagine being in more pain than I was then. But on another occasion, for a lesser level of pain that was still significant but nowhere near the 10 level I experienced, it was much harder for me to quantify, and I had to tell the staff I couldn't quantify it. I felt that not being able to quantify my pain level between 1 and 10 (which was recorded in my chart as "she is unable to quantify her pain") made me appear less credible, but it was actually the truth.

bgxyrnf, MSN, RN · Aug 1, 2017

I personally find the whole 1-10 scale to be largely meaningless and I don't accept that "pain is what the patient says it is" because so many people jump straight to 10 (or 15 or 40).

I don't mind if other nurses accept it as valid but I simply don't, based on years of experience asking the question of thousands of people.