Pain Scores Effective or not

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Specializes in RN, BSN, CHDN.

Who feels pain scoring is effective and why. As a patient having lots of pain when asked what my pain level was from 1-10 I found it difficult to score for many reasons

1/ I felt it was stupid way to ask about my pain

2/ I compared everything to the extreme pain of labour which has to be one of the worst pains I have ever experienced and I stll wouldnt say a 10

3/ When in pain I wanted the nurse to give me pain meds, not to talk to me ask stupid questions and go away and leave me alone.

Now as a nurse I ask what is your pain score and I hear 8 or 9 from people who are laughing eating reading NOW I am not saying they are not in pain because I do believe they are in pain but not at an 8 or 9 because I firmly believe that is so painful you would be almost at a screaming level, and if you read the description of anything above a 5 or 6 you have to be in agony.

There must be a better way of scoring pain that doesnt involve a number because I dont believe it works.

So what have other people found and is there any more research going on anywhere which will improve the way we report pain 'scoring'

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Specializes in ER, ICU, Infusion, peds, informatics.

i hate the pain scale with a passion.

[color=#483d8b]as a patient, it royally p'd me off to have to quantify my pain. mild, moderate, and severe worked just fine for me, and was easier for me to decide on. i know if my pain is moderate vs severe, but a 6 vs a 7???

[color=#483d8b]as a nurse, it irritates me that patients seem to think that if they don't answer "10" that we don't take their pain seriously. as i said in a previous thread, in my mind, i give more "points" to a pain of 8 than a pain of 10, because at least i know the person that said "8" thought about it. now, no matter what the patient says, i report the pain level as described by the patient. but in any given night in triage, more people report a pain level of "10" than all other pain levels (0-9) combined.

[color=#483d8b](by the way, the next most frequently cited "pain level," in my experience, is "0," and usually cited by someone that had to be dragged in by a worried family member.)

[color=#483d8b]i had a young female patient in triage one night, that brought her mother with her. i don't remember what her complaint was, this happened several years ago. what i do remember, however, was that when i inquired about her pain level, she replied something along the lines of a 7. her mother interrupted her, told her she was wrong, and that her pain was a 10. her mother then went on to tell her that she should always report her pain as a 10, nothing less.

[color=#483d8b]that attitude is pervasive, and it invalidates the whole thing.

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Specializes in Utilization Management.

The reason I have to ask about pain score is that I might have specific instructions to give one med or one dose for "mild" pain, another dose or med for "moderate" pain, and yet another for "severe" or breakthrough pain.

We're instructed to medicate anything over a 4, and that a pain rating of 7-8 is classed as a medical emergency.

(This doesn't include chest pain, by the way.)

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pain is subjective, it is what the patient says it is. I will try to re-explain the pain scale to my patients, especially if they say "10" and they are eating, laughing and watching tv. I ask them if I were to push on or hit the area that is hurting it can not get any worse? They usually say "oh it can get worse" then I remind them they must not be a 10.

For my patients who tell me they still do not understand, I explain that the numbers are up to you, but the key is that after my intervention (pain med, repositioning or heat or cold) the number should go down. When I reevaluate pain I will ask them for a number and remind them of there number they told me before intervention. This usually works and I will document in the nurses notes behaviors for those patients that call for the medicine "just because it it time" and not because they are hurting and if it is time I will give them the medicine.

We use a behavioral scale for non verbal adults and faces for pediatric patients also.

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Specializes in NICU.

And patients have such varying levels of pain, they're not sure where to start. "It's an 8 when I walk and a 5 when I roll over in bed and a 1 when I'm lying here . . . "

I make a point of explaining to them that we just use it as a way of comparing THEIR pain during the stay and that pain treatment isn't dependent on their giving a certain number. But I hate it, too.

In most cases, I think mild, moderate and severe would be much more useful and comfortable for the patients. Let's start a petition ;)

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Specializes in ER.

My pain is a ten, always a ten. Because I want the good drugs, and I want them fast, and lots of them. I also want to get ahead of the 50 other people in the lobby because I can't wait that long. Even if I could I wouldn't want to, who cares about them, this is an emergency room, and if I say it's an emergency then I should get my pills right now.

Oh, my ride says it's a ten, she reminded me that I was hurting more 30 minutes ago, and you should always describe when it hurt worst or they won't think you're sick. Besides, she'll be pissed off if I made all that fuss for an 8 or 9. Survivor is on tonight and she wants to get the heck out. If I say ten we might have time to stop for Chinese take-out. I haven't eaten all day you know and I'm hungry. The shop closes at nine, so we figured we could get out by then. How long could it take to write a prescription? I already know what I need cause I had this same pain last week and took a couple of her pills, and felt fine, so why don't you just ask the doc now if he could write for them?

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Specializes in nursery, L and D.
My pain is a ten, always a ten. Because I want the good drugs, and I want them fast, and lots of them. I also want to get ahead of the 50 other people in the lobby because I can't wait that long. Even if I could I wouldn't want to, who cares about them, this is an emergency room, and if I say it's an emergency then I should get my pills right now.

Oh, my ride says it's a ten, she reminded me that I was hurting more 30 minutes ago, and you should always describe when it hurt worst or they won't think you're sick. Besides, she'll be pissed off if I made all that fuss for an 8 or 9. Survivor is on tonight and she wants to get the heck out. If I say ten we might have time to stop for Chinese take-out. I haven't eaten all day you know and I'm hungry. The shop closes at nine, so we figured we could get out by then. How long could it take to write a prescription? I already know what I need cause I had this same pain last week and took a couple of her pills, and felt fine, so why don't you just ask the doc now if he could write for them?

:lol2: :lol2: :lol2: :lol2:

I know, I know its not funny, really. But so true, for a lot of the ER population.

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Specializes in ER.

We were just having a similar discussion in the Emergency Nursing area (see the CRAP scale).

The problem with the 0-10 pain scale is that the average patient has no idea where their pain should be on the scale. As someone else noted, I'm a huge fan of the patients that present to triage with 10/10 abdominal pain who are laughing, eating lunch, and looking for "that pain medicine - begins with a 'd'". Similarly, the older lady who has an ischemic gut who you know has to be ready to die from the pain who reports 2/10.

I'd love to see if someone has ever corolated a patient's report of pain with a scale like the FLACC scale.

Chip

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Specializes in home health, peds, case management.

i agree that the pain scale is imperfect, (i think its hard to try to objectively quantify a subjective experience) but it's the best we got right now. what i have found to be more helpful than the actual # (but gotta document that magic # so gotta ask for it) is to ask how they feel about their pain level...do they think it could be better controlled? are they able to function at that level?

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As a student I was a huge proponent of the pain scale. Now as an RN I don't really find it useful at all.

I work in oncology and we deal with a lot of pain issue. Numerical scales are somewhat confusing for a lot of patients. I find mild, moderate and severe pain much easier to work with. As well, the numerical value reported generally isn't likely to change my intervention since it's typically not a ranged dose.

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Specializes in ER.

If we use the FLACC scale do we base it on behavior in triage, or in the lobby when they think we aren't paying attention?

I have been witness to the incredible intermittent limp many times.

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Specializes in ICU, ER.

It's a waste of time. I constantly triage people who are sitting perfectly still, no signs of distress, and say it's "10 out 0f 10".

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