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'
I work in PACU and I find that most of my patients can't utilize the 1-10 pain scale. I too prefer to get the patient to describe their pain as mild, moderate or severe and go by visual cues in addition to vital signs when assessing someones pain.
I try to explain to my patients that my job is to get the comfortable enough that they can deep breath and cough effectively. In doing so I ask them if they want more analgesia/antiemetics/repositioning (as appropriate for their surgery) so as to make them more comfortable.
In my experiences some nurses can't understand that some patients cannot "rate" their pain on a scale.
Thank you for your honest replies I was begining to think that I was going crazy because I found the scale so completly useless. I have been a nurse a long time but this tool defies explination sometimes.
We found out recently that a score is kept in our facility on which RN gives the most pain meds Kind of a 1-10 of pain med giver I am sure I am must be in the top 10.
Sorry off topic but I do like the mild moderate severe scoring
As a patient I hate the pain scale of 1-10. I find it hard to put a number to my pain. I want to give it the number it deserves but I dont want to seem like I am really complaining and overexagerating. I really dont like it.
I also despise the pain scale. I think it can be good for reassessment of pn after an intervention, but it is generally useless. I chart 2 pain scores - 1 is the required numeric, but I also do a Wong Baker....even if I don't write "pt states pn 10/10, Wong Baker score of 2" I will chart "pt states pn 10/10, sitting up in bed laughing with friends, eating Fritos and drinking Coke. BP 120/80, HR 66." etc etc.
Just for fun, I try to pain score myself when I'm having issues. I've never been able to get over a 4/10. Menstrual cramps? 4/10. Gas pain? 4/10. Falling down the hill while gardening? 4/10. Kicked in the chest by an unruly toddler while trying to start an IV? 4/10. Dealing with the drug seeker who is allergic to everything but the "D" drug, who is on the call light as soon as I leave the room, insists she has a ride who will be here just as soon as I give her the narc and her d/c papers? That is my 10/10.
I work in the PACU and most patients who are waking up from anesthesia can't count to ten let along put a number on their pain so I go by them saying it hurts and their body language and score them on the faces or flacc scale.
once I had a patient who told me he was a 7 so I medicated him and next time I asked he said an 8 so I gave him some more medicine, then I ask him again and he says a 9 so I say the medicine isn't helping at all and he says no honey a 10 is the best and I am doing just fine. So I gave the man 10 mgs of Morphine for a pain of 3 but I always say with 10 being the worst pain you have ever felt and he apparently just didn't understand.
Specializes in ER, ICU, Infusion, peds, informatics.
this is not the patient's fault. he or she is not trained in the "proper" use of the pain scale.
~mel'
umm, no, we "train" them in the "proper" use of the pain scale when we educate them about it and pain management.
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[color=#483d8b]if the average patient doesn't understand with the simple exlpanation (or understands but still doesn't use it as intended), then it probably isn't a very good tool to use for pain assessment.
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[color=#483d8b]i think that is the point most of us are getting at.
Pain assessment requires the ART of nursing. A nurse will analize and synthasize vital signs, posture, facial expression, and statements made by the patient and family. Using only a pain scale is not a pain assessment.
Pain assessment is not solely data collection.
As has been posted one patient may rate his pain as a '10'. Another may be unwilling to move, cough, or take deep breaths due to level '2' pain.
We must advocate for the best interest of the patient. It may require teaching.
I once had a patient doing jumping jacks at the bedside. He was "working through this pressure in my chest"
He needed lots of teaching. His pain was relieved with NTG.
I like the 0-10 pain scale. The important thing isn't whether a patient says 5 or 10. It's not meant to convey information in a precise way that means the same thing for every patient.
The reason we need it is it lets us get an idea of the degree of relief or worsening.
Just as importantly, it implements hospital policy. Usually policy sets a break point on the low end of the scale, say between 3 and 4.
When the pt states a pain level of 3 or below, he conveys to the nurse a lessened concern and urgency, which when combined with S&S, gives her an escalating range of interventions to select from. She may opt to start anywhere on that continuum.
At 4 and above, whatever other interventions she may deem appropriate, hospital policy may require her to administer PRN pain meds within a set time.
Of course, if a pt who's new to me states pain of 5, I'll tell them what relief their orders authorize, teach and give them a choice. I think most nurses do that.
And if I know them, I'll cut to the chase, always asking if they're requesting the med.
But we need that scale. At least it keeps us in court from looking like we make things up as we go along.
About pts who say 10 all the time, it is a way of communicating to us they want to cut to the chase and get max available relief. To me, that is good, valid communication.
this is not the patient's fault. he or she is not trained in the "proper" use of the pain scale.
~mel'
so whose fault is it? the nurse's? do you have a better method of educating you'd like to share? something new they're teaching now? i'd love to know as i find the pain scale useless. i do however find it very simple to teach.
umm, no, we "train" them in the "proper" use of the pain scale when we educate them about it and pain management.
[color=#483d8b]if the average patient doesn't understand with the simple exlpanation (or understands but still doesn't use it as intended), then it probably isn't a very good tool to use for pain assessment.
[color=#483d8b]i think that is the point most of us are getting at.
yep, that is the point. it is not a good tool for pain assessment. i think most of us using it for years and hearing those "10's" know that !!
thank you for your honest replies i was begining to think that i was going crazy because i found the scale so completly useless. i have been a nurse a long time but this tool defies explination sometimes.
i know that when my patients tell me they have a "10", i tell them that a 10 should send them to the er and do they need to go? (i'm in homecare) most of them then quickly change their score ! btw, i've never sent anyone to the er for pain issues.
oldiebutgoodie, RN
643 Posts
Thank you for this thread! I HATE THE PAIN SCALE, and I think it is a load of c***.
It is obviously the product of the bad old days when pain was not medicated appropriately, but we have swung totally the other way.
I like the previous poster's question, "Is your pain mild, moderate, or severe?"
Although we will still have the laughers and smilers who are planning their vacation say it is a 10.
I agree, why not a FLACC scale for adults?
Oldiebutgoodie