Rate Your Pain

[Joe V]

Pain is very personal and subjective. It's difficult to assess just how much pain a patient is experiencing. There is no blood test or X-ray or other diagnostic study to measure pain. Nurses and other healthcare providers often utilize different types of tools such as rating pain on a numeric scale or pointing to the face that best describes how the patient feels when in pain. But, in the end, pain is still subjective and many factors can affect just how useful these tools can be. How often do you utilize these pain rating scales? Which ones? How valuable are these to you as a Nurse? Tell us your stories.

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[djh123]

I love the 'I look like #3 but feel like #5'. Many of us have had 'those' patients who always want a strong pain med when they're not showing many or any signs of pain.

[HeySis, BSN, RN]

Harveyslake said:

Yes, the 10/10 pain scale is meaningless. I was in the ER as a patient once with abdominal pain. I was asked the standard questions about pain. I honestly stated it was a 10/10 because it was the worst pain I've ever had,....but, I followed with it was annoying pain but tolerable. 10/10 pain is not always debilitating, excruciating pain. Stupid, subjective pain scale. Completely meaningless. Next!

I explain the scale as rate on a scale of 0 to 10, 0 being no pain and 10 being the most excruciating pain from being burned up you can imagine (cause most people have had at least one burn and understand the pain that goes with it). That way they are not rating based on their exact experience with pain in the past (the worst pain they've ever had) but the worst pain they can imagine. I think it puts it into perspective for some, and I have had patients that are hurting so much they continue to rate it a 10/10. And that's fine.

Worst is trying to get a pain scale out of a patient when just waking up from anesthesia and they rate it a 7/10, you give meds and then 5/10 mins later they are more awake and state it's gotten better but now rate it a 8/10.

And I hate zofran for post-op nausea, it may work prophylacticly, but once they have that feeling.... phenergan all the way.

And I love when people let their anesthesiologist know that they've had post-op N/V before hand. Our anesthesiologist will give dexamethasone, reglan, zofran and sometimes even a beta blocker (if their heart and BP can handle it) while still in surgery and do a little propofol slurry there at the end.

Because lets face it opioids make N/V worse so who wants to choose between hurting and throwing up?

[WKShadowNP, DNP, APRN]

If I had to choose, I'd rather hurt than be nauseated/throw up.

[Midazzled]

My previous comment was a bit rant-y and kinda juvenile. My real issue with pain scales is the way that they get used, and how we are expected to use them. It's not a vital sign. Treat the patient, not the number.

Nutella hit the nail on the head.

[3ringnursing, BSN]

I trust when someone tells me their pain is severe that it is. How could I possibly prove otherwise?

[traumaholic, BSN, RN]

I ask about pain with every patient. I get a lot of 7/10+ pain. Pain is not the same for every person but when someone has a history of drug abuse and describes their pain 10/10 but childbirth was 1,000,000/10 I have to question that. Also I have had quite of few people tell me no pain and as soon as they get to the hospital they are crying in pain wanting a refill on their prescription.

[JadedCPN, BSN, RN]

Harveyslake said:

Yes, the 10/10 pain scale is meaningless. I was in the ER as a patient once with abdominal pain. I was asked the standard questions about pain. I honestly stated it was a 10/10 because it was the worst pain I've ever had,....but, I followed with it was annoying pain but tolerable. 10/10 pain is not always debilitating, excruciating pain. Stupid, subjective pain scale. Completely meaningless. Next!

Ditto! I recently had preventative double mastectomies that required an overnight hospital stay. I've had many abdominal surgeries in the past and consider that I have a high pain tolerance, but this was truly "the most pain I've ever felt in my life." I explained to the nurse that technically based on those standards, yes it was a 10 out of 10 but at the same time I could bear through it with oral pain medication rather than IV.

I don't know an alternative to the subjective pain scales. In pediatric world if they are under a certain age or of a certain developmental level, we use a little less subjective scales like FLACC but even that can be left up to some nursing interpretation.