The Pain Scale - too subjective IMO

[FZ1Tom]

I've noticed that when you go to the ER or the doc nowadays for something acute (refer to my other thread in this forum) they always ask you "on a scale of 1 to 10, what would you rate your pain?" After being asked this 3 times in 13 days, I'm simply confused. First time (UTI/pyelo) I said 6......pain was more like a 4 but I added 2 points for its persistence. Second time, in the followup doc's office I told the nurse 7 and today in the ER I called it 8/10 (it varies, worse at night and after peeing). But I fail to see the use of it. How do you quantify it and how does it affect your evaluation of acuity or when/how soon you see a patient (clearly, if the doc decides you've put up with acute prostatitis secondary to pyelonephritis for 13 days, taking an extra hour to do rounds or lunch won't kill ya :imbar )

I think you have to have a reference point. Fortunately I have plenty to draw from, tho I wasn't asked to grade it back then.

Acute injuries:

- Fractured pinkie, self treatment with reset and tape: 4/10

- Dislocated thumb, again I reset it myself after 3 people at work either couldn't or wouldn't assist: 6/10

- Weber C leg frx and ankle with severe foot dislocation (turned it out and back after dunking a basketball off a picnic table, crash landed. Flaming youth and stupidity go hand in hand ): This one was a 9/10, but when the doc reset it, sneak attack style, no painkiller (had already been on a gurney 5 hrs and was shaking like crazy) the index exploded to oh about 10,000/10 for a few milliseconds :angryfire

- Cracked/broke tip of #9 rib after getting pitched off motorcycle: 7.5/10

- Stupidly throwing away a Percocet Rx out of fear of narcotics following a brutal tooth extraction (no gas, equally stupid) and then developing dry socket and allowing yourself to linger for 2 days: 8.5/10

And then you have the more subjective area of illnesses, so to speak. Maybe a misery index would be more useful?

Severe salmonella: 8/10

Influenza: 8/10

blood infection: 9/10

Severe dehydration (see blood infection): 9/10

Skin infection: 6/10 but 9/10 when the doc drains it and stuffs 25' of Betadine guaze into the hole left in the armpit 1 inch at a time.

Observations, anyone? I think a pain scale would be useful but only if you have reference points, and moreover, the time to relate them (like above). But its not practical to sit there and talk for 15 minutes about "well, when I got this bug back in.....". All of nursing would grind to a halt if every patient did that :chuckle

Tom

[redwinggirlie]

How could someone else have a reference point for you? Forget that question. Everyone's pain is their own. In a world of rates and values, 1 to 10 in my opinion is a clear scale.

[nurseunderwater]

i love to compare a 10 to unmedicated childbirth....leg cut off w/ out anethesia....and go from there. :)

[jemb]

It might be helpful to ask the patient what he/she would consider a 10 on the pain scale, then ask what the current pain is.

My problem with the pain scale is that so many patients I've had cannot comprehend the question. It's not bad where I work now, but when I worked in an area where the population was for the most part uneducated, many patients just didn't 'get it'.

[Tweety, BSN, RN]

Hi Tom. I work on a trauma floor and see people with a fractured femur or a broken back rightfully rate their pain a 10/10. But next door another person with the same kind of fracture rate it a 4/10. So coming up with a reference point as to what it should feel like is not right.

I think we need to stick with a pain scale that is subjective. Suppose someone is rating a UTI a 10/10. We go back to our reference point and say humph, it should only be a 5/10 and undermedicate.

Plus also it's an indicator that something might be wrong. Someone with a broken wrist complaining of 10/10 might be having compartment syndrome.

I say leave it alone. Let it stay subjective. It's supposed to be.

Of course, it all depends on the honesty of the patient, for instance you adding a couple of points for effect doesn't help. :)

jemb, I run into that problem with the pain scale too and just have to really on their description. The pain scale isn't appropriate for everyone.

[RN92]

I think the point of the pain scale is to have a baseline (whether its 2 or 10 - isnt as important as what the number goes to after treatment. Did the pain management given, decrease or increase the number on the scale. JCHO wants to see that the pts pain was addressed appropriately. It has nothing to do with anyone else except the patient. My kidney stone at its worst may be 8 and yours may be >10.

[begalli]

It might be helpful to ask the patient what he/she would consider a 10 on the pain scale, then ask what the current pain is.

I think this is a excellent answer.

Pain is 100% subjective.

I cannot compare how I rate pain personally to how my patient rates their pain for the same type of injury/condition. That would be totally inappropriate.

Sadly, pain is way undertreated because of what we think it should be.

[91WhiskeyM6]

The pain scale should just be from 1 to 3 with 1 being mild and 3 being severe.

What's the freaking difference between 6 and 7 ?

[rsh3rn]

The 1-10 scale drives me crazy people are afraid that if they don't give the 'right' number they won't get treated. My answer, ask the following: Does it hurt? Do you wan't pain medicine? I do get strange looks when I fill in the pain score space in my papers with a Y or N, but how can you decide if a pt need medicated at a pain level of five. I have patients who say their pain is a five and are estatic with it

[CEG]

The pain scale drove me insane when I was in labor. I am not a nurse yet, so I had no expertise to go along with it. First I said "4". The nurse said, "Really? 4? That's almost halfway to 10?" So I said "2" even thought I was in a lot of pain. I kept having to think about it so they jumped all over the place. I haven't really done anything painful up to that point so my point of reference would be a stubbed toe or a hangnail or something. I know what a 10 is now, LOL..

I told my husband next time we have a baby my birth plan will say "Please, no pain scale". :)

[armyrn]

The pain scale should just be from 1 to 3 with 1 being mild and 3 being severe.

What's the freaking difference between 6 and 7 ?

Six is one less than seven.

I use the 0-10 scale as part of my pain management, but there are other ways to assess pain that should be used as well. If a patient comes to recovery screaming, crying, 10/10 and after medication is 8/10 but relaxed, comfy, and chatting with a buddy, then my friend their pain is under control. Do the right thing and document everything and it will be hard for a JCAHO inspector to ding you, if that is what you are worried about (which everyone is, when it comes to pain management these days).

Just one man's opinion...

[Brickman]

When I admit a patient I always let them know that a 4 is when we start to medicate the pain. I tell them that if they are in pain, but not enough that they would like something for it then to give me a 2 or 3 so I am aware that it is a potential problem. Once their pain increases to something they want't addressed then to give me a number 4 or higher and I will address it. This seems to work well me and my patients.