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
Pain is what the patient says it is. However, like some other posters, I do ask the patients for their experiences with pain. Myself, I know I'm a weanie and if I was to say I had 10/10 pain from a splinter - it would hurt. BTW - I had two totally unmedicated births and they weren't painful. (I have very fast labors and delivery - it really only hurt a little bit.)
When I did my discs,L2-3 and L5-S1 the doc kept pushing for a number. He got argumentative when I said it varies, so I finally said 6.172 (or something like that) and it satisfied him. If I lay very still it was about a three but when he lifted the opposite leg it was about and eleven going on twenty-two. I actually felt I would pass out from the pain.
Now I've been Nursing for 30+ years most of it in ortho, and sometimes *I* don't understand scales. I've never been able to pinpoint burning vs dull vs sharp etc. It just HURTS and that should be sufficient. I agree some patients think it is a bargaining chip as to whether they can have pain med. But as TraumaRus says pain is what the patient says it is.
I always get confused about burning pain, dull pain... etc. Also different cultures have different ways of looking at pain. In traditional Chinese culture, their description of pain are totally different if I remember... like one of them is something like "sour pain" or something and for the life of me I have no ideal what that is...
Oh, you can usually tell who is an engineer because they will say something like 3.23343334563245 :) Also you can tell who is a statistician because they will say it is about a 4 with a standard deviation of 1.2 and the median is 3.5 :) assuming a normal distribution curve.
Pain is always subjective. However, the doc's in the clinic have come up with a pretty good rateing system based on Mild, Moderate, Severe.
Mild= pain is present, but not enought to keep pt from doing normal activities
Moderate= pain is present and prevented pt from doing some of his/her normal activities.
Severe= pain is present and prevented pt from doing all of their normal activities
It becomes a usefu scale for pt's that state they have severe pain, but were still able to go to work, attend the kid's soccer practice, and play a round of golf:uhoh3:
I really don't need a pain scale. I know this is probably blaspheny but I just ask "Are you hurting" and assess my patient and give them pain medication if they hurt. Why do I need a scale? Am I not going to medicate them if I get a low number from a fresh post-op?Am I going to get someone having an MI less MSo4 if they say it is better but still hurts?Do I really need a crying little kid to point to a smiley/frowny face to know he/she needs something for pain? And how about my Spanish/Mong/and non-English speaking paitent?When I have an alert English-speaking patient and can give either a pill or an injection I ask"Do you want a pill or a shot?"Why do we make everything so complicated?
i love to compare a 10 to unmedicated childbirth....leg cut off w/ out anethesia....and go from there. :)
Excellent comparison, IMO. (I've been there with the childbirth twice)
I have had such bad back pain that I had to say 9 of 10 today, as I was crying, and in such discomfort I wanted to jump off a bridge. Lack of sleep will exacerbate pain I think.
I had kidney stones, and would call them a 10 also.
Same with kideny infection when I was 25.
OTOH, broke two toes and would call initally call it a 8, but reduced to 7.5 within a week with no medical intervention.
Never, ever forget that Pain is subjective, and it is ALWAYS what a pt says it is.
Tom i hope that you are feeling better by now....as for scale..other posts are right pain is what the pt says it is...some people have a very low threshold (?) for pain..if you are able to make them comfortable..sometimes changing a position will help some times you need demerol...be senistive to their needs..the past 8 months i have had more illness than in my whole life time...really give you a new perspective to be on the other side...i can not tell how disappointed i am with many of the health professionals i have had the displeasure of being a VICTIM to...other the other hand i had many professional caring nurses also...my hat is off to them and they have my eternal gratitude..
I work at a LTC facility which is trying to get JCAHO accreditation.
We are told to ask each time about the pain scale 1-10 each time we give a pain pill. All it seems to do is aggravate the residents. They get angry and say "I'm sick of these questions everytime. Just give me my damn pain pill."
Thanks Chatsdale.......yeah, I feel better now, tho you might say it didn't exactly happen the way I'd hoped. Just check out my new "infection from hell" thread for the sordid details. :)
And yeah, I got to where I was kinda irritated by the apparent policy of having to ask me what my pain was on the scale every time they gave me my med. "I'm tired, my *** and significant members are REALLY hurting and I would like to be able to sleep a few minutes before the phlebotomist comes in at 2:30 in the morning to suck my blood and can I have my meds now, thanks?" :stone
I also think that if a nurse can acquire enough skill (and observation time, not always possible) he/she can tell just how much pain a person is in by certain behaviors. For example, if my pain is getting severe my breathing gets fast as my body tries to make itself relax, but failing even so. A person doesn't have to be screaming to be in severe pain. Maybe they're the silent type instead. It just all depends.
quite honestly, i seldom use the pain scale with patients but when i fill in the numbers, i make certain that it reflects the justification of the narcotic given.
if a patient wants pain meds, i am definitely going to assess as well as assume that the pain is such, that it's preventing them from going on with their day uneventfully. 9x out of 10, i find the questions belittling and unnecessary.
I was thinkinbg about that. Know what? you are right. Pain Scale is not always Objective. But to validate the pain scale given by the client- Include in your assestment data the facial reaction (your OWN observation) e.g facialgrimacing, frowning etc... That way you would know if the cilent is giving you the accurate measurement of pain. :)
): 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 
I work at a LTC facility which is trying to get JCAHO accreditation.
traumaRUs, MSN, APRN
87 Articles; 21,288 Posts
Pain is what the patient says it is. However, like some other posters, I do ask the patients for their experiences with pain. Myself, I know I'm a weanie and if I was to say I had 10/10 pain from a splinter - it would hurt. BTW - I had two totally unmedicated births and they weren't painful. (I have very fast labors and delivery - it really only hurt a little bit.)