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
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."
That is damn funny, and so true...
And, what IS the difference between 6 and 7?
Yes, we all know it's 1...
That poster's point is well taken...1-5 is more precise, and makes more sense...
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.
leslie
Don't understand what you're doing here. Are you making up numbers to justify the pain med?
I pass lot of pain medication, just about every patient, sometimes once an hour on fresh traumas, so they are used to being asked. Our techs ask with each vital sign as well. I usually say "are you ready for pain medicine" and give it to them. As I'm giving it I'll ask the pain scale number, since that's our policy. I find it particuarly hand in reassessing the patient an hour later. But I think we were doing fine without it.
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.
Well stated.
I was given a card by Purdue Pharma L.P. that on one side has a scale drawn from 0-10 (that the patient can see). 0 is indicated by "No pain", 5 is "Distressing pain" and 10 is "unbearable pain". Not very helpful IMHO. The other side though is more useful. It has faces, from a nice happy face to the unbearably sad crying face. But underneath it, it has the following (under each face)
0 - No Hurt
2 - Hurts Little Bit
4 - Hurts Little More
6 - Hurts Even More
8 - Hurts Whole Lot
10 - Hurts Worst.
I usually approach it by asking the patient "on a scale of 0-10, 0 being pain free and 10 being the worse pain that you can ever imagine, how would you rate your 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 
hogan4736, BSN, RN
739 Posts
That is damn funny, and so true...
And, what IS the difference between 6 and 7?
Yes, we all know it's 1...
That poster's point is well taken...1-5 is more precise, and makes more sense...
sean