I see a lot of 'failure to understand the definition of pain.' "Well it's not really pain, it just feels like someone is stabbing me."
I have a question. Do you "calibrate" the pain scale with each patient? In other words, do you ask them to describe what they mean when they say pain is a 2, 3, 4, etc.? Because one patient's 4 may be another's 10, and vice versa. I'm curious because sometimes I wonder what my doctor gets out of my telling her what my pain level is, when she has never done this with me. I get that if i report my pain level as a 5 when the week before it was a 7, then the doctor knows my pain level is decreasing. But how does the doctor know if a 5 still warrants treatment or medication if she doesn't know if the patient is describing pain equivalent to a paper cut versus pain equivalent to a badly twisted knee?
Exactly. The pain scale is probably most useful when you're seeing a patient repeatedly and can compare their number before and after a treatment.
My mother despises likert pain scales for the subjectivity of them. Reallly, for someone not in the medical field at all (she's a travel agent) she has a lot of emotional energy wrapped up in her anger about it! : )
the pain scale is only used to measure the CHANGE in pain, so the actual number isn't so important. As stated earlier, a 4 for one person might be a 10 for another, and that is OK.
I ask about the pain scale purely so I have something to write in the chart.
Anon 5:15You have hit the problem squarely on the head. A completely subjective experience has become an objective finding(at least per CMS, JACHO and other regulatory bodies).A 5 is a 5 and a 10 is a 10 for everyone despite the blatantly obvious fact that it is not.JustADoc
Ha! If a patient can be thinking of irritating numbers to give you, like pi or square roots, I wouldn't be bothered too much about his pain level.
I had a hard of hearing patient in no distress with a recorded pain level of 6. When I asked where his pain originated, he said he had no pain. When I asked why he had told the MA 6 at check in, he stated he thought she was just asking him to pick a number between one and 10 and he choose 6.
For those who haven't seen it a new pain scale with better faces.
We (at least my medic-mentor who is teaching me) use the subjective number (if it seems fairly plausible and not just drug seeking) to calibrate how much medication a person might need and to make sure whatever we've done is effective. However, I have come to learn that a lot of time the number I get from my patients does not match the physical findings, like the 10/10 stomach pain who climbed in our truck and bounced around like a kid on a candy high. I like to always try to compare it to other pain or previous experiences with this specific pain so I can try to better understand why its a 7, 2 or whatever.
I like when they ask you to imagine the worst pain ever. Being broken on the wheel. Burned on the stake. Drawn and quartered. Flayed alive.I hope I never have any pain like those.
As both a nurse and someone who, on occasion, has had pain, my expert opinion is that the scale is patently ridiculous for most situations. The MD/RN asks you to imagine the worst pain possible. Hm. I don't know how it would feel to be burned alive or run over by a truck, but I assume those are pretty bad things. Doesn't it make more sense to ask the patient, "What is the worst pain you have ever had?" Since you are asking the patient to objectify a subjective experience, you need to know what the patient's baseline for comparison is. Then you could say to the patient, how does this pain relate to that pain? Now you're getting somewhere. Presumably, we have all observed patients with real pain issues - a gallbladder attack, or kidney stones, labor, or post-op whatever, or an abscessed tooth - it doesn't matter. We can now better compare the patient's current pain with a known entity. The next gripe is the scale. 1 to 10. That is a lot of numbers. I don't know. I think it is a 7, no maybe a 6, no it is worse than a 6, maybe a 6.5. All we need is 0-5 with 0 being no pain and 5 being the "new 10," each level with a specific description, like whether it radiates.Finally, people usually ask about the location of the pain (right under this knife sticking into my abdomen), but what ever happened to asking about the characteristics of the pain like burning, stabbing, throbbing, etc? That seems to have been lost when 1 to 10 gained acceptance. Uh oh, Fizzy. You got me on a rant. Tricia
Who doesn't ask about pain characteristics??? They certainly should. I always ask that. Often I need to try to distinguish between neuropathic and musculoskeletal pain and that's a big clue.I would hope any doctor trying to get to the bottom of what's causing pain would ask more questions than just the 1-10 pain scale. But in an interventional pain clinic, it's important to get that number too, because you want to be able to compare before and after the procedure.
I have never been to see a physiatrist. But my rheumatologist never asks about pain characteristics. Just asks me to rate the pain on scale from 1 to 10. Which is frustrating, because I have different types of pain depending on the day. Sometimes it is sharp, sometimes dull and aching. Sometimes hands and wrists are more painful than ankles. Othertimes, the opposite. I just had my first appointment with a new PCP and he actually asked my what my pain characteristics are, and is the pain the same all over or not, and I was shocked but thrilled. He gets it.
Cute :-) I always hate using VAS too. Too subjective and not standardized!Jasmine
you forgot about eleventeen: http://25.media.tumblr.com/tumblr_lgqoooY3EL1qeurs3o1_500.jpg
Oh I hate the pain scale! I fell on the stairs and severely sprained my ankle a week and a half ago. I couldn't go to the hospital for an x-ray till the next morning, so I was over the initial sobbing agony. Having had chronic kidney infections and a stone, and given birth to 3 children, the pain in my ankle by comparison was like a 3. But on a normal, daily basis, it was more like a 7. Probably should have said 7, because I only got 10 vicodin which really wasn't enough. I'm a pharmacy technician, and generally averse to taking meds, but now I sure regret giving a low number, especially since I work on my feet.
I've learned that ladies with vast vocabularies (my wife, for example) who have given birth are often able to give excrutiatingly lucid and accurate descriptions of ANY pain on a scale of one to ten. Particularly when comparing the pain of an immobilizing and debilitating migraine to, for example, the pain after a recent foot surgery, when the T3's were being ignored COMPLETELY by her foot. There are whole cities of pain out there to experience, I guess. I've been lucky so far, with the only real ten (pulsing insanely past ten, SUBJECTIVELY INDESCRIBABLE!) being the time I had Lidocaine injected into the tip of my nose multiple times during an lengthy MOHS excision. It's the only time I've ever actually emitted a loud, sharp, keening whine while trying to hold perfectly still. It even beat the time I had my fingernail cut down the middle to have a splinter excavated. All the numbing agents in the world didn't help at all on that one, but still, better than the nose!
I usually just go with "with zero being no pain, and 10 being actively mauled by a bear. A polar bear. NOW rate your pain"