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Rating Your Pain (On A Scale From 1-10)

From this post, I received a lot of comments about the pain scale that we use in healthcare. In the last couple of years, JCAHO (our accreditation bureaucracy for health care) has mandated that we must ask if our patients are having pain at least every 2 hours. Of course, for this to be of any use at all, we must first ask the patient what a tolerable level of pain would be; a level of pain that would require no intervention from us in terms of getting pain medication. For most people, that number is 4. Don’t ask me why; that’s just what most people say.

Most of the commenters said that the pain scale was stupid: “I also hate that pain scale. JCAHCO imposed it on us. If someone walks into my office there is no way that I am going to believe that their pain is a 10.” And: “I was always told that 1 is barely any pain at all, and 10 is the worst pain that YOU have ever felt in your life. That means that everyone has experienced one or more 10′s in his life, doesn’t it? I mean, my 10 might be a new mother’s 3, but like, how am I gonna know that?

I believe the second commenter got it right. The pain scale is supposed to rate YOUR level of pain in regards to your tolerance of it. When I had a kidney stone, I walked into the ER and confidently rated that pain a 10. It was the worst pain I had ever felt in my life. Of course, this process breaks down if the worst pain someone’s ever had in their life is, like, a splinter.

I think the pain scale is pretty much useless.. I had cancer in 95 went through 3 surgeries and the recovery from one of them was the worst pain I could ever have imagined. so, now when someone asks me what my pain is I can’t imagine it ever being a 10, so of course that is what I compare my pain to, and even though it may be very bad pain I will say something like a 3-4.” But you CAN imagine it being a 10! You lived through the worst pain you could have imagined. Regardless, it all depends on your tolerance. If you said that you could tolerate a 5 or 6, then I doubt the nurse would give you pain meds for a 3 or 4.

I totally understand the frustration with the pain scale and not wanting to be poked. I had my gallbladder out last March and would get extremely frustrated during my trips to the ER. Luckily I had a friend there to point out that I am extremely stoic so I was probably in more pain than I would admit. I think I was poked by 3-4 nurses and doctors one day and was ready to say yes, I hurt because you’ve been poking me all day.” This comment just made me roll my eyes. As if I don’t have enough to do, now I need to learn how to read your mind? Listen, do yourself a favor: screw being stoic. If we ask you if you’re having pain, and you say no because you’re being macho, what do you expect us to do? Furthermore, I’m sorry that you had to be poked so much, but until we invent and regularly start using medical instruments from Star Trek, there isn’t much else we can do. We don’t really relish causing pain.

One more thing about pain… Pain medications aren’t really intended to completely take away pain. Sometimes they do, but mostly they just dull the pain to a tolerable level. If you feel like the pain scale is stupid and that you simply cannot come up with a number that reflects your pain level, just ask for some pain medicine if you need it. Maybe that’s what we should be asking instead, anyway.

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Recently I found myself in a rehab facility following a car accident that resulted in a lot of broken bones and a lot of metal being implanted into various body parts to stabalize the broken places. When the WONDERFUL (and I can’t stress how WONDERFUL the nursing staff was) asked me for a pain scale I usually said “It’s about 2, and will stay there as long as you come right back with more Darvocet N-100 thank you for asking.” I think it is important as a patient to state that a low pain scale rating has been made possible by previous consumption of helpful chemical pain retardants!

I have a colleague who asks smiling people who rate their pain as a 10, “…and how would you rate your pain if I were removing your eye with a grapefruit spoon?” He says most of them smile and say, “10″.
“So, how’s your pain now”? he’ll ask.
“10″ they say.

Crummy scale. Should be binary: yes and no.

I hate that crummy pain scale, too.
I had an injury that became chronically painful. I never knew how to answer the stupid pain scale question, and I said so every time I was asked.

I tried to describe the pain I was actually having, but they wouldn’t jump over the damned “scale” question: I hadto rate my pain with this scale where the beginning and end were never clearly defined.

Zero was sometimes rated as normal, or a feeling of ultimate well-being.

Some asked me to make ten the worst pain I’d ever had, and some asked me to make 10 the worst pain I could possibly *imagine*.

And they’d never give any specific examples.
.

I have a good imagination, so scenarios like being lowered into a chipper feet first, or being flayed alive then having bits on the ends chopped off, until they got to the middle. Or having my ribs pulled out while being roasted over a fire ( heard that in an old spencer tracy movie)

THe worst pain I’d ever had at the time was unmedicated surgical pain from a c-section, when the epridural had worn off rapidlly, and a mistake was made with my pain medicine, leaving me with none for about eight hours.

I was incoherent from the pain before they would give me any, FWIW.

This tended to depress my
I figured a grinding, aching daily pain that kept me from looking up rated about a 2 or three, if one was a nasty toe stub.

The thing is, is that as much as I dislike the pain scale, it does seem to be internally consistent. That is, the patient’s judgement of the level of pain seems more or less consistent with the pain experienced. Unless, of course, the patient is drug seeking- then all bets are off.

I agree, though- quantifying anything that should be noted qualitatively is doomed to failure.

When I was a young man, I fell off a cliff and broke my neck. I was lying on the ground, totally crushed. The pain that was coursing through my body felt like an electric current; except it had the volume of the Mississippi, and was moving 10,000 miles an hour. I was like a thread in a wind tunnel, straightened by a force that dwarfed my puny powers to resist. I remember I was totally awed by the sheer magnitude of the power that was coursing through you, in the same slack-jawed way you are when you suddenly realize the vastness of the cosmos on a clear, starry night. It was absolutely stupendous. I had no idea people were even capable of feelings like that. Then and there I concluded that pain is the strongest force in the universe. Years later, while in NYC on a visit, I had what turned out to be an acute kidney stone attack, writhing all over the place, puking on the sidewalk, etc. Of course I was hurting. But compared to my broken neck, it was like comic relief, and in fact I laughed about it to my wife the next morning, when I got back to my hotel room from the hospital. She didn’t even know where I had been. I offer this anecdote for what it is worth. What continues to impress me even now is that something as powerful as pain still cannot be measured, at least objectively. Pain is not even a scientific concept, narrowly defined. How odd.

Personally, I’m coming to hate the pain scale. I think it’s ok for acute pain: post-surgery, broken bones, etc.
I think it really starts to fail in chronic pain situations. I’m just coming off of a 2 month long migraine–after that long, pain takes on a very strange quality, and I really couldn’t say what the daily, constant pain I was in rated. The times when it got bad, when I was in the hospital–sure, then I could tell you, but the day-to-day pain? No way, and it was really frustrating to try to come up with something to put on the chart several times a day.

The pain scale is pretty useless… Especially when patients tell you that they have 15/10 pain, yet they managed to cheerfully hop into the ED.

The mystery further unravels when they list drug allergies to every known pain reliever except Lortab or Percocet.

This summer I worked on a medical floor as a nurse extern. Although I didn’t get to give any meds, I still got to help assess patients and their pain. I will probably get in trouble for doing this someday, since it’s not exactly what you are supposed to say. Instead of stating, “10 being the worst pain you have ever experienced…” I would say “0 being no pain at all and 10 being so bad that you want to throw up and pass out at the same time.” Only two people claimed to have a 10 after that, and one had meningitis and the other was a drug seeker. Most people would laugh and give me a lower number. The pain scale isn’t perfect but it’s better than nothing!

I don’t even use the pain scale 99% of the time. I just make up numbers. Yes, I do assess my patients. I use qualitative questions, such as “Is the pain really bad or not too bad?” “Do you feel better, worse, or about the same since I gave you that shot?” Some people don’t want to be seen as complainers. I like to tell them that I am giving them a “job”, which is to tell me how they are really doing. I reassure them that we will get their pain under control. We may not be able to take it away completely, but we can get it to a tolerable level. Since we start with a small dose and work up until we hit the right dose, I need feedback. When people understand that they are evaluating a pain regime, which is not magically set in stone, but which they have some power over, they give me useful descriptive statements. I concentrate on trying to a) accomplish real tasks, like actually controlling their pain, and b) spending as little time as possible on mandatory bs like these pain scales.

Love the title to this section. I came to this hospital today looking for a copy of the pain scale that the OT & PT therapists used. It made more sense to me. It was a 1 to 10 scale, but the descriptions were understandable for me. It had things like “continually on my mind” and I don’t remember what else.

Six months ago, I was in freak accident with a tree. There was 4 broken ribs, a broken shoulder, sprained arm, wrist, and hand, plus much internal bruising front and back. There was lots of damage. Laying on a gurney in ER they asked how much pain on a scale of 1 to 10, 10 being the worse pain I ever had or could imagine. I couldn’t decide if it was the worse I had ever had; I didn’t know if I had ever had the worse I could imagine.

I’m a detailed analytical perfectionist, don’t ask me questions like this without more data let alone when I am in pain so bad I can’t think straight. The pain was so bad I was shaking uncontrollably, I was moaning, groaning, humming, and who knows what else. Yet, I said my pain was an 8. I could not bring myself to say 10 for some stupid reason. The pain was extreme, yet it was probably a 5 compared to the pain Luke (broken neck above) had. You know how bad it hurts to stub your barefoot toe hard? It hurts so bad for a moment you think call an ambulance I need some morphine. In 5 minutes it still hurts, but until you try to put on a shoe you forget about it. It hurt that bad, but didn’t recede in 5 minutes. It hurt so bad that the morphine didn’t touch it, and they were generous (I think) with the morphine. Was that a 10 on the medical pain scale, probably, but I don’t want to max out my scale and not have a number in reserve in case there is a worse pain some time. Was it my worse or equal to my worse pain ever, probably. Was it the worse pain I can imagine, no. Maybe it was only a 9. I was not laying on the gurney willing myself to die, or at least go unconscious, which is what I tell myself I will do if ever I am kidnapped by terrorists.

Chronic pain, is another story.

Thanks for letting me tell my story. I thought I was the only one who thought the pain scale was stupid. Silly me … I am not so weird after all.

I must be human as well.

I too hate the pain scale. When I was younger I’d get cramps so badly that I could barely get out of bed, and once I was up, all I could do was sit somewhere and cry. If I had to go to the bathroom or go to the kitchen for motrin and water, I had to lean against the wall and walk very slowly, as all movement was painful. My mother finally relented and took me to urgent care, where I was asked where it rated on a scale of 1-10. I replied “well, I dunno. What do you consider pain that feels like you’ve been cut open and your insides have been shredded up and coated in salt?”, but I don’t know what the nurse actually wrote. They gave me a prescription for Motrin 800s for my trouble, but that still didn’t do much; I ended up taking my mother’s migraine medicine to knock myself out instead. I know that the nurse I saw was probably suspicious that I was a drug-seeker, so I don’t fault her, but I do think they need a better way to assess pain than a subjective 1-10 scale.

Just throwing in my 2 cents. You have an excellent blog, I’ve been working on my nursing pre-reqs and it’s helpful to see what’s in store for me. Thank you!

Chronic pain IS a weird beast. What’s really frustrating is when you’re using the pain scale all the time for daily pain (I have fibromyalgia) and then have something acute happen. “What is your pain?” he asks. I am between waves of pain from the kidney infection, and answer with teeth only slightly gritted, “About a seven, compared to childbirth, flaring to about a nine when…”and I shut up as another wave of pain hits because it’s impolite to scream in public. “And what do you want the pain to be when we’re done treating you?” he asks according to formula. “About a two or three,” I say. “Oh, we can do better than that,” he says, patting my shoulder.

Hmmph, I thought. If you can do better, why do I hurt so much every day?

(I will also add that I’m one of the many who wish that when you had chronic pain you turned purple, so people believed something was actually wrong with you.)

I work a lot of hospice cases and I had problems with patients that take 80 mg of Roxanol Q hour for pain & SOB, ramble yet still manage to state their pain is at 8/10 when asked.



So, what brought you to the hospital today?

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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