A post at GirlVet’s blog made me crack up about the pain scale that the Medical Marijuana Advocates make us document on all our patients. I know that the pain scale is one of Nurse K’s pet peeves, too.
When we describe the pain scale, we try to give example to illustrate what a “10” on a 1-10 scale is. Some people just don’t seem to know what 10 out of 10 pain really means. How do we get the point across?
I have heard the following descriptions:
“The most unimaginable, indescribable pain you could ever have in your life.”
“Someone lit your body on fire and put it out with a track shoe.”
“Someone ripped both your arms and legs off.”
“You got run over with a steamroller.”
The one I use is that 10 out of 10 pain is pain that is bad enough that you are “on the ground wailing and pounding your fists on the floor because the pain is so bad.” This gives me an objective way to follow up the subjective ratings of “10.”
“So using my description, how bad is your pain from 1-10?”
The patient, sitting on the bed munching Doritos and watching TV, says “Oh, it’s definitely a 10.”
I reply, “That’s funny, because you’re still sitting on the bed, you’re not pounding your fists on the floor, and you’re not wailing. In fact, you appear to be rather comfortable.”
The usual response?
“Oh, then it’s a nine and a half.”
Yeah, right. Even Paris Hilton can act better than that.
So how does everyone else describe 10 out of 10 pain? I’d like some fresh ideas.
UPDATE FEBRUARY 27, 2008
First, thanks to everyone who responded to this post. All of your experiences have helped me (and hopefully others) put things into a little better perspective.
One of the things I have noted is how variable people’s perception of 10 out of 10 pain really is. Kind of like having a bunch of different rulers. On one ruler an inch equals 2 centimeters, on another an inch equals 5 centimeters, and on a third an inch equals 16 centimeters. How can we have an accurate measurement of pain if we don’t have a standard way to measure it? We can use “gall bladder attack” or “kidney stone” as baselines, but people who have never had those problems would have nothing to compare their pain to. Similarly, guys have no idea what “labor pain” feels like. Right now everyone is walking around with different “rulers.”
Second, it is interesting to me how many people commented on how useless this “fifth vital sign” really is. People in true pain under-report their pain and those with the “worst pain in their lives” go about their daily activities as if nothing is wrong while waiting for their magical pain shot.
All that this extra administrative burden of “pain scale” reporting has done is to make health care personnel look at patients complaining of severe pain with a questioning eye and to make patients afraid of accurately rating their pain because they are afraid of being labeled as drug seekers.
So these “standards” that health care personnel are required to use aren’t really “standards” at all. In practice, they seem to be harming patient care more than they help.
Isn’t there something fundamentally wrong with this picture?
Are you listening, Joint Commission?