Making The Pain Scale Work For You

Physical pain is one of the few incidents that are experienced virtually by all living creatures. Nonetheless, unlike animals we as human have the existential ability to apprise and be consciously aware of what we are feeling. Although pain, whether acute or chronic, can be very difficult to describe especially when trying to convey the feeling to a physician. This is why numerous subjective pain scales have been developed in the hopes that doctors may better understand a patient’s current level of pain. As mentioned, there are a variety of pain scales such as the Pain Quality Assessment Scale (PQAS), the Visual Analog Scale (VAS), the Numeric Rating Scale (NRS), and the Wong-Baker FACES® Pain Rating Scale (WBFPRS); to name a few. But for our conversation, let’s view pain scales as either a Verbal Rating Scale (VRS) or a Nonverbal Rating Scale (NVRS). Research has shown that patients prefer the VRS; unfortunately, it lacks sensitivity and the data it produces can be easily misunderstood. This misunderstanding is largely due to the fact that everyone tolerates pain differently, where someone’s “5” could be an “8” for another person based on a 1 to 10-pain rating scale. Thus, patients and doctors alike can find it difficult to arrive at an appropriate prognosis when someone’s pain is not easily defined or relatable.

Diabetic Neuropathy Vignette

Treating patients based solely off a pain scale would not only be difficult, it would also be a disservice to the patient. Let’s use two patients both with diabetic neuropathy as an example. Dr. Smith has two diabetic neuropathy patients; patient #1’s pain is a “10” and patient #2’s pain is a “7”. Given only this subjective information, Dr. Smith places patient #1 on a higher dose of Lyrica® for pain-relief while Dr. Smith puts patient #2 on a lower than average dose. Three weeks later for each patient’s follow-up appointment, patient #1, unfortunately, presents with similar diabetic foot pain and labored breathing, confusion, and difficulty in bowel movements. Patient #2 presents with similar (if not slightly worse) foot pain subsequent to being prescribed Lyrica®. Ostensibly something is wrong. Not only did both patients receive slim-to-no pain-relief because of a dose that did not fit their level of foot pain, but also unwanted side effects resulted that could have been avoided. Being provided with a subjective explanation of pain does not allow a physician to tailor a precise prognosis. So what’s the best way to convey as to how you’re truly feeling?

Sharing is Caring

It is clear that pain scales need accompanying objective context. For example, the National Institutes of Health (NIH) do use a numeric pain scale, but also ask questions that bring a more reasonable, albeit imperfect, assessment. Below we have provided some example questions that your doctor may ask. Note, although your doctor may not ask you these exact questions, still be sure to talk about these points of reference; for the more your healthcare practitioner knows about your current pain, the better chance you have of a pain-free (or reduced pain) outcome.

  1. Elaborate on what was the worst pain you have ever experienced. Maybe it was when you broke your arm or during childbirth. Whatever, the case, make it known that it is your worst pain ever felt. This can be used as a metric for what your “10” feels like and can be compared to the pain you are currently experiencing.
  2. Elaborate on your mental state. Let your doctor know if you are feeling anxious, depressed, irritated, hopelessness, etc. By identifying your feelings and emotions, it will give your doctor a better picture on how pain is affecting you overall.
  3. Show your doctor exactly where the pain is located. Instead of giving an overall-general pain level, try to pinpoint where on your body the pain is located. If the pain is radiating away from the focal point, be sure to tell your doctor the varying intensity you may be experiencing.
  4. Tell your doctor what makes the pain go away or what makes it worse. Are you taking any over-the-counter (OTC) medications once a day, or every few hours? Are you having to turn to stronger medications (e.g. opioids) for pain-relief? Does your pain get worse when doing normal daily activities, or is your pain only worsened by strenuous activity?
  5. Elaborate as to how frequent your pain is occurring. If you are struggling with chronic pain, let your doctor know the frequency and length of a pain episode. Be sure to describe a chronic pain episode that parallels how you are feeling when talking to your doctor. That way your doctor will get a “feel” as to how you are feeling on a regular basis.

Any subjective diagnostic tool that a doctor may use is always going to have its drawbacks; and yes, a pain scale is subjective. Use the five examples we mentioned as objective evidence that you can provide your doctor; but solely see our examples as a guide for communicating your current pain level. You of course can come up with your own points of reference to convey to your doctor how you are feeling. Look at your pain management regimen as a team between you and your doctor. Communication is key in any team and the more you and your doctor understand one another, the more effective you will be in reaching the goal you both are striving for, complete pain-relief. What’s the best way you have found to communicate your level of pain with your doctor? Please let us know!

Tags: pain scale, acute pain, chronic pain, diabetic neuropathy

References:

  1. de C Williams AC, Davies HT, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain. 2000 Apr;85(3):457–463.
  2. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986 Oct;27(1):117–126.
  3. Lang EV, Tan G, Amihai I, Jensen MP. Analyzing acute procedural pain in clinical trials. Pain. 2014 Jul;155(7):1365–1373.
  4. Paice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs. 1997 Apr;20(2):88–93.
  5. Robinson-Papp J. Barriers to Chronic Pain Measurement: A Qualitative Study of Patient Perspectives. Pain Med. 2015 Jul;16(7):1256-64