Patients HATE this question. HATE IT. Usually I get a big eye roll when I ask this question.
But I LOVE this question. It tells me SO MUCH about you. I have a little speel that I can roll off of my tongue in my sleep:
“Can you rate your pain on a scale of 0-10. 0 is no pain 10 is the worst pain.”
Then the patient almost always responds:
“Well it isn’t really a pain but more of a discomfort.”
“Okay. Can you rate your discomfort on a scale of 0-10. 0 is no discomfort, 10 is the most uncomfortable feeling ever.”
And sometimes I get a rating then but then sometimes they say:
“Well it is more of a pressure than a discomfort.”
“Okay. Can you rate the pressure on a scale of 0-10? 0 is no pressure, 10 is the most pressure like an elephant is sitting on your chest.”
Sometimes I even ask this: “Can you rate your shortness of breath on a scale of 0-10? 0 is breathing easy and feeling great, 10 is you feel like you are going to die, suffocate or are drowning.”
I love LOVE the rating scale for several reasons:
- It tells me how much a concern this is for you. If you rate it a two or a three, that doesn’t seem all that concerning and I probably won’t need to intervene or advocate for orders. If you tell me the pressure on your chest is a 10/10, that really perks our ears up. That tells me we need to intervene right away. That tells me this is not something you can just brush off.
- I don’t feel what you feel. I don’t know what you can or cannot tolerate. This is the best way I can understand how your feel.
- Certain pains mean certain things. If you have a sudden onset, 10/10 headache, you’re likely getting a CT scan to rule out a stroke. If you have 10/10 unbearable tearing crushing abdominal pain/chest pain, you need a chest/abdominal CT scan ASAP because you could have a dissecting aortic aneurysm which is immediately life threatening. If you have this nagging uncomfortable feeling between your shoulder blades, I’m going to run an EKG to check your heart because it could be a heart attack. It tells us what tests we need to run and gives us an idea of what problems we are looking for.
- Combinations of pain means certain problems. If you are vomiting with your back pain, and it feels like your testicle is going to explode, we will go down the kidney stone route and need a urine sample.
I’ll leave you with this: Be HONEST about your pain. Give the best description you can. Write down your symptoms if this is a long term problem that you and your care team are investigating. Note everywhere you’re having pain even if it doesn’t seem significant.
Most importantly, don’t roll your eyes at the nurse and say “I hate that question!” every time we ask. Because of the reasons listed above but also because we are mandated by our credentialing agencies to ask and monitored on how well we control your pain.
Thanks guys! See you again tomorrow morning!
I always wanted to know if you “adjust” that scale in your mind, depending on the patient. My then 10 year old son was starting the long process of getting food sensitivities diagnosed, and he would tell the nurse and doctor that his pain level was a 6. At the same time, he would be breakdancing around the exam room. And, he had the reference point of a generally healthy 10 year old.
Thank you so much for this post. As a person that has had 2 back surgeries and recurring pain in my back I so appreciate your perspective. It is so hard to describe pain especially with a high pain tolerance, like me. Thank you for this insight!
Thank you for some great information
I hate that pain scale. I have pain in my finger, (trigger finger) just had surgery. If I don’t move it, IT DON’T HURT…. but boy when I do! LOL. Not way to rate that.
My mom always hated having to rate her pain, but I could understand why it was important. I think your last chart is about the most helpful thing I’ve seen on the pain scale. The faces picture you often see means little to me, but the description in that last chart puts it in perspective. Thanks!
I’m with Paulette…that last chart is wonderful!!! Everyone’s pain is relative to the pain they have had in the past. The pain of having a baby come out sunny-side up is definitely different from one coming out with the proper orientation. Worst pain ever…abdominoplasty…for the first week every time I had to get up or lay back down it felt like someone poured liquid sterno on me and lit it up!! That’s my 10. But unless someone has a severe pain to relate it to and both parties know what that baseline is, it is hard to be on the same page. Your last chart really makes it perfectly clear what that number 10 it, for everyone!!!