MEASURING PAIN - page 3
The following is an editorial on the topic of Measuring Pain. It is provided complements of Jim Meadows from his regular newsletter on orthopedic physical therapy. It is from Newsletter #4 which can be found with the rest of his newsletters in the Newsletters section of Swodeam.com .
As far as it being more scientific, well yes it is, given that it is used in scientific research but so what. The clinical therapist is not engaged in hard-core scientific research and the tools we use should be the ones that best help us treat our patients. They are patients and not subjects after all. It is also unarguable that some insurance companies require this method of reporting and you must render unto Cesar that which is Cesars (or at least you must if you want to be paid) but this does not mean that you have to use a particular reporting method for clinical practice if it is not optimal.
Prior to the rise of numeric pain scales the therapist would have a conversation with the patient that would go something like How bad is your pain? to which the patient might reply Severe. Everybody now knew what the patients description of the pain level meant. Now the conversation goes something like Zero is no pain and 10 is pain that will take you to the emergency room, now on that scale how bad is your pain? To which often comes the reply 10 leaving the therapist wondering why the patient is not at the emergency room. Or the patient says it is an 8 leaving the impression that the pain is severe. How this is different from the patient saying the pain is severe is beyond me. So for me using numeric or VA scales reduces precision in the assessment of pain intensity, tends to reduce the perceived need to dig deeper into pain behavior, gets in the way of meaningful conversation between the therapist and the patient and may reduce the patients problem from a human scale to a number scale. But I suppose that in the absence of hard evidence to the contrary and probably more importantly in the absence of an authoritarian statement repeated many times by many people over a long period, these scales are here to stay so lets see if there is a better way of using them.
Rather than using the 10 to measure an absolute pain level why not use it the way it was designed to be used, to monitor changes in the patients pain as a result of time and intervention. The 10 now becomes the worse this pain has been since its onset so for example after a whiplash, the patient can state that immediately it was a 2 but on waking the next morning it was a 7 and now a week later it averages a 5 with spikes reaching 7 and lows of 0. This would suggest that there was no serious injury to muscle or bone, as typically there would be relatively immediate severe pain, but that moderate inflammation was a factor. This also leaves the patient free to state that after treatment it went to a 12 (or maybe we dont want that ability!). Or you can compare a current episode of back pain with a previous one with this episodes maximum being 10 but the previous episodes being a 15 so that you know that this episodes is maybe not half as bad as the previous episode but at least substantially less. But you are still forced to deal with the fact that only the patient knows how bad the pain is and he/she can best describe it in words.
Try talking to your patients instead of measuring them.
Related Articles, Links
Good M, Stiller C, Zauszniewski JA, Anderson GC,
Stanton-Hicks M, Grass JA. Sensation and Distress of
Pain Scales: reliability, validity, and sensitivity. J
Nurs Meas. 2001 Winter;9(3):219-38.
Blake Bulloch, MD and Milton Tenenbein, MD. Validation
of 2 Pain Scales for Use in the Pediatric Emergency
Department. ELECTRONIC ARTICLE. PEDIATRICS Vol. 110 No.
3 September 2002, pp. e33
S. Suraseranivongse*, U. Santawat, K. Kraiprasit, S.
Petcharatana, S. Prakkamodom and N. Muntraporn.
Cross-validation of a composite pain scale for
preschool children within 24 hours of surgery. British
Journal of Anaesthesia, 2001, Vol. 87, No. 3 400-405
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