Wednesday, September 19, 2007

The Pain Scale

I hate the pain scale. What I hate more, is JCAHO for deciding that pain is the "5th vital sign."

Vital signs are vital for life. You must have a blood pressure to be alive. You must have respirations to be alive. You must have a pulse to be alive. You must have a body temperature to be alive. You DO NOT have to have pain to be alive.

BP, pulse, respirations and temperature can be measured quantitatively. Pain level is a quality of life measurement. For those of you who haven't been to the hospital or doctor's office in a while, the pain assessment goes like this:

On a scale of zero to ten, zero being no pain and ten being the worst pain you can have, where would you rate your pain?

So, what is an example of the worst pain you can have? It differs with everyone. And motivation often determines the answer.

In the health center I run, I find that there are 2 pain scales.

If motivation is to file a false worker's comp claim, the "worker's comp" pain scale doesn't go below an 8 and is often a 10.

If motivation is to be able to work and not get sent home or to the doctor for the day, the "working" pain scale rarely goes above a 5. The fact that Tylenol is the strongest thing I can give you for pain doesn't hurt (sorry for the pun.)

I wonder what JCAHO will decide is the 6th vital sign? I know, patient satisfaction!


RobC said...

As a man I rate kidney stones a 10, a splinter 0, a cut 1, a broken bone 4... the gap between bone and stone is like the Richter Scale... :-)

digher said...

As someone with a apparently high pain tolerance and an active imagination, I have had difficulty with the pain scale as well. Most amount of pain you can have is so ambiguous. I've heard others say, and I tend to agree, that if you can sit still and calmly answer it's probably not a ten.

jon said...

A ten is when the dentist drills into the nerve he couldn't deaden for a root canal. Another ten is when the intern digs into the abcess in the back of your neck after he gets below the deadened surface. Brief but involves biting things that don't break teeth and groaning in agony. I don't know if you can stay conscious with a ten for any period of time.

Amy said...

Ten is being dragged naked through a cactus patch behind a herd of wild horses. Heard that a loooong time ago. Not that I'm originally from the southwest or anything.

RobC said...

Nope... those are puny compared to kidney stones... :-)

Unix Ronin said...

I'm not really sure what my "10" is. What I do know is that when someone asks me "How bad is your pain on a scale of 1 to 10", I really have very little idea of how to answer.

I remember sitting in the roadway eight years ago with two shattered kneecaps, pieces of my tibia sticking out of my leg, and about half of the skin on my lower left leg degloved. At the time, it didn't seem to hurt that much; my attention was far more focussed on whether I needed to get out of the way of oncoming traffic, and I was quite ready to start crawling if I did. I couldn't spare the attention to start hurting until they got me safely to the ER. I had a 3" pin removed from my left foot without anaesthesia about three years ago, but it didn't really hurt that badly compared to my normal level of everyday foot and knee pain. I had a specialist working on me one time cleaning out a thrombosed vein, which was causing me to gasp and grunt a bit, and he told me, "You're doing pretty good. Most people are screaming in agony by now."

Honestly, I can't imagine what a "10" for me would have to be. Which leaves the rest of the scale kind of hanging out in the wind.

NurseWilliam said...

Yep. I relate. Being a trauma, nurse, I have to ask that same stinkin' question. The kidney stones rate a legitimate ten. The impalements rate a legitimate ten. The migraines... okay, at least an eight.

But the drug-seeking, doctor-shopping, hospital-hopping little creep- your pain is a ZERO. You'll have to wait. And YEAH, we can find your information on our handy little computer system.

"...By the way, would you mind waiting? The DEA wants to speak with you..."

RobC said...

Ronin... I have had two accidents with the same leg (should have learned a lesson?) The first time was similar to yours, had 27 odd bits of bone floating around that used to be Tib/Fib and major tissue damage... that was 1980 and this time round it was not nearly as painful... but those kidney stones! Man I was begging to be shot! :-)
Morphine is a gift from God I swear! :-)