Scalpel's Helpful New Pain Scale
Here's how it works:
A nurse or doctor or associate walks into the patient's room.
A simple question is asked, "So, how are you feeling?"
I don't want to hear any freaking numbers, just answer the question. I'll assign the number.
0 - Asleep. Doesn't answer.
1 - Shake to arouse, repeat question. It doesn't matter what answer the patient gives, they're a 1.
1 - "I'm OK"
2 - "Pretty good"
3 - "Not too bad"
4 - "It hurts a little"
5 - "It hurts"
6 - It really hurts"
7 - "It hurts really bad"
8 - "AHHHH!! IT REALLY F__KING HURTS!"
9 - "AHHHH! AHHHH! AHHHH! AHHHH!" (heard from nurses' station, no questioning necessary)
Nobody's a 10.
Here is how I might use the information to guide my treatment.
We really only need four categories:
For 3 or less: no more pain meds need to be given in the ER, but they might get a prescription to take at home.
For 4 or 5: an oral medication is probably sufficient. The patient is probably ready for discharge.
For 6 or 7: they will probably be offered an injection of something or other, and they will be re-evaluated before disposition.
For 8 or 9: they will likely need IV medications until they move down on the scale.
Some painful conditions are going to get IV meds anyway: MI, appendicitis, cholecystitis, hip fractures, or nonspecific abdominal pain with vomiting, for example. Some traumatic injuries or musculoskeletal pains will probably get an IM injection even if at the higher levels, unless we need an IV for other reasons. Some treatment of mystery pains without objective evidence of disease or in the setting of multiple repeat visits might depend on how busy we are. If a nerve block is appropriate, it is the treatment of choice for many painful conditions.
Any descriptions of pain which demonstrate any form of complex thought will be defaulted to the 6-7 level. Any mention of baseball bats, knives, sledgehammers, or dismemberment would fall into this category (unless the patient really was hit in the head with a baseball bat, of course).
Any mention of the number 10 will cause me to default to the Objective Pain Scale.
A nurse or doctor or associate walks into the patient's room.
A simple question is asked, "So, how are you feeling?"
I don't want to hear any freaking numbers, just answer the question. I'll assign the number.
0 - Asleep. Doesn't answer.
1 - Shake to arouse, repeat question. It doesn't matter what answer the patient gives, they're a 1.
1 - "I'm OK"
2 - "Pretty good"
3 - "Not too bad"
4 - "It hurts a little"
5 - "It hurts"
6 - It really hurts"
7 - "It hurts really bad"
8 - "AHHHH!! IT REALLY F__KING HURTS!"
9 - "AHHHH! AHHHH! AHHHH! AHHHH!" (heard from nurses' station, no questioning necessary)
Nobody's a 10.
Here is how I might use the information to guide my treatment.
We really only need four categories:
For 3 or less: no more pain meds need to be given in the ER, but they might get a prescription to take at home.
For 4 or 5: an oral medication is probably sufficient. The patient is probably ready for discharge.
For 6 or 7: they will probably be offered an injection of something or other, and they will be re-evaluated before disposition.
For 8 or 9: they will likely need IV medications until they move down on the scale.
Some painful conditions are going to get IV meds anyway: MI, appendicitis, cholecystitis, hip fractures, or nonspecific abdominal pain with vomiting, for example. Some traumatic injuries or musculoskeletal pains will probably get an IM injection even if at the higher levels, unless we need an IV for other reasons. Some treatment of mystery pains without objective evidence of disease or in the setting of multiple repeat visits might depend on how busy we are. If a nerve block is appropriate, it is the treatment of choice for many painful conditions.
Any descriptions of pain which demonstrate any form of complex thought will be defaulted to the 6-7 level. Any mention of baseball bats, knives, sledgehammers, or dismemberment would fall into this category (unless the patient really was hit in the head with a baseball bat, of course).
Any mention of the number 10 will cause me to default to the Objective Pain Scale.
Labels: pain
posted by scalpel at 9:52 AM
25 Comments:
Amusing and interesting scalpel. I would think a stuck kidney stone for hours that will never come out on it's own qualifies as a 10.
So really...what is a 10..dismemberment..but then you have shock..so no pain?
If there truly isn't a 10 then a kidney stone like I am speaking of surely must be a 9.99 :)uwk
O.k., maybe I take it back. After just reading your previous post...I can see where burning in fire (as stated in one comment & God forbid!) would trump kidney stone in the pain category
dowI was reading your objective pain post that you linked to. I agree, I feel that it is more important to look at a person's physical characteristics than to go by some subjective number. I dislocated my hip at age 16 - rated my pain as a 2/10 in the ambulance on the way over. I was shaking, disoriented and wouldn't let my mom touch my hand because it hurt my hip. I refused morphine when offered. Doctor later said it was the worst dislocation he had ever seen. When pain is acute and severe, the patient WILL shown signs of being in pain.
Thanks for the post.
See also ARTHROS's August contribution.
link
"What is a 10 like? Let's work our way up.
0 = no pain. This is as good as it gets. Enjoy yourself!
1 = the least perceptible pain. You can only feel it if there is nothing else going on. A bruise, or contusion."
and so on.
My last trip to the ER, when I injured my shoulder, I had to answer the "pain" question. To be honest, if I held still, it was about a 2 or 3. However, any movement or jolting of the arm gave me enough pain that I was dizzy and nauseous. So, that's what I told the nurse--2/3 if no movement, 5-6 if I move it. She, and the MD, appreciated the facts.
I stuck myself with a needle during a section and I had to take myself to the ER. (Employee health was closed at 0230 am go figure....)
I was asked the pain scale question and I rated it a 0.2. The triage nurse was not amused and wrote down zero....
I hate the pain question--I really can't imagine pain being much over a five consistently. I occasionally get migraines, but even those are bearable . . . If I lose a limb, that might do it.
Sorry, Scalpel, but your pain scale sucks the big one.
It's, in fact, similar to this.
It would reward people with narcotics for screaming cuss words at the top of their lungs, like my lady who was screaming with the #22 IV insertion that was pre-numbed with lidocaine. Her pain with the IV would have been a 9/10 on your scale.
How would you rate it if the patient answers sarcastically back "Just dandy!”? I know if I was laying on the bed in pain the last thing I would want is someone coming up to me asking me how I am. My attitude would be either help me or buzz off. I am in no mood for chitchat. I make a cranky patient don't I? ;-)
We teach middle school. If anyone needs pain meds...it's us. However, we're generally funny minus medication.
http://superciliousbabble.blogspot.com/
Nurse K, real men don't cry.
I have to put in a vote for labor + sciatica as being off the chart. Pain meds barely touched it (and I put migraineurs to shame with my pleas for drugs).
M
I like it.
You rock Scapel.
If the patient is a well-oriented straight male Englishman reporting a 2 to 4, add two points before determining management plan. (I'm married to a stoic with aggressive RA. Not all patients exaggerate their pain.)
That scale would actually make a lot of sense, I think.
Nurse K,
The Wong-Baker pain scale you link to is for pediatrics, not for adults. And in my experience with peds patients it works relatively well. As for the 0-10 pain scale, it has its drawbacks, and probably is not best for use in the ED, but when you have an established ongoing relationship with a patient who is honest and open it works great.
And the scale is pretty funny. Thanks Scalpel
Wow, my scale is way different than yours. I rate a 2-3 as being a 4-5 on your scale and a 4-5 on my scale is a 6-7 on yours. When I woke up from tubal surgery, I called that a 10. They couldn't give me enough Demerol, Morphine, whatever the hell they were giving me. I was begging and crying for anything. Someone finally knocked me out, so I could mercifully sleep through the worst of it. I compare all my pain now to that experience. (Tubal's should be a piece of cake, I know, but my surgeon tried to kill me I think...it took me 3 months before I could bend over without pain, most people recover in a few weeks).
I may not agree with your politics, but this is actually quite interesting. However, in my very limited experience, seekers will still scream their heads off to get the narcs.
Seekers will scream to get the narcs and some who genuinely need the pain meds wouldn't dream of asking for them or even rating their pain too high because of how they've been treated in the ER. I was recently in an ER with stomach pain from nausea and vomiting for 5 days straight. I have chronic pain and couldn't keep my normal pain meds down and I still didn't cry, curse, make faces etc. But earlier had to my established pain doctor rated my pain an 8. It's constant, unrelenting and so easily relieved when I can take the proper meds. But not being able to take them (not just the narcotics but the adjunctive meds too) is pure horror. But it wasn't until I was faced with an N/G tube that I finally cried. Painful IV insertion due to dehydration and multiple sticks, not a problem.
What one person finds painful is a piece of cake to another. I've had nerves burnt off via radio frequency in my back with no more than the local numbing agent my doc uses and think it is nothing but other people I know find that so painful they need IV sedation or anti-anxiety meds. For me labor and delivery weren't painful, but a migraine or toothache will knock me for a loop. I am a whiny baby with those. Each person's tolerance for pain is different. I tend to under report my pain because I'm a chronic pain patient and have been accused of drug seeking when all I really wanted was to be able to take the drugs I have.
But the first time I was sick for 5 days without normal meds due to N/V I rated my pain a 10, I've never felt anything that painful. Breathing hurt the rest of my body. Blinking hurt.
Glad to see ER staff make light of people in pain. Gives me hope for going to the ER if I have to.
just want you to know this: This scale was printed out and is on the Dr's bulletin board in our ER.
And I didn't do it.
Wow, that's pretty cool.
Small world, isn't it?
No 10 huh... Small bowel obstruction is off the chart. Makes labor a zero. Was not screaming (except in my head) because I've been living with crohn's disease for 4 decades and conditioned to control under extreme circumstances. You should be ashamed making light of people in torture.
Will definitely keep in mind when on the wards.
I have trigeminal neuralgia. 10 exists, although I would not be able to say anything at all when it's happening, might even pass out. 10 is a lighting bolt hitting your face, only by that point you don't know it's your face because it's taken over your brain so much that as far as you're concerned your entire being has been taken over by pain until you don't know who you are anymore, you're just a conduit for electricity.
I take six medications and receive regular nerve blocks to pull it down to a 5 on a really good day.
I've rated organ failure as a 3 before, sat through an exam designed to provoke pain without making a single grimace. Almost died.
I've sat in emergency rooms doing everything I could to hide my real pain level because I knew someone in the next room just had a heart attack and didn't want to distract anyone.
Drug seekers may annoy medical professionals and create numerous jokes about them on the Internet, but they endanger the lives of those of us who have real pain to report. I'm with the Anonymous 11/07/2007, this has been life and death for me many times.
I just want to say 10 does exist. I was recently on a ventilator and my doctors allowed no sedation and very little pain medicine due to my unknown neurological condition. Unless you've gone through the pure torture that is suctioning into your lungs multiple times an hour, you have no right to say there is not a 10. Once I could write, I begged to be chemically put to sleep just to escape the pain.
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