07 February 2007

Pain scale

I was reading this post today and it got me thinking about my own experiences with the pain scale. When an EMT or hospital person finds that you are complaining of pain in some body area, they will usually ask you "On a scale of 1 to 10, how do you rate your pain?" We all have our own slight variations of how we describe the two ends of the scale (not to mention those non-conformists who like to start the scale at zero). I usually use "with 1 being no pain and 10 being the worst pain you could ever imagine". Usually works for me and if there isn't much I'm doing to treat the patient, it gives me a conversation starter about what people are thinking might be a 10. Morbid maybe, but I haven't encountered anyone who flinched at describing what they thought might be a 10 and it usually segues right into another topic.

We all know that pain is subjective. What seems like a 4 to me might be an 8 to you and that could be a very real difference. Part of the reason we ask though, is to assess whether we need to treat for pain and to get some understanding of severity. I've seen a patient who had lost the tips of two fingers, holding his hand up in the air to help control bleeding, looking pale and pained but otherwise not complaining, rate his pain 8/10 and turn down pain medication. He just thought it wasn't that important and everyone should quit making such a fuss over him. I've seen patients looking completely comfortable tell me their pain is 11/10 and then promptly forget that they're supposed to be in pain if I do a physical exam.

My favorite recently though, was a patient from motor vehicle accident. I got refusal of care forms signed for two people while my partner was assessing and working on extrication with the FD for the other three. I return to the vehicle just in time to get handed a backboarded patient and a FF to assist with loading him in the ambulance. I hop in with him and discover that I've got a very polite, scared, 8 year old boy. He was very attentive and intersted in everything I described to him as I walked him through a set of vitals and describing to me how he was feeling. When I got to the head and neck pain he was having (hence the long board), he'd clearly never been asked before to do this numeric rating. He thought carefully about it and told me 1/10. A little further through the assessment, he mentions chest pain where his shoulder harness on the seatbelt crossed his chest and again tells me 1/10. We got rolling to the hospital and I talked with him and his mother about what happened, who was hurt, the baby in the carseat that was going with us and so on. I kept checking back in with my 8 year old about his pain and he always said it was about the same.

Just before we get to the hospital, I point out that we're almost there and this beautiful boy smiles at me and tells me this was the coolest ride ever. He says it felt just like a roller coaster and he couldn't believe that we got to use the sirens for him. I was extremely happy to check in with them 15-20 minutes after we got to the hospital and see that they'd already cleared his spine so he was off the board and having a great time.


Ambulance Driver said...

Pain is indeed subjective. I've come to like the Wong baker faces because some people just can't seem to grasp the 1-10 scale.

One thing that helps...ask the patient to tell you of the worst pain THEY have ever personally experienced. That rates a 10 on their personal scale. Now they have a basis for comparison to their current pain...

But I'm probably preaching to the choir here...;)

Wyatt said...

Thanks for the link. Sounds like a cute kid. There's another interesting post about the pain scale here.

Wyatt said...

Hmm, that link didn't take. . .here:

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