Since the inception of pain as the fifth vital sign, developing a method for clearly assessing the pain level of a patient has been a challenge. All of the other vital signs have tangible/objective measures. The pain scale (1-5 or 1-10), in my opinion, has been applied in an arbitrary manner.
For example, after asking the patient to describe the character of their discomfort (sharp, dull, ache-like) and related factors (radiation, consistency, remission, exacerbation), the “how much discomfort do you feel right now” question is usually last. One method that can be useful to anchor the pain scale in a concrete fashion is to ask a few follow-up questions:
- What is the worst pain you have ever had?
- If this incidence is the worst pain, what was the worst pain before this incidence?
- What did you do about that discomfort? (eg, go to an emergency department, clinic, or primary care provider)
Then follow up with: given your past experience, how would you rate your present discomfort?
If the previous worst pain was a fracture or kidney stone, then the scale has some tangible basis. If the worst pain was a simple sprain or strain, that may change the clinical response. Frequently, in my experience, the rating usually is lower after these anchor questions are asked.
Alfred Cichon, PA, is a manager of a correctional health company with 28-years-experience working in correctional clinics in Maine. Mr Cichon served in the military for 17 years, including 4 years in active duty and 12 year working in the emergency department.