For God’s sake, we even named a pain scale.
(For this post, we’re not going to talk about the wussies, for whom everything from a cut finger to a stubbed toe is 10 out of 10 painful. They need no more attention from anyone.)
Some hospitals have made the pain scale “the 5th vital sign**,” and, after some cursory research, which really just means that I clicked around, I’m told that this is likely thanks to JCAHO, now called TJC in an attempt to get away from the negative opinions it attracts the same way criminals use aliases. For folks outside of health care, JCAHO is the bureaucracy that believes that such attributes as the locations of trash bins and the number of times per hour the floor is mopped are actually very important in order for hospitals to maintain their accreditations.
(If you can find ONE patient-level provider who does not think JCAHO is absolutely ridiculous, I’m sure all of us would like to meet this person.)
Back in the real world, I must admit I feel like an asshole whenever I ask a patient whose arm fell off what number they would rate their pain. Even if I don’t ask for it – and trust me, most of the times I don’t – the ED will ask for it, not because nurses are blind to human suffering and deaf to all the screaming, but because that’s a box they have to fill out. It’s reached the point of asking for the sake of asking.
It’s quitting time when you preface the question with, “I know this is a stupid question, but…”
The only time I can see it being useful is when it’s used to compare the pain before and after interventions. But, only with reliable patients. Which means, perhaps one patient per week.
For instance, it has some value when we have patients rate chest pain. But, just as I do not typically pay a whole lot of attention to how patients subjectively describe their chest pain, mindful of how most sensations are beyond words and of the deteriorating language ability of the average person thanks to the deteriorating educational standards on this side of the planet, we should remember that asking them to assign their pain a number on a scale of 1 to 10* is just as subjective. And therefore not very reliable.
Now, as a very simple example, imagine for a second you’re having chest pain, and let’s say more likely than not it’s some legitimate badness, because there are sirens and I’m not hiding behind you in the jumpseat, ignoring you and doing paperwork. While you’re trying not to freak the fuck out over the chest pain and silently hoping I don’t have to stick you 4 times because you’re “scared of needles,” I’m making you come up with some random number on a scale of 1 to 10 after every spray of this disgusting, vaguely cherry-like substance that is giving you a raging headache, not to mention the dizziness and the blurry vision that come with it, obscuring the view of your life flashing before your eyes. Even though you’re convinced this is your last day on Earth and you wish you called your mother more often, you spit out a number a few minutes after every spray. How accurate do you think these numbers are?
(By the way, those of you who still push on patients’ chests to see if the pain is worse hoping to “rule out cardiac”: Please stop doing that.)
Besides, wouldn’t you agree that any subjective assessment tool that gets the same result – 10 out of 10 – like 90% of the time is just pretty much useless? (OK, I guess we had to get back to the wussies at some point.)