Pain Scales
Attrib.: http://www.flickr.com/photos/o5com/
There are a lot of different scales to gauge a person’s/patient’s pain; most are from a subjective (“tell me how much it hurts”) perspective. (Here are a few examples of pain interpretation: http://www.tipna.org/info/documents/ComparativePainScale.htm, http://painconsortium.nih.gov/pain_scales/, http://en.wikipedia.org/wiki/Pain_scale, http://www.nursingcenter.com/prodev/ce_article.asp?tid=799083 and http://www.iasp-pain.org/Content/NavigationMenu/GeneralResourceLinks/FacesPainScaleRevised/default.htm.
Or, pain is interpreted based on the visual presentation of the person (facial expression, breathing, restlessness, muscle tension, etc.); however, this may have an observer bias thrown in based on interpretation rather than the reporting of the person having the pain.
Even if it is reported from an activity or activities of daily living (ADL) standpoint, it is still dependent on the person who is reporting the level of pain. A person’s lifestyle and prior experience will influence how they are able to tolerate, and report, their pain.
The pain may be rated 10/10, but is the person really not feeling that bad? After all, they are still getting up and around; the pain isn’t keeping them from doing some activities. But maybe it’s rated that way not for the pain that it is producing, but for the lasting effects of activity. For example, my husband had a project that was going to last for a week. Although he under-reported his pain as 8-9/10, in order to keep it under control he had to greatly increase his medication and also modify the way the tasks were done. And, the amount of pain medication was such that he was more sedated and had poorer cognition. Is that truly the level of pain that was provoked?
So, if it hurts a moderate amount, but it will take 2 or 3 days to recover from the activity, is it only “a moderate amount”? Or if greater than normal means of pain control are required to keep functioning, is it only “moderate”?
And there’s also the cultural perception of pain, which mucks up having a “scientific, reproducible” type of scale. By this, and any of the above, I suppose it is not only the type and intensity of pain that a person is having, but also the type and extent of pain intervention that I’m considering.
Because pain is such a personal experience, pain intervention has to be also. Taking oral, prescribed pain medication on an “every 4 hours” basis may work for some; whereas taking the same medication when waking up and before going to bed may be adequate for another. A different person my do fine with an over-the-counter pain reliever, and heat or cold a few times during the day. All for the same type of condition or injury.
