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If you’ve had any type of health assessment then you’ve probably encountered the 0-10 pain scale.  It is one tool to assess pain levels but it is an imperfect one.  It gives the illusion of quantitative assessment because it has a numerical value (e.g., breaths or heartbeats per minute, % of oxygen saturation) but that value’s greatest usefulness is qualitative.  Is the number greater or less than before?  Did the pain treatment decrease the pain a little bit, a lot, or not at all?  Any given value, say 4, has no absolute meaning but if it did, would you know what it is?

Trying to put a number on something as subjective as pain has a high “guess” factor.  And unlike getting your anger or the neighbor’s likeability scale value wrong, getting your pain scale number “wrong” can have negative consequences.  In this context, we’ll define “wrong” as a scale value that doesn’t generate a treatment that successfully ameliorates the actual pain sensation you feel and for which you would like relief.  If you don’t want something for pain then it doesn’t matter so much whether the scale value you give is right or wrong.

The first problem is that you are usually shooting at an invisible target - the answer that will provide sufficient pain relief - on a subjective scale that is treated as an absolute when it comes to choosing which medication to give, if any.  Pain medication orders are often based on pain scale values - e.g., Tylenol for 3-5, Norco 5/325 for 6-7, Morphine for 8+.  Those are just random examples, not guidelines.  Maybe you feel like your pain is only a 5 on your personal pain scale but you know Tylenol doesn’t really give relief for the type of pain you’re having.  You really need a Norco so you say 6-7.  That’s you trying to guess the magic number.

It doesn’t end there.  The nurse or doctor you’re talking to is performing their own assessment of your pain AND your answer.  Does your answer fit their own assessment?  They have seen a lot of people in pain and judge your condition and answer against that experience level.  If your answer seems too high then maybe you are a drug seeker and shouldn’t be given prescription meds. We were told in Nursing school that pain is whatever the patient says it is, but the reality is that a provider doesn’t ignore their own medical experience with people in pain.  So not only do you have to guess what is supposed to be a subjective target, you’re graded on the accuracy of your answer based on a standard you’re not ever aware of.

Avoid the pain scale trap by refusing to use it.  Instead, describe your symptoms and the impact they are having on you: "Can't think about anything else", "Can't find a comfortable position to ease the aching pain in my lower back", "Alters my mobility because I can’t put pressure on my left ankle",  “When I move my right arm I have a sharp pain in my shoulder that makes me gasp”, "Makes me tense so I can't relax", "The pain is preventing me from sleeping well."  The 0-10 scale is designed for convenience, not accurate information. If someone tries to force you into a number, tell them to use whatever number they think is appropriate for your description of how the pain is affecting you.

The other advantage to you of not playing pain scale roulette is that it gives the medical provider more information to work with.  Pain is a symptom of a problem.  Masking pain with medication doesn’t fix the problem.  Maybe an anti-inflammatory is needed to reduce swelling.  Perhaps a muscle relaxant or physical therapy could help decrease back pain.  Perhaps a sleeping medication is called for, or a mild sedative.  Maybe a particular pain medication is especially helpful for your specific problem and symptoms.  You are much more likely to get the most appropriate treatment with a description of your pain rather than a number.

Don’t be afraid of asking for and taking pain medication during a hospitalization.  You’re not going to get hooked on the amount of drugs you might get during a hospital stay.  Hanging out at the hospital isn’t as exciting as it sounds.  It can be pretty boring and pain can be harder to ignore without the usual distractions.  Doctors vary on their pain treatment philosophies but there is almost no therapeutic purpose for you having to put up with pain.  If a provider isn’t relieving your pain then you should ask them what is the therapeutic benefit of your pain.  How is it helping you get better?  If the answers don’t improve your relief then you can ask to talk to another doctor about your pain or contact Customer Relations.  Having said that, don’t reject prescribed treatments or medications without trying them if you’ve discussed the situation with your provider and that is their recommendation.  Sometimes you have to take intermediate steps to reach a final goal.  And, unless you know from prior experience that the recommended treatments won’t work - which presumably you would have shared with the provider - don’t try to substitute their medical judgment with yours.  If you give the prescribed treatments a fair shot and they aren’t doing the job, report that and ask for additional relief.  Everyone’s pain is personal.  It may not be possible to achieve total pain relief, in which case the goal is to make it manageable and not dominate in your consciousness. 

In summary, the standard 0-10 pain scale is designed more for convenience than accuracy.  If pain is actually a concern then you are much better served by avoiding the scale and describing your pain instead.  Your job isn’t to help providers with their documentation, it is to get relief for your pain.  A description helps them understand and treat your pain more appropriately than telling them your pain is a 6, particularly when you think a 6 means one thing and your provider thinks it means another.  Nothing gets lost in translation if you describe the problem instead of trying to rank it.

Tom Allred, RN