This is not a particular case study as such........
This is a repeating issue that i have on all placements. The question of rating pain out of 10. There are lots of patients that struggles to understand the scoring system. We often tell them that "10 is the most excruiciating pain you can have, like childbirth" to use as an analogy, but some mothers don't consider childbirth as 10/10 pain. It's confusing for patients and they get rather annoyed when we repeatedly as them to rate their pain again and again. I think in my current musculo placement 50% of my patients don't really understand what it means (i've actually asked them "do you know what the rating means?"). I understand that it becomes an objective measure for us for reassessement and all, but it is really accurate? I think sometimes just asking the patient whether the pain is the same, better or worse is sufficient for reassessment purposes. At the same time i think i tend to focus on pain so much that i sound like a broken record, "where is the pain? how painful is it? Is it the same pain as you were getting? Is the pain deep or superficial? How is it now? What score is it?" It's the way university has taught us, and that's what we use. I understand that the measure is individual to the patient, yet, one day they can be 4/10, and next week is 8/10 even though the pain is exactly the same.
I still use the VAS scoring to all my patients if they get it, that's fine, but if i know they struggle to understand the system, i ask them whether the pain is mild, moderate or strong and that usually fixes the problem, sometimes by using percentage works too 10%, 50%, 90% etc, even though it's exactly the same as the 0 to 10 system. I've learnt that the system is useful for us as an objective measure, though we can't rely on it. You can also look at other objective measures such as ROM, strength, swelling size etc for reassessment too. Some patients will just not get it! Rather than get your patient frustrated and annoyed, it is better just to ask them whether what you just did makes the pain better.
Anyone else have similar problems? What other strategies have you used?
2 comments:
Forgot to add,
Prior to starting 4th year pracs, i'd thought that everyone or a lot of people would understand the pain scoring system. Well i didn't expect so many patients to not understand the concept!
You do bring up a very good point kenny. I've found that some pt's have no grasp of the 0-10 VAS system, while for others it is quite useful. You get the impression they dont get it when pt's continue to push 8/10 pain, or are 'pain limited' by 1-2/10.
Wat i found particularly good like you suggested is bringing it back to 'same/better/worse'. For musculo inparticular for all ongoing pts i will say last week it was x/10, wat is it this week? So it applies both. And this is the same with AROM, ie. saying your baseline pain is x/10, wat is it now? So it is really giving a measure of how much better or worse. That seems to work most times and pt's dont hesitate so much and just throw out a figure haha.
I will admit though as you said, pt's do get sick of pain Q's. So if you remind them wat you want, then they will tell you when and where pain is present. I told a few pt's that i need to be specific so tell me everything. This seems to work especially for chronic pain pt's that are more than happy to tell you this. thanks for the post, ive been thinking about it also.
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