How many of you hate the pain scale? You know, the one which makes a patient give an arbitrary numerical value which corresponds to their perceived level of pain. If you’ve been doing this for any amount of time you’ve had patients who tell you their pain is a 10 out of 10 as they walk to the rig. Or the patient who tells you this pain is a “like a 300″ out of 10 as they text their bestie they’re going to the ER via the Ambulance. Experiencing this is likely to make you jaded when it comes to the pain scale, I know it did for me for several years. The entire mentality of a Patient valuing pain on an analog system which has no real merit to numerical representations other than perception is rather obscure. In response to this, there is a push for adaptation to the Wong-Banker FACES scale, which seems to be a good and understandable pain assessment tool, at least from a provider stand point.
It would appear that many in EMS get caught up at the wrong place and ineffectively use the numerical pain scale. Providers seem to place too much on the physical value of what the patient gives you, this isn’t how the 1-10 scale was meant to work.
Take a 30 Male with obvious deformity to the right forearm from an accident occurred during riding his bicycle. Initial pain rated as a 10, after splinting he rates pain at a 9. Administration of Pain med’s brings his number to a 4 and by the time you arrive at the hospital with all the cute nurses he rates his pain at a 2.
The pain scale is more about trending the complaint of pain rather than the number given. Our focus with pain management, should not be on the value given. Rather the positive or negative trend created by the management of said patient lets us know if the patient is getting better or worse.
Now take the same scenario, but it is one of those patients who seem to blow the number out of proportion. ”Sir on a scale one to ten, how’d you rate your pain” Patient ” its a hundred!” Great an exaggeration or at least that is what I use to think, and truthfully I may not have given him as much of the concern that was warranted. He initially rated pain as a 100, after splinting he rates pain at a 75. Administration of Pain med’s brings his number to a 60 and by the time you arrive at the hospital with all the cute nurses he still rates his pain at a 60.
As long as the numerical representation of pain decreases after any intervention one can infer a positive trend towards pain relief. This should be our goal in EMS when i comes to pain management, trending a patients pain towards relief.