Ask A Magnet Nurse: The Pain Scale

Patsy Wallace, Nurse Manager of Specialty Services

Smart Living: What is a pain scale?

Patsy Wallace: A pain assessment scale is a tool that we use to determine how we are going to treat a patient. It is a scale numbered from 0-10, with 0 meaning no pain and 10 meaning the worst pain you’ve ever had. Based on the number the patient chooses, our goal is to control their pain.

SL: How does the scale work? Isn’t pain subjective?

PW: Yes, it is. That’s why this kind of communication between the patient and the nurse is so important. How you hurt may not be how I hurt—for example, if we both stub our toe the same way, it may keep me off my foot for the rest of the day, while you are able to go back to work within an hour. So the goal of controlling pain, comfort and functionality would be reached differently for you than it would be for me. Patsy Wallace RN

Also, for a patient who might have chronic pain as a symptom of his condition, he might be at a level 4 or 5—a nagging or distressing pain—every day of his life. If he came into the hospital in a crisis with something acute, we might never get him down to a 0, but we would set a goal to get him out of the crisis level where he can function.

SL: So the goal is not always 0, or no pain at all?

PW: Right, unless that is the patient’s normal level. For example, if a patient came in for an elective surgery, he may have 0 pain at home. But if he has something like arthritis, that might make him closer to a 2, which is considered mild or annoying pain. We need to know what his normal level is so that we can work to reach that goal for him while he is in the hospital.

SL: What about patients that can’t communicate verbally?

PW: We use different pain scales. For babies, we have what’s called a cry scale, where we listen and look for indicators such as the pitch of the cry, or if the baby holds her breath, or kicks her feet. For patients who are ventilated, in the ICU for example, we have a list of observational indicators that we can use to determine the pain level non-verbally.

I also want to add that we use the pain scale at discharge so that we can help the patient control their pain after they go home. We try to educate patients to the fact that they may leave the hospital with some pain after surgery. We want patients to maintain comfort, functionality, and a better quality of life after they leave the hospital. 
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