Do you cringe when the doctor or nurse begins with “On a scale of 0-10…?” Here we go again, you think. They ask the same questions over and over again. Have you ever wondered why? Have you ever worried that you aren’t answering correctly? Let’s look at the ‘why’ behind pain assessments and their typical components so you know what to expect
As a nurse, I document how a patient describes their pain. Doctors and other healthcare workers can see the documentation and use the same questions to get a good comparison of the pain you’re experiencing when they see you. By standardizing our approach to assessing pain, your healthcare team is all speaking the same language.
This approach works well for the healthcare team, but it is rarely explained to our patients. We just continue to ask the questions over and over and assume you’re on the same page.
However, pain is such a subjective and sensitive topic that patients often feel like they cannot adequately express what they are feeling during a routine pain assessment. I’ve had many patients express frustration because they feel limited by the question/answer approach of most pain assessments. I’m going to break down a standard pain assessment in hopes that you’ll be able to speak the same language as your healthcare team and help them understand your pain.
This is probably the one that causes the most confusion. Typically, we ask patients to rate their pain on a scale of 0-10 with zero being no pain and 10 being the most excruciating pain they could imagine. This is a decent scale for acute pain. It allows us to establish a baseline and then track the effectiveness of treatment. For chronic pain, this is a much harder question to answer. The intensity of chronic pain fluctuates continuously. At the time you are being asked the question, you might not be in excruciating pain, but you were earlier that day.
So, how do you answer this question to reflect an accurate portrayal of your pain? If most of the day your pain stays at a moderate level of 5-6 but spikes at night to a 9, then you’d want to describe that fluctuation on the pain scale and end with the number that you are experiencing at that moment. This is just one piece of your pain assessment. Don’t worry that if you answer too high or too low your treatment will be significantly impacted. Assessing chronic pain requires gathering a lot of data to fully understand the patient’s pain experiences.
Description of the pain
Depending on your provider, they may or may not offer you a list of descriptive terms to choose from. Sometimes, they leave it up to you to come up with a term. This description characterizes your pain and can sometimes shed light on the cause. Try to be specific with your description. Go beyond “It hurts” to really paint a picture of what you are experiencing.
Here are a few adjectives that are commonly used:
- Sharp or stabbing
- Prickly or Pins and needles (like when your foot falls asleep)
- Tight or stiff
- Radiating (does it start one place and spread to another)
I encourage you to use these words as precisely as you are able. Also, if a certain trigger changes the pain from one thing to another, be sure to include that in your description.
Frequency and duration of the pain
For chronic pain sufferers, this question can be challenging to answer. You hurt almost all the time, and you’ve been hurting for a long while. Instead of answering with that broad information, try to describe your day to day pain journey. Talk about how your pain fluctuates during the day. If the provider doesn’t know your full story, give a brief recap of when your pain started and its progress.
Any recent changes are particularly important to note. For instance, if your back pain is typically achy and cramping, but over the last several days, it has become sharp and shooting, focus your discussion on the frequency and duration of that new development.
In this aspect of the pain assessment, your provider wants to know about what makes your pain better or worse. They also want to know if there is any recurring pattern to your pain. Is your pain worse in the morning when you get out of bed? Does your pain intensify if you sit or stand for long periods? Do ice, heat, stretching, or massage help the pain? With chronic pain, patterns often develop that suggest treatment options. Think through your daily ups and downs with your pain and describe that to your provider.
This part of the discussion should fill in the blanks about the impact of chronic pain on your life. Sometimes, you might simply be asked if there is anything else you’d like to share about your pain, or they might ask specific questions. Things to consider here:
The impact of pain on your ability to do necessary daily activities (bathing, dressing, eating, etc…)
Some providers might not ask about other factors directly in their pain assessment. If you feel like these have been overlooked, I encourage you to broach the subject. You are empowered to add to the discussion about anything you feel is essential for your provider to know. The more detailed the picture you give your provider, the more comprehensive the treatment plan they can create.
These components build the framework of a standard pain assessment. To most accurately represent your pain journey to your provider, I suggest keeping a pain journal. The Pathways App (download links below) offers guidance on how to get the most from your journaling experience. Make sure that you include a self-assessment using the components above to detail your daily pain.
A well-organized journal is a powerful documentation tool that serves as a foundation in pain discussions with your provider. No one can understand your pain unless you describe it to them. It is completely unique to you. Now that you know how they approach assessing your pain, you can speak the same language as your healthcare providers. A team that uses the same playbook is always more successful!
Please note: This article is made available for educational purposes only, not to provide personal medical advice.