Lately, I’ve been thinking about pain — specifically, how to match a number to my pain.
While lying on a treatment table my physical therapist Richard asked me to rate my pain, on a scale from zero to 10, as he manipulated my shoulder. I’m sure many of you have been asked something similar by a healthcare provider, as it’s a standard way of assessing pain. But it doesn’t make a lot of sense to me.
A pain scale that doesn’t add up
Let’s assume that for me, zero equals no pain at all, and Level One equals a slight feeling of discomfort that’s nearly always present. Where do we go from there?
As Richard continued to tug, twist, and palpate my left rotator cuff, my pain increased. Level Two, in my mind, was uncomfortable. Level Three was painful enough to make me wince, but I could handle it. (No pain, no gain, right?) At the next pain stage, Level Four, I told Richard to stop. If we had reached Level Five, I would have let out a banshee scream.
So, what’s the point of Level Six through 10 for me? I guess I could have skipped levels and rated my pain as two (I’m uncomfortable), five (I’m wincing), eight (stop now), and 10 (screaming), but that didn’t seem to provide a better assessment.
“Who thought up this numbering system?” I asked Richard. He didn’t know. My thought: Use words rather than numbers: “I hardly feel it,” “That’s uncomfortable,” “It hurts but I can handle it,” “Stop, now.”
Guess what? There’s actually a scale that does that.
Other pain scales
In researching this post, I discovered there are at least three pain scales used in healthcare.
The Numerical Rating Scale (NRS) is the one my physical therapist uses. It rates zero as no pain, one to three as mild, four to six as moderate pain, and seven to 10 as severe.
The Visual Analogue Scale (VAS) is a visual NRS. A patient is asked to mark their pain intensity on a line that’s usually 100 mm long. Generally, it’s divided as: no pain (0–4 mm), mild pain (5–44 mm), moderate pain (45–74 mm), and severe pain (75–100 mm).
The Verbal Rating Scale (VRS), sometimes called the Verbal Pain Intensity Scale, uses five adjectives to describe pain intensity: none, mild, moderate, severe, and very severe.
The VRS is exactly what I was thinking of. It’s simple, clear, and in my opinion, precisely describes what a patient actually feels. Why mess around with anything more complicated? Why ask me to choose from a group of numbers and hope that the healthcare provider will understand what each number means to me? Don’t words do this much better?
I think my physical therapist and others in healthcare should use this more practical pain scale. I’ll tell him I rate it a 10. (Or should that be a zero?)
(A version of this post first appeared as my column on the MS News Today website.)
(Featured image by OpenClipart-Vectors from Pixabay.)
