What are pain scales for?
The most common scale has been around for 50 years. It asks people to rate their pain from zero (no pain) to ten (typically “the worst pain imaginable”).
A narrow tool for a complex experience
Consider my daughter’s dilemma. How can anyone imagine the worst possible pain? Does everyone imagine the same thing? Research suggests they don’t. Even kids think very individually about that word “pain”.
Who we are affects our pain
In reality, pain ratings are influenced by how much pain interferes with a person’s daily activities, how upsetting they find it, their mood, fatigue and how it compares to their usual pain.
Impossible ratings
Still, we work with the tools available. There is evidence people do use the zero-to-ten pain scale to try and communicate much more than only pain’s “intensity”. So when a patient says “it’s eleven out of ten”, this “impossible” rating is likely communicating more than severity.
How can we communicate better about pain?
There are strategies to address language or cultural differences in how people express pain. Visual scales are one tool. For example, the “Faces Pain Scale-Revised” asks patients to choose a facial expression to communicate their pain.
What can we do?
Health professionals
- Take time to explain the pain scale consistently, remembering that the way you phrase the anchors matters.
- Listen for the story behind the number, because the same number means different things to different people.
- Use the rating as a launchpad for a more personalized conversation. Consider cultural and individual differences. Ask for descriptive words. Confirm your interpretation with the patient, to make sure you’re both on the same page.
Patients
- To better describe pain, use the number scale, but add context.
- Try describing the quality of your pain (burning? throbbing? stabbing?) and compare it to previous experiences.
- Explain the impact the pain is having on you – both emotionally and how it affects your daily activities.
Parents
- Ask the clinician to use a child-suitable pain scale. There are special tools developed for different ages such as the “Faces Pain Scale-Revised”.
A starting point
In reality, scales will never be perfect measures of pain. Let’s see them as conversation starters to help people communicate about a deeply personal experience. That’s what my daughter did — she found her own way to describe her pain: “It feels like when I fell off the monkey bars, but in my arm instead of my knee, and it doesn’t get better when I stay still.” From there, we moved towards effective pain treatment. Sometimes words work better than numbers.
FAQs
Q: Why are pain scales not perfect?
A: Because they are a limited tool for a complex experience.
Q: What are some alternative ways to communicate about pain?
A: Use descriptive words, metaphors, and visual scales.
Q: How can health professionals improve their communication with patients about pain?
A: Take time to explain the pain scale consistently, listen for the story behind the number, and use the rating as a launchpad for a more personalized conversation.
