The pain scale is useless

The pain scale is a number. It’s data (agreed, usually useless data). It’s what you do with the data that counts.

Just because someone comes in and says the pain is 10/10 does not mean the person needs high-dose opiates, or any opiates for that matter.

As opposed to, say, a person who comes in with a medical condition and says pain is 4/10, and a couple hours later says it’s 8/10, maybe we have useful data for a change.

I’ve had known, proven, true addicts admitted with unconsciousness, aspiration pneumonia, that sort of thing. One, with a spouse that says this is a pattern for years, doctor-shops, takes drugs until out cold. That is not “pain relief seeking”, that’s drug-seeking. Another took controlled substances and met with other doctor-shopping friends, and they literally had a party, exchanging what they got from their docs, see what happens in combination. One gets comatose, aspirates, they bring patient in hospital, literally admitting that’s what they did.

In the face of blatant, proven, demonstrated addictive behavior, I get call after call after call from nurses about the 10/10 pain complaints, wanting to know why I’m not running a PCA or prescribing oral opiates.

That pain scales are crap is the big secret. I run a pain service at a children’s hospital and have not found any of the pain scales to be of any help.
Pain scales might be of some use for research purposes because with an ordinal scale you can apply all the usual statistical tests and produce the allmighty p value. JCAHO and the suits like scales because they like simple metrics in the business world; set a metric, set a goal, achieve a goal.

The bogus party line goes ‘pain is what the patient says it is’. The reality is pain is what the health care provider understands it to be. Pain is a mix of a pathophysiologic process, anxiety, coping skills and cultural expectations and behaviors; this just cannot be meaninfully captured and relayed between patient and provider in a single number.