Eliminate The 1-10 Pain Scale

Blog#58- 1/27/21

Richard Davis

Anyone experiencing pain who has had contact with the health care system has had one of the most meaningless and offensive questions posed to them. “On a scale of one to ten, ten being the worst pain you have ever had, what is your pain now?” Nurses are often the ones asking the question. Asking that question makes life simple for nurses, but it is not fair to patients to ask them to characterize their pain that way.

In the 1990’s health care professionals started to pay more attention to pain. I was working as a nurse then and accepted the 1-10 scale as gospel, as did most nurses. But I was never entirely comfortable with this rating system and I always tried to ask more questions of people experiencing pain.

We were hearing phrases such as “pain is what the patient says it is” and there was a positive awakening of sensitivity among health care professionals that gave them the license to be less judgmental about pain and treat it more aggressively.

I was hopeful that professionals might evolve in their thinking and possibly realize how meaningless the 1-10 scale is after using it for so many years. Most professionals asking questions about pain do make an effort to gather more information about a person’s pain, but I do not think it is necessary to continue using the 1-10 scale It is important to take a look at the history of this pain scale to get a perspective on the issue.

In 1995 the American Pain Society started a campaign to promote pain as a fifth vital sign. On the surface it seemed like a good idea and it was heavily promoted. As this was happening the seeds of the opioid epidemic were being planted.

Purdue Pharma was one of the backers of the fifth vital sign campaign just as they were about to start promoting their new drug OxyContin. In 1996 Purdue Pharma launched the biggest marketing campaign in pharmaceutical history as they aggressively promoted use of the 1-10 pain scale and backed the fifth vital sign push.

Purdue then started working with the Joint Commission on the Accreditation of Hospitals and in 2001the commission promoted the 1-10 pain scale and started judging hospitals based on patient satisfaction of pain treatment. The push was on and Purdue had figured out how to manipulate an entire industry solely for the sake of profit.

The Joint Commission and Purdue joined forces and published a guide for doctors and patients that said, “There is no evidence that addiction is a significant issue when persons are given opioids for pain control.” As Purdue sent its army of drug detailers to doctors’ offices and hospitals Purdue had taken control of clinical aspects of pain control. The rest is history.

The 1-10 pain scale is a symptom of a system taken over by evil forces. We must stop using it, if for no other reason than it has such an immoral history in the evolution of the treatment of pain.

I would like to see a push by doctors and nurses to replace the 1-10 scale with a way of characterizing pain that does not put patients into a neat numerical box when they are having one of the worst episodes in their lives. People deserve to be treated better.

I have had years of personal experience with pain and I feel insulted and feel that I have been reduced to a number when nurses ask me to rate my pain from 1-10. I usually oblige, but I have decided to stop being complicit in the inaccurate pain assessment process.

I suggest we eliminate the 1-10 scale and replace it with a few questions. Can you describe your pain for me? What does your pain prevent you from doing? The answer to those questions then opens the door to more precise diagnostic questions about pain location and history.

A patient shows up in the emergency department with back ang leg pain bad enough to make them unable to walk while their whole body is shaking. A nurse asks the 1-10 pain question. Instead they should ask the person to describe their pain. One answer might simply be “10”. A better answer would be, “It feels like someone has stuck a long needle into my leg and connected it to an electrical transformer that gives me random electrical shocks.”

It’s time for us to move on and treat people experiencing pain with more respect than we have given to a drug company that has been found guilty of immoral and illegal actions.

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