The difficulties of measuring pain
Pain is a difficult medical condition to assess because only the person with the pain can actually feel it. Also, each person experiences pain differently.
Measuring or diagnosing pain is also difficult for healthcare providers because there is no generally accepted, accurate device that can measure pain. When you have a fever, you can quickly check your temperature using a thermometer. People with hypertension know their blood pressure is too high because they have it measured at the clinic. However, there is no way to tell how much pain a person is going through.
Doctors can use some tests as a guide to help find the cause of pain and have a better picture of the patient’s condition. These include:
- Electrodiagnostic procedures, like electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies, can show which muscles or nerves are affected by weakness or pain.
- Imaging, especially magnetic resonance imaging or MRI, provides pictures of the body’s structures and tissues. MRI uses magnetic fields and radio waves to differentiate between healthy and abnormal tissue.
- X-rays produce pictures of the body’s internal structures, such as bones and joints.
- Doctors also use a neurologic exam to test a patient’s movement, reflexes, sensation, balance and coordination. This exam can reveal if there is a problem with how a person’s nervous system is functioning.
The importance of communication
Because doctors cannot treat pain based on medical tests alone, communication is vital to pain management. When you have a stomachache, you will need to tell your doctor or other healthcare professional about the feeling in full detail – if it’s stabbing or vague; if it’s just in the lower right part of your tummy or all over – for him or her to get a better idea of what you are going through. Being able to communicate well with your healthcare team is a good first step in getting help for your pain.
It’s a good idea to prepare before going to your doctor. Make a list of things you want to discuss about your pain. Write down the details of your pain so you won’t forget and you can describe the pain in detail: when you felt the pain; the body part affected; the characteristics of the pain; what relieved the pain; other symptoms that you felt apart from the pain; questions about the pain you want to ask your doctor; and so on.
Tools for communicating and assessing pain
One way to track your pain is by keeping a pain diary or journal, which you can easily bring to the hospital or clinic and show your doctor. Keeping records in a pain diary will not only give your doctor a better understanding of your pain, but can also possibly identify potential pain triggers and which medications work best for you. Your doctor can improve your pain treatment based on the diary details.
A pain diary can look like this:
You can also use a diary like this to remind you of future doctor appointments, or rank your pain on one of the scales discussed below.
Many different pain scales are available, including for infants, children, adults and patients with difficulties communicating. A pain scale will usually include a range and you can choose the severity based on the range presented. For instance, the nurse may ask you, “How bad is your pain right now on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain you ever had?”
Here are just some pain scales that healthcare professionals may use to assess your current pain and how well your medications are working:
- Visual analog scale (VAS). When using this scale, adult patients indicate their current level of pain along a 10-cm line with ‘no pain’ at one end and ‘worst pain imaginable’ at the other.
- Numeric rating scale (NRS). The NRS is just like the VAS, but with visible numbers. Patients rate their pain either verbally or by placing a mark on a simple scale from 0 to 10, where 0 is no pain and 10 is worst pain imaginable
- The Wong-Baker FACES Pain Rating Scale uses drawings of faces to show the range of pain. It is used for people aged 3 and older. The Faces Pain Scale – Revised (FPS-R) is a version used for younger children (<8 years old).
Faces Pain Scale – Revised (FPS-R)
Your healthcare team may use other ways to assess pain, like using questionnaires or other tools. Some scales have also been translated to make the process easier for both doctors and patients. The aim of all these tools is to assess pain as accurately as possible so that pain management is best suited to the patient.