Pain is an extremely difficult subject to study, because individuals experience pain differently — some people have a much greater tolerance for pain than others, and some people just seem to complain more. Doctors typically handle the problem with assessing pain by asking patients to rate the pain they are feeling on a scale of 1 to 10. This gets around some of the issues of measuring pain because the individual’s subjective experience is accounted for by the rating scale.
But the 1 to 10 scale might also be problematic. People might exaggerate their pain just to get access to stronger painkillers. Worse, they might not be reporting pain because of problems with the measurement scale itself. A new study claims to be “the first to evaluate the accuracy of the widely-used numeric rating scale [NRS] as a screening test to identify primary care patients with clinically important pain.” Here’s what they found:
The authors found that, while the NRS is easy to administer, it fails to identify about a third of patients with pain serious enough to impair day-to-day functioning. Most patients in this study had long-standing pain, and many had more than one pain problem. The authors did not evaluate the accuracy of pain ratings in settings where short-term pain is more common, such as after surgery.
The researchers noted that because it focuses on current pain, the NRS may miss intermittent symptoms. They also reported that “pain” was not the preferred word for some patients. For example, one study participant indicated that he felt discomfort, but not pain.
So some patients experiencing significant pain are missed because they aren’t in pain when the doctor happens to ask them about it, and others are missed because they don’t share the doctor’s understanding of the concept of “pain.” To me this concept of impairing “day-to-day functioning” is also very important. Perhaps doctors need to be asking at least two questions about pain: First, the numeric rating scale, and second, a question about how they are functioning day-to-day.
Other CogDaily posts about pain: