If a nurse practitioner ever wants to know a patient's blood pressure, it is easily measured with a blood pressure cuff and a watch. If a GP is curious about a patient's cholesterol levels, ordering a blood test takes care of it. That's not the way pain works. There is no definitive lab test for measuring pain. In fact, how doctors go about it can be an eye-opening experience.
In short, doctors and advanced practice nurses rely mainly on four tools for measuring pain:
Even with these tools in play, pain measurement is subjective. Doctors need to rely almost exclusively on a combination of what patients tell them and what they observe with their own eyes. It is by far an inexact science. Could that be why managing chronic pain is so difficult? It is certainly part of the equation.
The first tool doctors use to measure pain involve scales rooted in patients' self-reported ratings of pain. In other words, doctors will ask patients to rate their pain based on some sort of scale. Four of the scales that immediately come to mind are:
The first scale relies on a number system. It could be the simplest one for most adults to understand. As for kids, they tend to be more responsive to the Faces Pain Scale because it allows them to choose from a series of facial expressions to describe how severe their pain is.
Under the multidimensional questionnaires category are two tools healthcare providers tend to utilize with chronic pain patients. They are considered multidimensional because they offer more comprehensive assessments.
The Brief Pain Inventory (BPI) questionnaire focuses mainly on pain intensity and how it has impacted a patient's daily function over the past 24 hours. Meanwhile, the McGill Pain Questionnaire (MPQ) seeks to assess pain severity by asking patients to describe it using words of their own choosing.
There are times when doctors struggle to communicate with pain patients via traditional means. Perhaps a doctor is trying to assess pain in someone with cognitive impairment, for example. In such cases, observational practices can take advantage of things like facial expressions, body movements, and even whether a patient can be adequately consoled.
Observational assessments of pain are demonstrably more difficult because a healthcare provider can never really know for sure what is going on in a patient's mind. But combined with functional assessments, observations can be pretty revealing.
Speaking of functional assessments, they actually tell us quite a bit about pain. Imagine someone complaining about persistent pain in the back. The doctor can ask the patient to rate their pain using what is known as the Pain, Enjoyment of Life and General Activity (PEG) scale to better understand how it is affecting the patient's general activities and enjoyment of life.
They can also observe how the patient moves in a functional sense. How do they stand, walk, bend, and so forth? Limited function combined with a high PEG rating would suggest serious pain.
The truth of the matter is that treating pain is challenging because measuring it is also challenging. This reality explains why pain medicine is now a specialty. It is something we specialize in here at KindlyMD. If you are living with chronic pain for which you have found no relief in any other way, perhaps we can help.
