Is it Time to Retire the Pain Scale?

Depending on who you listen to, responsibility for the opioid crisis in the United States lies with “Big Pharma,” physicians, patients, insurance companies…all of which is true to some extent. It’s a complex problem borne out of a legitimate need to help ease the pain of patients who are suffering. However, a new KevinMD blog post suggests that removing a very noncomplex tool—the pain scale—from patient interactions may be a big step in rebooting how we talk about pain itself and, by doing so, reducing risk inherent in relying on narcotic pain meds. The problem with the pain scale, it argues, is that pain is so subjective and transient. In the context of urgent care, any pain that moves the patient to visit you instead of waiting to see their primary care physician or a specialist must be fairly severe at the moment. As such, they may give an exaggerated (albeit sincere) score on a 1-to-10 scale or point to an especially agonized facial icon on a visual scale. The piece suggests, instead, asking the patient about how their pain is affecting their everyday functioning: Are they able to carry groceries, to do their job effectively, to pick up their child? That may be the true assessment of pain severity, it reasons. The author, Vijay Rajput, MD of Ross University School of Medicine, concludes that well-intentioned reliance on tools that may be outdated could be the first step toward violating the oath to “do no harm,” and that moving away from the pain scale may be a simple act that would wind up saving lives.