Should Doctors Use the Pain Scale for Injuries?

Doctors use a differential diagnostic process to assess patients’ problems; a doctor records a patient’s symptoms and vital signs to form a list of possible diagnoses and then uses a process of elimination to arrive at the most likely diagnosis for the patient.

One of the factors many doctors rely upon to accurately diagnose patients is the degree of pain their conditions cause. Unfortunately, there is no way to objectively measure pain. It is an entirely personal experience and there is no medical test that can “prove” a patient’s level of pain.

Doctors use the pain scale in many cases to help determine a patient’s condition, but this is also subjective. The pain scale is a one to ten scale that patients can use to rank the severity of their pain. A rating of one to three typically indicates mild pain and discomfort that the patient may barely notice or only find mildly distracting.

Four to six on the pain scale indicate moderate pain that can be distracting, make it difficult to move, or perform certain actions for short periods. Seven to ten indicate severe pain that the patient cannot ignore. The patient may cry out, demand painkillers, or even fall unconscious from the severity of the pain.

Since pain is purely personal and subjective, one person’s “seven” could be another person’s “three.” It’s also possible for a patient to simply exaggerate his or her level of pain either knowingly or unknowingly. The pain rating that a patient provides to a caregiver or doctor will go onto the patient’s medical record. If the patient’s issue leads to an insurance claim or lawsuit, then it’s possible that different legal parties and insurance companies will view this record.

If a provider believes that a patient’s reported level of pain does not fall in line with the provider’s observations and diagnosis, the provider may doubt the patient’s sincerity. This may also happen if the patient reports different levels of pain at multiple visits without justification. Ultimately, inconsistencies in reported pain levels can cause problems for patients later if these inconsistencies cast doubt on a legal claim.

There are several things any patient should remember when a doctor asks him or her to report pain using the pain scale. First, simply responding with a “ten” may seem like a good way to get providers’ attention, but a patient should only report a ten if he or she is on the brink of collapse and the pain is so unbearable the patient is ready to pass out. Some patients may report a “ten” to simply get painkillers or to create a sense of urgency. Ultimately, this can be a big mistake for several reasons.

A patient’s pain levels may be the determining factor between two possible diagnoses, one more severe and requiring complex treatment. If the patient exaggerates his or her level of pain it may lead to unnecessary medical procedures or surgeries that cause further discomfort.

Exaggerating pain levels can also cause problems for a patient who attempts to take legal action for his or her injury or illness. A defense attorney, insurer, or a judge may see a “ten” rating as an exaggeration if the plaintiff can manage to hold a conversation. This may cause them to doubt the patient’s claim or even believe the patient has been deliberately deceptive.

It’s best for patients to try and report a range of possible ratings. For example, a patient could report that an injury feels like an “eight” during short periods but feels like a “four” most of the time. This can help a provider form a more accurate picture of the patient’s condition and provide better treatment. Ultimately, the pain scale isn’t foolproof, but it remains an important diagnostic tool until some type of objective pain measurement technique becomes available.

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