by Lynda Lampert

Created on: September 13, 2009

Pain is a situation that effects most patient populations in hospitals today. It is so important to patient care that the assessment of pain level has been called the "fourth vital sign". Indeed, pain management is a hot button issue, but it is fraught with many roadblocks for the healthcare practitioner. Blood pressure, pulse, and temperature can be measured and recorded as an objective number, but the same does not hold true for pain. Instead, hospitals have employed the use of the visual analogue scale for pain.

The VAS scale requires the patient to name their pain number on a scale of one to ten. Zero would have the rating of no pain and ten would be the rating of worst pain imaginable. The intermediate numbers have sometimes been associated with other descriptive adjectives. For instance, a pain level of eight can also be referred to as "miserable" where a four would be merely "uncomfortable." This ranking allows nurses to assess a patient's pain level and then assess a change after interventions are administered. Although it appears simplistic on the surface, this method of pain assessment and management has very distinctive pros and cons to its usage.

Pro: The scale is easily explained.

A large majority of patients can understand a 1-10 scale. They can imagine a "no pain" situation and are likely to grasp a "worst imaginable" level of pain. The intermediate numbers can be discussed and associated with words to pictorial pain representations. This visual representation of the different pain numbers can also assist non-English speaking patients to rate their pain as well.

Con: The scale can be confusing for patients or does not apply to certain populations.

Although the scale can be easily explained, it is difficult for patients to know what the "right" answer is. Some patients may not understand why the nurse is asking or how important the information is. This can cause some patients to feel anxiety about choosing the correct number in a hope to please the practitioner. Further explanation of the different numbers and a visual chart can be helpful in directing a patient to choosing a number with the least anxiety possible. In the case of pediatrics or comatose patients, there is no way to obtain a subjective assessment of pain. In these cases, we must go by what we can assess objectively - and there may not be very much to go on.

Pro: The scale gives us a quantifiable number.

A number shows us what sort of pain we are dealing with and helps us make decisions

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