Severe Pain

The NRS is the most commonly used one-dimensional pain scale. It is an 11-point Likert-type scale where 0 means "no pain" and 10 means "worst possible pain." To use the scale, the nurse asks the patient to rate their pain intensity between 0 and 10. The higher the number is, the more intense the pain:

■ Mild pain is considered to be pain ratings in the 1—3 range.

■ Moderate pain is considered to be pain ratings in the 4—6 range.

■ Severe pain is considered to be pain ratings in the 7—10 range.

Although there is a discussion about whether a single number rating of pain is accurate, the data indicate that single item ratings can be useful. With chronic pain, the intensity rating is only one of a number of items used to assess pain. The complexity of chronic pain requires a fuller assessment than just a pain intensity rating. There is no good or bad, right or wrong number for the patient to report. It is important to believe the report of pain that the patient provides. A patient's self-report is still considered the gold standard for pain assessment.

Limitations include:

■ Only measures one aspect of pain.

Strengths include:

■ Allows for reassessment and comparison of pain scores.

■ Simple format is easy for most patients to use.

Combined Thermometer Scale

Pain Distress/Intensity Scale

Pain Distress/Intensity Scale

Some patients do well when they can see a graphic pain scale. The combined thermometer scale combines one-dimensional scales: the VDS and the NRS. Some patients do well with this scale and like the vertical orientation where the numbers increase from the bottom upward. The colors also highlight the increasing pain intensity as the color changes from blue to red.1

1 The Combined Thermometer Scale appears in color on the inside front cover.

Strengths include:

■ Ability to replicate pain ratings for reassessment.

Multidimensional Pain Scales

Multidimensional scales are used to assess patients with chronic pain with various pain conditions. The two scales that are most often used in the clinical setting are the McGill Pain Questionnaire (MPQ) and the Brief Pain Inventory (BPI). The difference between the one-dimensional and the multidimensional scales is the combination of indexes in the multidimensional scale that can utilize the following:

■ Pain intensity

■ A body diagram to locate pain

■ Verbal descriptors

■ Medication efficacy questions

When the patient rates his or her pain using a multidimensional pain scale, there is the opportunity for the patient to more completely convey the pain experience to the health care provider. The mood scales on some multidimensional scales can help define the impact of the continued pain on the patient's personal life and relationships.

These scales are meant to measure chronic pain either for research or for clinical purposes. Another approach to assessing chronic pain that may be easier in the clinical setting is to use a set of structured questions, such as the Brief Pain Impact Questionnaire (BPIQ). This set of questions is particularly helpful for a primary interview when the patient is new to the health care provider.

Brief Pain Impact Questionnaire

The interview questions of the BPIQ capture the major elements of pain assessment for patients with chronic pain and are easy to use in the clinical setting. It is designed to be a particularly good way to organize a first assessment that can be used as a baseline. Using this format also allows the patient and health care provider to establish open communication about the pain that the patient is experiencing.

Brief Pain Impact Questionnaire

■ How strong is your pain, right now, worst/average over the past week?

■ How many days over the past week have you been unable to do what you would like to do because of your pain?

■ Over the past week, how often has pain interfered with your ability to take care of yourself, for example, with bathing, eating, dressing, and going to the toilet?

■ Over the past week, how often has pain interfered with your ability to take care of your home-related chores, such as grocery shopping, preparing meals, paying bills, and driving?

■ How often do you participate in pleasurable activities, such as hobbies, socializing with friends, and travel? Over the past week how often has pain interfered with these activities?

■ How often do you do some type of exercise? Over the past week, how often has pain interfered with your ability to exercise?

■ Does pain interfere with your ability to think clearly?

■ Does pain interfere with your appetite? Have you lost weight?

■ Does pain interfere with your sleep? How often over the last week?

■ Has pain interfered with your energy, mood, personality, or relationships with other people?

■ Over the past week, have you taken pain medications?

■ Has your use of alcohol or other drugs ever caused a problem for you or those close to you?

■ How would you rate your health at the present time? (Weiner, Herr, & Rudy, 2002).

Source: Used with permission of the author.

McGill Pain Questionnaire

McGill Pain Questionnaire (MPQ)—Short Form


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