Why The Need for Pain Scales?
Most people who suffer from CRPS will tell you they never experienced such pain before. This is because of the intense nerve pain we don’t usually get exposed to for long amounts of time. Perhaps the closest is a root canal or rotten tooth in your mouth that needs extracting to illustrate the “type” of unrelenting pain. One of the main challenges becomes describing the pain in a way that healthy people can understand in efforts of getting treatment. This can be challenging.
Pain is subjective and also changes over time and with treatment, this is where Pain Scales come into play. They are a tool for doctors and healthcare providers to assess your pain severity, quality, and impact on daily life in a clinical setting.
Read on to discover some of the most widely used pain scales for assessing CRPS, Fibromyalgia, and other chronic pain syndromes.
Widely Used Pain Scales and Questionnaires
- McGill Pain Questionnaire: Assesses the quality and intensity of pain from 1-50. The patient selects the descriptors that best represent their pain experience. See more below.
- Brief Pain Inventory (BPI): Assesses pain severity, location, and impact on daily activities. It includes questions about pain relief and the degree to which pain interferes with sleep, mood, and quality of life.
- Pain Catastrophising Scale (PCS): Assesses the degree to which a patient catastrophises, or amplifies, their pain. It includes questions about negative thoughts, feelings, and behaviors related to pain.
- Visual Analog Scale (VAS): Uses a straight line, with one end representing no pain and the other end representing the worst pain imaginable. Patients are asked to mark the line to indicate their pain level.
- Numeric Rating Scale (NRS): Asks patients to rate their pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain imaginable.
- Verbal Rating Scale (VRS): Uses words to describe the intensity of pain, such as “mild,” “moderate,” or “severe.”
- Wong-Baker FACES Pain Rating Scale: Uses a series of faces to represent different levels of pain. It is commonly used with children or those who have difficulty communicating their pain level verbally.
These are some of the existing pain scales used to assess chronic pain. Comprehensive pain assessments give doctors a better understanding of your pain and quality of life and develop an appropriate treatment plan.
It’s important to note that pain is a complex and subjective experience, and no single pain scale can capture the full range of pain experiences.
The McGill Pain Scale
The McGill Pain Scale, developed in 1971 by Ronald Melzack and Warren Torgerson at McGill University in Montreal, Canada.
The scale rates pain from 1-50 and consists of 78 descriptive words and phrases related to to capture the sensory, affective, and evaluative aspects of pain (such as dull, throbbing, shooting, etc.). The patient is asked to select the words that best describe their pain and the severity is rated on a scale of 0-5.
The McGill Pain Questionnaire is used in rehabilitation to comprehensively assess the quality and intensity of pain in CRPS and Fibromyalgia and to measure the effectiveness of different pain management interventions.
Phrases from the McGill Pain Scale:
Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding,Jumping, Flashing, Shooting, Pricking, Boring, Drilling, Stabbing, Sharp, Cutting, Lacerating, Pinching, Pressing, Gnawing, Cramping, Crushing
Example scores from the McGill Pain Scale:
- Mild pain: 2-3
- Moderate pain: 4-5
- Severe pain: 6-7
The McGill Holistic Approach to Measuring Pain
Many of the McGill Pain Scale descriptors are not just related to the physical sensation of pain, but also to the emotional and psychological aspects of pain like: distressing, tiring, depressing, Punishing, Grueling, Cruel, Vicious, Killing, Wretched, Blinding, Annoying, Troublesome, Miserable, Intense, Unbearable and more. These are intended to capture the overall impact of pain on a person’s life.
This holistic approach to measuring pain and its affect on a person’s life has made the McGill Pain Scale a valuable tool in the assessment of chronic pain.
The McGill Pain Scale is unique compared to other pain scales in several ways:
- Holistic approach: The scale measures both the physical and emotional aspects of pain, giving a more complete picture of the patient’s experience.
- Descriptive words: Instead of relying on numerical ratings, the scale uses descriptive words and phrases to help patients accurately describe their pain.
- Versatility: The scale is flexible and can be used in a variety of settings, including hospitals, clinics, and research studies.
- Widely used: The McGill Pain Scale is widely used and recognized by healthcare professionals around the world, making it a valuable tool in the assessment of chronic pain.
Brief Pain Inventory (BPI) Pain Scale
The Brief Pain Inventory (BPI) is designed to assess the severity and impact of pain on daily activities. It is often used to assess pain in patients with cancer, chronic pain, or other conditions where pain is a significant factor. It is frequently used to assess the effectiveness of pain management treatments, such as medication, physical therapy, or other interventions.
The BPI consists of nine items:
- Pain Severity: This item asks patients to rate their pain intensity on a scale of 0 to 10, with 0 being no pain and 10 being the worst possible pain. This rating is used to measure the patient’s overall pain severity.
- Pain Interference: This item assesses the degree to which pain interferes with daily activities, including general activity, mood, walking, work, sleep, and enjoyment of life. Patients rate each area on a scale of 0 to 10, with 0 being no interference and 10 being complete interference.
- Pain Relief: This item asks patients to rate the degree to which pain medication or treatment is relieving their pain on a scale of 0 to 10, with 0 being no relief and 10 being complete relief.
- Pain Quality: This item asks patients to describe the quality of their pain, using words such as shooting, throbbing, or aching.
- Location of Pain: This item asks patients to indicate where they are experiencing pain, using a body diagram to identify specific locations.
- Pain Medication: This item asks patients to list the types of pain medication they are taking, including dosage and frequency.
- Medication Side Effects: This item asks patients to describe any side effects they may be experiencing from their pain medication.
- General Activity: This item assesses the degree to which pain interferes with general activity, such as work and household chores.
- Mood: This item assesses the degree to which pain interferes with mood, including feelings of anxiety, depression, and irritability.
These nine items are used to assess the severity and impact of pain on a patient’s life. By completing the BPI, patients and healthcare providers can better understand the nature of the pain and develop an appropriate treatment plan. The BPI is a valuable tool for assessing pain and its impact on quality of life.
The Pain Catastrophising Scale (PCS)
If you suffer from constant severe pain, most likely this experience will cause anxiety and depression over time. The more severe pain you experience, the more afraid of it you become, realising it’s power and reach on your life. This is where catastrophising comes in. It creeps in without noticing.
The PCS is one way to understand how much this is affecting you so you can be aware of it and work to rid yourself of this”extra” pain.
Catastrophising is the tendency to magnify or exaggerate the negative aspects of a situation, like the experience of pain. It is one of the negative thinking styles addressed in CBT Therapy (Cognitive Behavioral Therapy).
The PCS includes questions about negative thoughts, feelings, and behaviors related to pain, for example: “I feel like I can’t go on” or “I worry that I will never get better.” By assessing your level of catastrophising, your doctors and PT and OT can gain insight into your experience of pain and how it is impacting your daily life.
The pain associated with CRPS can be overwhelming and can lead to a range of psychological symptoms, including anxiety and depression. By assessing a patient’s level of catastrophising, healthcare providers can better understand the patient’s psychological state and develop an appropriate treatment plan.
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