Pain scale
Formal Definition
A standardized tool to quantify a patient's subjective pain intensity; the Numeric Rating Scale (NRS, 0–10) is most widely used in adults; alternatives include the Visual Analog Scale (VAS), Wong-Baker FACES scale (pediatrics/cognitively impaired), and behavioral pain scales (BPS, CPOT) for non-verbal or sedated ICU patients.
How It's Used on the Ward
"Rate your pain from 0 to 10" or "pain score" — the ubiquitous fifth vital sign that drives analgesic decisions throughout the hospital.
Example
""Patient reports pain as 8/10 at rest, 10/10 with movement. Prior dose of IV morphine brought it from 9 to 6. Reassessing 30 minutes after next dose. Goal is to get to a functional pain level — pain-free is not always achievable, but able to breathe and mobilize is.""
Clinical Context
The 0–10 NRS is a guide, not a prescription. Pain 7/10 does not automatically equal IV opioid — assess functional impact, trajectory, and what worked previously. Pain management principles: multimodal analgesia (combining non-opioid agents reduces opioid requirements and side effects); around-the-clock dosing for persistent pain (not just PRN); scheduled non-opioids as foundation (acetaminophen, NSAIDs, gabapentinoids for neuropathic). Reassess after each intervention — document the pain score pre- and post-treatment. Behavioral Pain Scale (BPS) or Critical-Care Pain Observation Tool (CPOT): for non-verbal or sedated patients, assess grimacing, body movement, and ventilator compliance.
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