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  • Writer's pictureLee Livingston

The Pain Scale: The Fifth Vital Sign in Medical Malpractice Cases


A woman doubled over in pain.

Pain, termed as the "fifth vital sign" by the American Medical Society, plays a critical role in patient care. Its subjective nature might lead some to underestimate its significance, but the complexity surrounding pain assessment and its relevance in medical malpractice is soil that needs careful tilling to fairly adjudicate whether a healthcare provider has breached the standard of care.


Decoding the Pain Scale

Traditionally, the pain scale ranges from 0 to 10. A score of 0 indicates no pain, while a 10 reflects the most excruciating pain conceivable. Despite its subjective nature, decades of research have endorsed the reliability of pain scales, so much so that they are now equated with vital signs like heart rate, blood pressure, and respiration rate.


Pain is a pervasive issue. An astounding 50 million individuals grapple with chronic pain, and nine out of ten people frequently experience some form of pain.


Assessing Pain: A Dual Approach

Pain assessment can be bifurcated into two categories:

  1. Doctor-Assessed: Where a healthcare provider gauges the patient's discomfort based on clinical examination and the patient's verbal feedback.

  2. Patient-Assessed: Where patients self-report their pain intensity.

The Evolution of the Pain Scale

Surprisingly, the inception of the pain scale was rooted in children's drawings, ranging from cheerful smiley faces to tear-filled grimaces. This innovative approach not only aids non-verbal patients but also serves as a universally recognized system for conveying pain.


Beyond the Numbers: The Observational Aspect of Pain

Healthcare providers employ a multi-faceted approach when evaluating pain:

  1. Observational Pain: Facial expressions are paramount. A patient's grimace or a tear can sometimes convey more than words.

  2. Behavioral Pain: Symptoms like groaning or guarding indicate the extent of the discomfort.

  3. Physiological Pain: Some bodily reactions, such as nausea, can be indicative of severe pain.

The Reliability of the Pain Scale

Despite having no machinery or tests to objectively measure pain, repeated attempts have established a reliable barometer when comparing an individual's prior pain reports to subsequent ones. Everyone has unique pain thresholds, but the scale provides consistent feedback for each individual. While healthcare providers may have a valid point to push back when asked to compare one patient’s pain to another, a pain scale for the same patient is a very reliable tool, because patients are good historians when it comes to comparing pain at one time and then another.


Addressing the Stoic: Special Considerations for the Elderly and others

Some elderly patients' stoic souls often underreport pain, perhaps due to pride or an unwillingness to accept the vulnerabilities of age.


Astute healthcare providers might inquire about "discomfort" or "aches" obtaining more accurate pain insights from otherwise reserved individuals. These populations of people are more likely to endorse “pain” under these names.


In Conclusion

It's tempting to dismiss pain reports as mere subjectivity, especially in the clinical setting. Yet, the scientific validation of pain scales emphasizes their importance. While a minority might exaggerate pain for various reasons, such as seeking opioids, most patients strive for accuracy.


When asked to pinpoint your pain on this scale, remember its significance and the rigorous research validating its use. If you want to create a strong medical record, look back at how you rated your experience of pain previously. The availability of medical records online makes this easier now. Also, ask your health care provider to check for you if you need a refresh your memory.


Finally, never be afraid to ask specific questions about your health care provider's assessment of your pain. This will protect you and help the clinician render the right diagnosis and to prescribe the best treatment.

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