Words Have the Power to Heal: A New Approach to the 0-10 Pain Scale

Rather than utilizing the 0-10 pain scale, wouldn’t it be amazing if you could just ask your patients to feel better?

That certainly would make your job as a nurse easier and less stressful, and your patients would appreciate it, too!  

 Nurses often feel the angst of having to deal with patients in pain. When you empathize with a person’s pain, it can begin to make you feel discomfort. That’s the difference between empathy, to feel what another is experiencing, and compassion, which is to recognize the suffering of others and then take action to help.  

The most important action you can take is to describe a path of improving comfort for your patient to follow.  Simply, ask for what you want, and be careful not to unwittingly ask for what you don’t want. 

Your words have the power to harm or heal. 

There are several problems with the 0-10 pain scale. One being, popular to contrary belief, there really is no formal training on how to use it — people just expect you to know it.

As a result, clinicians don’t always apply the 0-10 pain scale well and often don’t believe it in return.  

When a triage nurse in the emergency department asks a patient to rate their discomfort on a 0-10 pain scale, and the patient replies “15,” the nurse may be skeptical. This is also true when a patient rates their pain as an 8, but the nurse does not think they look ‘that’ uncomfortable.   

This interaction can result in the patient intuitively perceiving the clinician as uncaring, which can lead them to becoming more stressed, and potentially increasing their physical discomfort. 

Common practice is to ask a patient, “How is your pain?”  What does it do to a person’s mind and body when this question is asked repeatedly, over and over? What are you asking for? What do you really want, pain or comfort? 

Everyone has a different tolerance for pain, and since pain is a sensory perception, it means that it can be modified. So, as providers, the goal is to direct patients toward comfort.  

However, I am certain we have all heard clinicians say something like, “Rate your pain from zero to ten, with ten being the worst possible pain you’ve ever experienced.” Is this really the best way to utilize this scale? When the patient is currently in pain, we’re now asking them to remember other extreme painful experiences? 

Here are a few simple ways to enhance the use of the 0-10 pain scale to provide a consistent, effective, and compassionate approach that promotes greater comfort for patients.   

This is the new approach to using the 0-10 pain scale. 

Initial Pain Scale Assessment 

Clinician says, “Please rate the pain on a 0-10 scale with ‘0’ being no pain, and ‘10’ being the highest.”  

By utilizing this approach, it not only places a cap on the pain scale to prevent the patient from going over, but also offers a realistic quantifier.

This modified initial pain scale assessment provides for a more accurate and consistent measure without unknowingly leading the patient to recall previous painful experiences that may impact their response.   

Why is this important?   

The Power of Association
Recalling previous painful experiences may enhance the current experience of pain. All sensory information, including painful sensations, is processed in the outside layer of the brain, the primary somatosensory (S1) cortex.  These pain memories manifest themselves in alterations in the S1 cortex and may contribute to hypersensitivity even in the absence of peripheral stimulation. 

The Stress Response
Recalling past painful experiences can trigger the stress response. The pain experience may be worsened with increased stress, which results in tight muscles, increased pulse rate and blood pressure, and the release of stress hormones. 

Your Goal
You always want to bring comfort and reduce discomfort. Begin thinking of the pain scale as a tool to measure comfort as well. 

Pain Reassessment 

 Clinician asks, “Feeling Better?” or, “How are you feeling?” 

Rather than asking, “How is your pain?” that may lead the patient toward further discomfort or recollection of previous painful experiences, this approach directs the patient toward a more neutral, and comfort-oriented response.

By focusing on the patient feeling better, it immediately shows your compassion for them, which positively impacts the quality of patient care given and can potentially improve outcomes. You can even reinforce this feeling of comfort with a supporting response such as “Great, I’m so happy you’re feeling better!”  

In order to guide further treatment if needed and complete documentation, it’s still important to implement the pain scale. However, instead of asking where their pain is at, ask, “How much better do you feel?”  

Of course, outcomes will not always improve immediately and that is okay. If the patient informs you that their comfort is not improving, or that it is worsening, make sure to express sympathy, but act. 

It’s vital to acknowledge a patient’s discomfort, express compassion, and take action to help when it’s needed.

When the patient feels that you genuinely care about them and that you want their discomfort to improve, it allows for a much better experience and improves the overall quality of care given.

By utilizing this new approach, not only will we focus on measuring levels of comfort, but the patient now has a positive goal in mind of healing and not just relieving pain. 

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