Although pain scales are useful tools, they need to be paired with more objective information to create effective treatment plans. Most issues with pain scales happen when they are used as the only or primary source of information about a person’s pain.
Pain scales give providers valuable — but subjective — information. For example, some people can rank their pain at an 8 out of 10 and still go to work, while others can’t get out of bed with a score of 3. One study showed that even asking a follow-up question such as “Is your pain tolerable?” adds critical information for the provider and helps align someone’s expectations with realistic treatment goals.
In addition, many pain scales focus on a person’s pain level at the moment of the test and fail to address how pain affects people’s daily life. For example, pain scales often don’t accurately assess:
- Pain tolerance. Every individual’s tolerance to pain is unique. It’s shaped by biological and psychological factors — including genetics.
- Pain history. An account of previous or ongoing pain can inform how a person copes with pain and what treatments have worked in the past.
- Emotional state. Emotions can influence a person’s pain scale ratings. In addition to pain, people often feel anxiety, anger, grief, stress and helplessness.
- Pain changes with activity. Pain may get better during certain activities and get worse with others. For example, a person with chronic back pain could feel worse after sitting at a desk all day and better after a yoga class.
- Pain fluctuations over time. Many pain assessments only reflect how much pain the person is feeling at the time of the test. It can increase or decrease with the time of day. Recent studies suggest it’s more valuable to ask individuals to rate their average pain over a week or more.
Other problems can occur when providers place too much emphasis on a pain scale and focus on reducing short-term pain intensity instead of long-term pain management. As a result, their efforts to keep pain scores low with medication can be a barrier to getting people back to their regular routines. Many experts believe that providing education about active pain treatments, such as relaxation techniques and mindfulness practices, can help people manage pain more effectively over time.