Should We Use Pain Scores? Let’s Change the Narrative.

Posted on in Clinical, News
Should We Use Pain Scores? Let’s Change the Narrative

Typically, a numerical pain rating scale (NPRS) is a tool to help us evaluate and assess a patient’s given symptoms. The NPRS is also helpful to gauge a patient’s response to certain interventions throughout the course of the episode of care. 

The scale ranges from 0 – no pain to 10 – worst pain possible.

The use of a NPRS gives the clinician insight into what the patient is currently experiencing.  However, perhaps emphasizing pain and concentrating on pain may not be the best method.  There may be some better alternatives to help us monitor function, while focusing on the positive aspects of the rehabilitation process.

Instead of using an NPRS, maybe we can use a scale that focus on function versus pain. 

Maybe we can ask:

On a scale of 0-100%, how well do you feel you can…

In this example, we are focusing on the positive.  This is like the analogy, ‘the glass is half full’ as opposed to ‘the glass is half empty’.  This becomes a little more optimistic and a more positive outlook.  This can potentially help shape the patient’s belief system and help them become more motivated in their own rehabilitation process.

We need to be able to change the narrative sometimes to help guide our patients better. There is no agreed definition of narrative medicine.2,3 However, narrative medicine refers to narrative competence, which means the “ability to acknowledge, absorb, interpret, and act on the stories and plights of others” as well as being able to recognize various factors that can influence to be able to adapt to the current situation.1-3

We need to use this strategy to better connect with our patients and establish a strong therapeutic alliance.  Using a NPRS or rating scale is useful, but maybe there are other strategies that we can use to our advantage.

Next time you look at your half-glass of water, ask yourself…

…is it half-full or half-empty?

Article Written By Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT


References:

  1. Fox DA, and Hauser JM. Exploring perception and usage of narrative medicine by physical speciality: a qualitative analysis. Philosophy, Ethics, and Humanities in Medicine, 2021, 16(7): 1-9.
  2. Charon R. A model for empathy, refection, profession, and trust. JAMA. 2001; 286: 1897–902.
  3. Charon R. Narrative and medicine. NEJM. 2004; 350: 862–4.