by Alan Jordan
The most common complaint that patients have when consulting a clinician at the Broadgate Spine & Joint Clinic is PAIN. Neck pain is the most common complaint of City workers, whereas in rural areas, lower back pain is more common. In order to organise appropriate treatment, the question that the clinician must ask is, just how much pain is the patient experiencing?
There are many factors that influence how a patient is experiencing their pain and these will be dealt with in coming articles, however, examples include stress levels, cultural traditions and so forth.
How to Measure Pain
So, how do clinicians measure pain as opposed to patients just expressing that they have lots or pain, or some pain, or occasional pain? The research community has developed a number of clinical instruments that are used to measure the clinical effect of different treatments that are used in clinical trials and these can easily be used in a clinical setting such as Broadgate.
For many years, the most commonly used instrument was the visual analogue scale.
Patients simply place an “X” along the scale at a point that they feel represents their level of pain. This scale has been shown to be very reliable; however, it is time consuming because doctors have to measure where the patient has placed their “X”.
New scales, called numerical scales have been shown to be as reliable and far simpler to use.
The most common is the 11 point box scale. It appears below, and as you would imagine, patients simply mark their level of pain with an “X”. This is obviously easier and quicker for the doctor to interpret.
For patients experiencing longstanding pain, a more detailed “description” of their pain is most useful and clinicians have begun to use three series of 11-point box scales – each asking slightly different questions relating to pain. They are the following:
What is your current level of pain?
What is the average level of pain that you have experienced during the past 14 days?
What is the worst level of pain that you have experienced during the past 14 days?
Responses are then added up and divided by three. An overall score out of 10 is then determined.
As you can readily see, this provides the clinician with far more insight as to how much pain the patient is really experiencing over a longer period of time and therefore a more comprehensive and accurate picture of the pain is provided.
At Broadgate, we are currently working on an electronic patient “welcoming” information system, which includes both pain and disability scales as well as other important information. This will enable us to better plan appropriate patient care and carry out an audit of our clinical results.