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Measuring Pain by the Numbers

© Lou Robinson

"Good morning, Mrs. Jones. How are you feeling today?" I asked, as I walked into her hospital room. Mrs. Jones was an elderly woman whose hip pain had caused her to stop taking care of herself.

Mrs. Jones forced a tiny smile. "Better than yesterday, but my leg still hurts really bad."

"I am sorry to hear that," I said. I explained that I was there to evaluate her and provide occupational therapy services. She was agreeable and eager to return to her home and independent living.

"I would like to evaluate your pain," I explained, "so that we can decide if we should try to work now or later. I showed her the pain measurement scale with faces and numbers (http://gasbone.herston.uq.edu.au/teach/s... On a scale of 0-10, with 0 being no pain, and 10 being the worst pain imaginable, how would you rate your pain?

Mrs. Jones furrowed her brow slightly. "I don't want to be a big baby, but I think it's about a 7 or 8."

I assured her that she was not being a baby, as her rating indicated significant pain. I also stated that it was important that we have an accurate assessment of her pain so that we would know how best to care for her. "I'll let your nurse know, and come back later for therapy after your pain is under better control."

I fully empathized with Mrs. Jones. As one diagnosed with sarcoidosis, I have experienced both mild and severe pain. Twenty years ago before I was diagnosed with the condition, my own pain sent me scurrying to the doctor. However, as a healthcare provider working in a hospital, I am expected to go beyond empathy when someone complains of pain.

"Pain is one of the most common reasons people seek medical attention," stated a representative of JCAHO (Joint Commission on Accreditation of Healthcare Organizations) when interviewed by the Worldwide Congress on Pain (http://www.pain.com/interview/pro_jcaho_... ). In 1999, JCAHO developed a pain management standard, and published it in 2000. The standard, which became effective January 1, 2001, mandates the consistent assessment of each patient's complaint of pain (http://www.jcaho.org/trkhco_frm.html). The use of a pain measurement scale, which may combine numbers, pictures, and/or verbal descriptions, is recommended. Hospitals, skilled nursing facilities, home health agencies, and other healthcare organizations JCAHO accredits must also provide appropriate treatment and education for patients and healthcare providers.

The American Academy of Family Physicians states that persons with sarcoidosis may experience pain in any of the multiple systems affected (http://www.aafp.org/afp/981200ap/belfer.... Bone sarcoidosis often affects the hands and feet, and may cause joint stiffness, swelling and pain. Muscle pain and polyarthritis are common symptoms of Lofgren's Syndrome. Approximately 3-5% of persons suffering from sarcoidosis will experience chest pain from cardiac or lung involvement. Peripheral neuropathy, which may include tingling, burning, and pain in the hands and feet, is symptomatic of neurological involvement. Eye pain and irritation often accompany uveitis.

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