Today’s post comes from guest author Roger Moore, from Rehm, Bennett & Moore.
This article will not be discussing Bo Derek’s memorable jog down a beach in that memorable movie of the same name. Instead it discusses the reliability of pain scales in the context of injury cases, a much less interesting topic!
According to the Journal of the American Board of Family Medicine, “Though the accuracy of the 5th vital sign for pain assessment is moderate, it is much lower in practice than under ideal research circumstances. Uniquely, we found that nurses may not always use the 0 to 10 scale to properly quantify pain levels and that informal screening practice leads to underestimation. Efforts to improve routine pain management can confidently use NRS, but provider training, education, and monitoring in screening techniques are needed, as are efforts to link the 5th vital sign to clinician action for better pain management. Reading between the lines, this organization found nurses and doctors need more education in order for pain scales to be reliably used.
Typically, patients are asked to rate their pain from 0-10. However, how those numbers are described seems to vary widely. One clinician may describe a “10” as the worst pain imaginable, while another may describe it as the worst pain you have ever felt. Of course, that can result in very different ratings depending on one’s history of prior injury and pain tolerance. The results may be further complicated by cultural distortions, difficulties in interpretation, psychological factors including depression, education level which could impact understanding and an individuals pain tolerance in general. Additionally, many injured people may generally feel that they must exaggerate their symptoms in order to be believed or to get the necessary medical treatment they require. It’s important for us to emphasize to our injured clients that exaggerating symptoms is never a good idea and could result in some very real credibility consequences with the Court, employer and medical professionals. On a similar note, it’s not uncommon to have some clients underestimate the symptoms they experience, and this also can result in difficulties related to being assigned appropriate work restrictions, getting necessary medical treatment and giving a full picture of the injury itself.
It’s not uncommon in trial for defense attorneys to make light of what they characterize as “exaggerated” pain ratings of 9 or 10. Additionally, if you are arguing that a condition has gotten worse, it’s difficult to do so when 9 or 10 pain ratings have been given previously. One colleague recently recounted an exchange during trial which is illustrative. A client was discussing non-operative back pain to a Judge and had told him his pain was a 10. When told to imagine Jesus Christ on the cross as the last spear thrust that ended his life as a “10”, and to compare his pain to that the client noted again his non-operable back pain was a “10”. One can imagine how this client’s credibility may have been negatively impacted by this statement.