Pain Scores: are they damaging us?

Are ‘Pain’ scores damaging the public’s health!

person in pain

Ever been asked to score your pain out of 10?

Ever been asked to describe your pain and even draw a picture of where it is?

Ever wondered why?

We are taught to believe that a description of our pain and its intensity will help us to find out what’s wrong. This approach has grown in popularity, in part fuelled by a trend in cultural expectations that we should be pain free. In part driven by commercial practice that attempts to sell a ‘pain free’ lifestyle. It is both tempting and financially lucrative.

So does this approach work?

No. The number of people with long term pain is rising, mental ill health associated with pain is rising, the financial cost for the management of long-term pain is increasing and the health of the nation is decreasing. 

So why is it that a standard medical consultation spends time discussing a persons experience of pain and how it affects them?

There are several reasons, the key ones include:

  • All NHS contracts in orthopaedics stipulate that outcome measures based on pain scores are put in place as part of service contracts. Consequently, the clinicians have to ask and patients have to score high in order to gain access to care.
  • It is cheaper to talk about pain than it is to investigate.
  • Many clinicians are taught to ask about pain and there is trend in becoming more empathetic as opposed to diagnostic. ‘How do feel’ has gained priority over ‘this is what’s wrong’. 

Is this pain discussion really that bad?

At its current level, yes. As a consequence of our focus on ‘pain’, our time and financial resources are being spent on ‘pain’ driven pathways instead of appropriate investigation and medical intervention. The focus on ‘pain’ is like having focus on the noise a fire alarm makes. The alarm is not the real problem, the alarm is a warning. It is the resultant investigation that determines if there is a problem and if so, where it is and how big it is.

Side note: Veterinary practitioners have the luxury of avoiding the whole pain score and pain discussion because animals don’t speak. Veterinary clinics have ultrasound scans, x-rays, some even have MRI’s. Many have blood laboratories on site and as a result our pet animals have immediate focus on ‘what is wrong’. 

So, if we don’t measure ‘pain’ what should we measure?

With regard to muscle and joint pain we should investigate and measure mechanical strength, alignment and movement patterns. We should observe the true status of tissues and look for tears, ruptures, levels of degeneration and damage. We should measure chemistry to ensure our blood, hormone and endocrine systems are normal and check our temperature. 

The image (on the right) shows a partial tear to a patients rotator cuff tendon. The left image is normal. This person had several treatments and discussions about their pain before visiting InjectionClinic. Once we established a diagnosis treatment could then focus on the condition, not just the ‘pain’ experience.
rotator cuff tear ultrasound scanFollowing investigation we should also acknowledge ‘normal’ findings as a process of exclusion. We should understand that not all pain arises because of damaged tissue, pain can occur because of irritation without damage. Most back pain for example occurs because of poor posture and patterns of movement, not medical pathology. We should therefore measure our improvements in mechanical and chemical terms if we really want to improve our health. The ‘pain alarm’ will then turn itself off.

Is it really that simple?

Yes and no. Yes, because best mechanical function and best chemistry are key to making us healthy.

No, because nationally this would require a significant shift in financial resources and a change in the current model of healthcare. We would need frontline clinicians with appropriate diagnostic skills, the time to diagnose and access to investigations.

It is however simple on an individual level, because it is easier for one person to elicit change than a national organisation.

If you are in pain but don’t know what tissues are damaged or irritated, then a physical examination enhanced by ultrasound is a great place to start. It costs £75.

Book your initial consultation including ultrasound scan

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