Too often, certain measures are thought to be easily rated on scales that are inaccurate and simplistic.

Pain can fracture a person’s life in terms of their mental and physical well-being, just as an auto accident can change everything. Individuals in pain haven’t received the care and attention they require because too many in healthcare adhere to the “medication-seeking” myth that is so common. If they provided adequate relief, wouldn’t the patient become addicted, and if they became an addict, wouldn’t they be seeking pain-relieving medications without genuine pain?

It happened in my family until we found an oncologist who understood what was needed. If you’re at death’s door, what does addiction mean? Relief is the only acceptable solution.

According to research, between 3% and 19% of people who got painkillers from a healthcare professional became addicted to them. It is not the rampant medication-seeking torrent of fake painkiller seekers the professionals thought existed.

It was a nasty, convoluted mental process, with lawsuits thrown into the mix because patients died. Some died after taking too much medication because their prescription didn't adequately relieve them or because their life circumstances had led to depression.

Either way, it was a lose-lose proposition, but pharmaceutical companies saw a shining light of profit if they promoted pain solutions, which added to the problems. Selling pain as a disease proved to garner billions in profits worldwide, and the infamous pain pill mills began sprouting up all over the country.

Anyone writing a prescription could make millions a year in income and leave their conscience in a desk drawer. After many years and many deaths, a settlement was reached with companies that were involved in selling opioids.

The realization that pain was not getting enough attention and was not being taken seriously dawned on healthcare professionals. People had long said, “Just take it, deal with it,” even after surgery. Doctors were very careful with opioids.

A friend, after serious, painful spinal surgery, had an older physician (the pain specialist) cut her medication off and say she needed aspirin or some OTC medication. She needed more potent medication, and it took a nurse practitioner to see it. The older psychiatrist/neurologist was, as she said, “old school” of the “she’ll become an addict” if treated. She didn’t become an addict with treatment.

How Is Pain Rated?

The questionable pain rating commonly used spread like wildfire all over the country. That’s because the American attitude toward pain changed in the early 2000s. From 0 to 10 was not new. Finding direct ways to check on patients’ pain and talk about it with them was another area where nursing had made progress before the year 2000. That being said, the 0 to 10 method became more common. After all, numbers can speak to everyone—not so much pain.

At first, there was a verbal scale with four levels: no pain, mild pain, moderate pain, and serious pain. One common analog scale had just one horizontal line that showed a range of pain or mood, with 0 (no pain) at one end and 10 (worst pain) at the other. The patient would make a mark on this to show where they fell. Is this reasonable?

Historically, the consideration of pain in medical education was abysmal. In 1983, researchers looked at 17 standard textbooks on surgery, medicine, and cancer. Out of the 22,000 pages in the books, only 54 pages discussed pain. Half of the books did not discuss pain at all. But one physician made at attempt at remedying the situation. Dr. Raymond Houde developed the Memorial Pain Assessment Card. He is known for creating many of the pain scores we use today. But pain rating remains elusive.

Nobel Prize winners in physiology or medicine in 2021 were scientists who figured out the mechanism for feeling cold and hot. But pain is a monster with many avenues that contribute to it. But a new assessment has been developed that may address this complex action.

The Department of Defense pain management task force developed the DVPRS, which combines several previously validated and familiar pain assessment tools with some important additions.

The DVPRS incorporates functional descriptions for each of the 0–10 pain levels so that successful pain management is also tied to improved function rather than simply getting pain to zero.

The scale also includes an assessment of the patient-reported impact of pain on four specific quality-of-life indicators: activity, sleep, mood, and stress. This provides clinicians with a deeper understanding of the patient’s pain condition and a better way to measure the progress and effectiveness of pain management treatments.

The question remains whether this new scale will be incorporated into healthcare as a general measure of pain in any patient. It would seem a new day for pain management may have arrived, but to ensure its dissemination, it needs to impress professionals in the field before it will become readily available.