What this is: A discussion about using the Pain Scale
- Ask the question the same way
- Explain it the same way to each patient
“Given the opioid crisis and [EAMP]’s ability to treat pain, we as a profession need to consistently document patient pain levels. And, of course, this is what L&I as well as most health insurance plans will pay for!” --Lisa Taylor-Swanson, Advisor, WEAMA L&I Committee
- Pain level is a vital sign. Patients are coming in with a symptom of "pain", you measure pain.
- Since you are already measuring it, use a validated tool.
- Using a validated tool in your chart note template makes it consistent for your use and measurement.
- When all practitioners in a program or clinic use the same tool and are using it in the same way, the tool becomes as consistent as that ruler when measuring change.
- So, if some day in the future, say 2-5 years from now, your clinic or program does a retrospective data pull, looking at metrics collected in your chart notes, the validated tools you and your colleagues used would be useful data points for measuring change.
When you ask your patient, “How is your pain today?”, have a copy of the DVPRS nearby. You can have a copy of it on your computer or printed and laminated as a visual tool in your treatment room—whichever helps you in your quest to use it consistently with every patient and every treatment.
- So, go here to print a copy of the DVPRS for yourself and your treatment space: The DVPRS tool, both sides, with concise instructions
- I like to print it in color on paper with the visual scale on one side and the biopsychosocial quick questions on the back side and then laminate the double-sided tool.
- If you want to print just one side at a time, without instructions, here is the front side and the back side.
- hand the DVPRS visual tool to your patient to review and give you a descriptive answer.
- The back side, the 4 questions (activity, sleep, mood, and stress) are there to prompt the practitioner to ask how the pain affects those aspects of life.
For example, you have treated Ann who has mechanical low back pain with a course of acupuncture at 2 tx/week for 8 weeks and you measured, at specific points in treatment (initial, mid-tx re-evaluation, and discharge/re-evaluation), not just her pain level (DVPRS), but also her MEQ (during medication review), range of motion of the low back, and a functional questionnaire (ODI). At initial visit, her pain level was 8/10, MEQ was 70, ODI was 85% and she was not able to work due to the pain. At the discharge visit, her pain level was 3/10 with no flare-ups for past 2 weeks, MEQ is 0, ROM has improved 30%, and ODI is 20% and she will be starting work tomorrow.
This combination of metrics shows:
- her pain decreased
- her function has improved, and
- she is no longer dependent on opioid-based medications for pain relief or basic function
So, because you used this combination of metrics, you are able to demonstrate to both the referring provider (or program director, department head, etc) that your clinical work has been clinically significant (30% or greater change in numbers) and it has been cost-effective. This patient, who is returning to her same job with no restrictions and good functional recovery, now has no or minimal long-term disability risks.
Review: Using this combination of metrics, DVPRS + MEQ, is essential to be able to measure-ably demonstrate your patient care is clinically significant and cost-effective.
copyright Megan Kingsley Gale
Want to learn more about how to use this Pain Scale as a metric in your clinic's patient outcome measures toolkit? Take our new mini-course, "How to use a validated pain scale in your Chart note". It contains this post as a download-able pdf, some simple templates you may use for recording this tool in your chart note, as well as videos that walk you through how to use it, and information to dive deeper into related resources.
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An 8-minute video overview of the history behind the DVPRS and why to use it.
Research, DVPRS validation study
Research paper citation on history and usefulness of the older pain scales: Visual Analog Scale (VAS), Graphic Rating Scale (GRS), and Numeric Rating Scale (NRS)
Calculating Morphine Equivalent Dose (MEQ)
Medication Review and Review of Symptoms: Side Effects of Opioid Meds
Joint Commission Pain Management Standard 2017 clarification
The White Paper 2017: Acupuncture's Role in Solving the Opioid Epidemic
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