What Is The Best Use Of The Visual Analog Pain Scale?

For over 15 years, and probably longer, the visual analog pain scale of zero to ten, is, in my observation, both a valuable and misleading metric in medicine. For those, who read my blog regularly, you know that I rely on keeping this pain scale between zero and two for patients in my rehabilitation programs. In my experience, it is in the zero to two range out of 10 that I am confident that the patient is most likely not causing any further injury or harm, and most of the time the injured tissue is allowed to heal. I try to prescribe treatment with the goal of reducing the pain level to zero to two as quickly as possible, and hold it there until they are back to complete function.

There are many visual representations available of this pain scale that illustrate where I advise patients of the area to try to function within. In my experience, as the pain gets into the next level of three to four, the situation goes from tolerable to distressing.

Yet, to ask a patient what their pain level is, is really asking them to do the impossible at times. Pain levels vary during the day due to many factors, so I personally think we need to gather this information at a minimum of five points during the average day to adequately assess. These points may be: first thing in the morning; during the morning; as the day goes on; with exercise; and after exercise. This level of detail can become very complicated during an office visit.

In our physical therapy department at St. Francis Memorial Hospital in San Francisco, they always ask the patient how they feel before, during and after the treatment session. The goal, of course, is for the patient to feel better; in other words, to have their pain go from, say five to three during the session. What does this have to do with anything? I think that, if you are really trying to rehabilitate a patient, that you should know more than just the average amount of pain they experienced during that day.

It makes sense to me to take a closer look at the convention of the visual analog pain scale and really apply it to the patient experience. Is it really serving us properly for our goals? It is setting reasonable and achievable expectations for our patients? What can we do to make this metric more meaningful in our assessments and treatment plans?

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com. 

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.