AN APPROACH TO PAIN SCORING

Our hospital uses a hybrid of a numeric rating scale that is dynamic and interactive. The patient's pain is scored on a 0 to 10 scale—0 being no pain and 10 being the worst possible pain that might be expected for that specific procedure. Taking the type of procedure performed into consideration has improved pain scoring predictability,^3,4 since the worst possible pain for an ovariohysterectomy (for example) will be much different (less) than the worst possible pain for limb amputation. The technique uses

1. Observation of the patient before any interaction

3. Palpation of the painful site.

This technique uses the totality of the observer's experience and patient's signs to render the score. It is important that, whenever possible, the same individual—one familiar with the patient's personality before the surgery—score the patient throughout the entire postoperative period to diminish interobserver variation.

For example, a patient that has undergone a 2-cm laceration repair and, three hours postoperatively, is guarding the surgery site and flinches when it is palpated may receive a score of 6/10. This is an unusual amount of pain given the relatively minimal tissue damage and inflammation and the fact that, with a local block, one could realistically expect the site to be completely pain-free (numb with a pain score of 0/10). But a cat that has undergone a fracture repair and, 12 hours postoperatively, is 60% weightbearing and withdraws slightly when the limb is palpated but yet exhibits few other signs of discomfort might receive only a 4/10 since this procedure involves significant trauma and inflammation and there is no expectation that the patient will be 100% weightbearing or pain-free. However, both of these patients might benefit by added pain management intervention.

A prime issue, of course, may not be the actual number (i.e. whether it is 2/10 vs. 3/10), but rather the trend in the number as the observer (usually a technician) monitors over time. If the pain score appears to be increasing, additional intervention would be warranted, and after intervention, the pain score should decrease.

It is important to note that this scoring system is not scientifically validated and it is not linear (i.e. a score of 6/10 is not necessarily twice as painful as a 3/10). However, it is an easy, rapid adaptation of basic behavior-based principles described by a number of authors.