Richard Rathe, MD

Associate Professor of Family Medicine (ret.) and Medical Informatician
22
Jun


An Alternative Symptom Score to Replace the Overused 10 Point Pain Scale

By •• Posted in HPI, Medicine

I was taught in medical school that pain scores were only useful for tracking progression/remission for individual patients. In my opinion it was a fundamental mistake to apply this tool as an objective “vital sign” across all patients. It simply doesn’t work that way. Scores remove context!

During my training we used an implicit 3 point scale: mild, moderate, severe. In later years I pondered why I still preferred this over the newer 10pt version. I decided it was because a 3pt scale is easy to tie to function: mild=annoying, mod=disruptive, severe=disabling.

I think the average patient views their condition in similar terms, rather than “my pain a 6 or a 7 out of 10.”

If you take the 3pt functional symptom scale and couple it with a 3pt frequency scale: intermittent, frequent, constant—then you have a 3×3 grid that might be more meaningful than a one dimensional 10pt scale.

3x3-symptom-scale

It may be appropriate to record more than one score, for example: the patient has constant mild dizziness (3/1) with occasional disabling episodes (1/3).

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