Pain scores not a reliable gauge of what treatment patients will seek

LETTER — Posted Aug. 21, 2006

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Regarding "Pain questions not leading to better control" (Article, June 26): I read with interest your front page article on pain scores. No surprises here.

As an ED doc I've found the documentation of pain scores not to help much, as acute pain complaints are the reason for over one-third of ED visits, I would estimate. That pain gets addressed, at least in our department.

It's also, however, very subjective. Chronic pain patients with exacerbations are essentially beyond the realm of emergency medicine and get treated like acute pain. Their subjective evaluation of their pain is even more unreliable.

I recently read that about 42% of Americans live with some type of chronic, recurrent or daily pain. When I read this, I realized that my own aging back would rate a 3 on a pain scale every day, and some mornings probably a 5. But on the really bad days I take a couple Aleve and go to work.

There is also no correlation between pain scores and apparent need for treatment of that pain. I certainly see patients every day with pain scores of 8 who say 'No, I don't need anything.' Even patients with renal colic have told me that. Others, with a pain score of 3, are demanding a shot of Dilaudid, sometimes for a 1 cm finger laceration.

Chuck Pilcher, MD, Kirkland, Wash.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/08/21/edlt0821.htm.

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