Bioethics Blogs

It is Time to Ditch Pain Scales

Western medicine is in large part based on objective evidence. If you can’t see, touch, taste or weigh it, it simply does not exist. Unfortunately, pain is subjective, with no “litmus test.” Each individual’s pain experience may vary depending on one’s genes, culture and/or world view, including religious beliefs.

Pain scales were an attempt by well-meaning people to address this problem. The idea was that if a mechanism were devised to make pain more comprehensible, less subjective, not quite so “slippery,” people with pain would get better care. And, at the same time, those who care for them could be more confident that they were doing the right thing when prescribing medications that have serious side effects, including addiction and unintended death. Pain scales also helped assure providers that they were treating people fairly — without regard to age, race, ethnicity, etc. – so that a person with a pain score of seven would be treated like any other person with a pain score of a seven.
Unfortunately, this grand experiment has not worked.

Although today pain is assessed far more often than it was before pain was labeled the 5th Vital Sign and pain scales were devised, there is significant evidence that pain care is no better than before.

On March 30, an article by Amy Dockser Marcus appeared in the Wall Street Journal titled, “In search of a better definition of pain.” In it, Tamara Michael, a 45-year old women who lives with chronic pain due to Multiple Sclerosis, describes work she has done with a group of researchers to come up with a better way to assess patients’ needs for pain control.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.