On a Scale from 1 to 10 – Measuring Subjective Pain

In workers’ compensation, it’s absolutely crucial to correctly detail the workers’ subjective residuals of their injury. This is because measuring objective factors like a limited range of motion are less tangible than concepts like pain, and aren’t always an accurate account of the extent that the injury affects the patient’s day-to-day life.

How bad does it hurt?

A physician will usually use the visual analog scale (VAS) to assess the pain of the patient’s injury. When a doctor asks a patient “How much does this hurt on a scale of one to ten”, they are using the VAS. This is an effective and reliable method on accounting for pain, as the patient is given a range of 0, which is no pain, to 10 which is intolerable agony and/or symptoms that limit the patient from all functions

To illustrate the weight that the patient’s pain has on the impairment, the AMA Guides 5th Edition to the Evaluation of Permanent Impairment (The Guides) recognizes “pain” as a direct manifestation of impairment. This means that impairment takes precedence over objective findings in reports. The AMA Guides states: “an impairment can be manifest objectively, for example, by fracture, and/or subjectively, through fatigue and pain.” (The Guides Page) This means that the insurance adjuster, judge or DEU will be looking (or should be looking) for consistencies (and inconsistencies) between the objective and subjective findings.

The Guides Chapter 18 Pain concerns itself with the concept of “pain”, and the corresponding levels of pain as it impacts activities of daily living (ADL) function. On page 575 Table 18-3 pain is placed into four formal classes or categories: Mild, Moderate, Moderately Severe, and Severe. The basic pain ranges are described on the ability to perform or not perform a function. Therefore, mild pain is a score between 1-4 out of 10 and moderate pain begins at five and extends to 8 out of 10 when applying the principles of interpolation of the text (The Guides page 20). It is important to note, moderate is the threshold for pain (symptoms) that begins to limit or cause difficulty managing an ADL. Pain scores of 9 and 10 are classified as Moderately Severe and Severe. These levels of pain result in a functional loss of ADLs with “substantial modification“ or must “get help from others for mini activities of daily living.

How often does it hurt?

To add to the intensity of the pain, the physician must also consider the frequency of the pain. A patient who describes their pain as 8 on the VAS will be having a much different experience whether they are in pain constantly, or if they are only affected by their injury symptoms at night. This will also affect the outcome of the impairment rating. While the intensity of pain is measured using the VAS, the frequency is measured in percentages of 25% (occasional), 50% (intermittent), 75% (frequent), and 100% (constant). If you imagine graphing the pain frequency and pain intensity as the x and y axes on a graph respectively, you can visualize the overall value of the pain experienced by the patient.

Conclusion

In conclusion by considering the intensity of a patient’s pain using the VAS (scale of 1 – 10), in conjunction with the frequency of their pain in increments of 25%, all stakeholdershave a fairly rounded idea of the scope of the injury, allowing the claim to go more smoothly.

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