Overview

Have you ever been in pain? None of you, I’m sure, would say a no.

Pain is certain in one’s life. It is a feeling of distress rooting from the nervous system in response to damaging stimuli. The brain triggers the pain response when something hurts our body. Pain is always multidimensional with emotional consequences entwined in it.

A pain could be dull, aching, pinching, or shooting depending upon disease or the injury occurring to the body. It is the common symptom in most diseases and is the most common reason for people visiting their physician.

Let’s first dive into the different types of pain for your better understanding of the context.

Types of Pain

The following are the common types of pain. However, some pain can fit into more than one category.

According to the duration, pain can be classified as acute, chronic, and breakthrough pain.

  1. Acute pain

Acute pain refers to short-term pain that arises from a specific reason. It may last for few minutes to six months (sometimes up to six months). Acute pain is normally associated with soft tissue injury. There are chances for acute pain to become chronic pain. The most common causes for acute pain include bone fractures, surgery, childbirth, cuts, and burns. Usually, an acute pain would subside as the injury heals.

  1. Chronic pain

When the pain persists even after six months it is called chronic pain.  Chronic pain may last even for years. A headache could be considered chronic pain if it lasts for more than six months. Chronic pain is often found to interfere with the day-to-day activities of an individual thereby affecting the quality of his life. Health issues like arthritis, fibromyalgia, or a spine condition could be the underlying reasons for chronic pain. 

  1. Breakthrough pain

 If a person is under analgesic medication for chronic pain, he may experience episodes of acute pain in between the medication period. This is called breakthrough pain.

According to the root cause, pain can be categorized as follows.

  1. Neuropathic pain

Neuropathic pain occurs due to any damage in the nerves or other parts of the nervous system. It is often a sharp, shooting pain that is intense when compared to other types of pain. 

  1. Radicular pain

It is the pain caused due to the compression or inflammation of the sensory root or the dorsal root ganglion (DRG) of a spinal nerve. Radicular pain is characterized by tingling, numbness, and muscle weakness. When the pain radiates from the back into the leg, it is called radiculopathy. It’s commonly known as sciatica. Activities like walking and sitting can make sciatica worse.

  1. Nociceptive pain

Nociceptive pain is a sharp, achy, or throbbing pain caused by the stimulation of nociceptive receptors in response to harmful stimuli. It is usually confined to a particular area in the body. The pain is usually associated with external injuries and may worsen with certain activities. Nociceptive pain can be both acute and chronic.

Whatever the type it would be, pain is subjective and every human being responds to it differently. Your tolerance to pain may be high. But my tolerance to the same pain may below.

Here is the reason for that.

An external pain signal is received by the pain receptors in our body which is then taken to the brain. The response of the pain receptors to the pain stimuli and the pathways which take these signals to the brain would be different for each individual. This makes the pain threshold and tolerance differ from one person to the other.

Let’s have a look at the theory which answers more on pain perception.

Gate Control Theory of Pain

This theory was put forward by Ronald Melzack and Patrick Wall. It states that the external stimuli are received by sensory receptors called nociceptors which are transformed into pain signals. These signals are carried through nerve fibers which reach the dorsal horn of the spinal cord and from there it reaches the brain. Pain signals travel via small nerve fibers whereas skin senses are sent by large nerve fibers.

As per the Gate control theory, a neurological gate is present in the spinal cord which is responsible for allowing the signals to the brain. In case of pain, if the signals are passed actively it would result in intense pain or else we would feel minimal pain.

Have you ever wondered why rubbing or massaging an injury site makes us feel good?

The massaging stimulus is allowed to reach the brain where the pain stimulus is minimized or blocked from reaching the brain. 

How terrible is your pain?

I know it’s not a good inquest. But it plays a crucial role when it comes to pain assessment. It would help physicians in diagnosing the disease, to opt for a treatment strategy, and also attorneys in insurance claims and personal injury lawsuits.

A physical injury is visible and could be easily evaluated by the physician. But when it comes to the pain related to injury, no one can understand what you are going through. It’s not easy for a patient to describe the pain in words for the physician to calculate it.

Assessing pain is always a hard mountain to climb.

Here, the concept of ‘Pain Scale’ comes to rescue

A pain scale is a tool used by physicians to assess the intensity of pain in a patient. It helps to improve communication between healthcare providers and patients.  Assessment of pain could be based on self-report, behavioral, or physiological data depending upon the type of pain scale used. Using the pain scale, the patient reports the severity of his pain with the help of a physician, medical professional, or a parent.

Implications of Pain Scale

The pain scale is used

  • To diagnose a disease or a condition
  • To assess the success and progression of a treatment
  • In insurance claims
  • In personal injury lawsuits

 Types of Pain Scale

 The following are the type of pain scales commonly used in pain assessment

pain-scale

  1. Numerical rating scales (NRS)

 The numerical pain scale is the most frequently used pain scale and is ideal for individuals above 9 years of age. It measures pain on a scale from 0 to 10. The patient can select a number verbally or mark a number that he finds would reflect the intensity of pain he is going through. The basic idea behind this scale is that zero indicates no pain and 10 represents the most intense pain possible.

A Study indicates that for adults with no cognitive impairments, a numerical rating scale is the easiest pain assessment method.

  1. Visual analog scales (VAS)

 A visual analog pain scale categorizes pain along a 10-centimeter horizontal line, ranging from “no pain,” to “the worst imaginable pain.” The patient is asked to mark a spot or X in the line to indicate the pain intensity. The physician would calculate the pain score by measuring the line with a ruler.

The advantage of a visual analog scale is that it helps to assess the pain more precisely. However, it is not useful for individuals with cognitive issues.

  1. Verbal Rating Scale

 The verbal rating scale is a scale with markings like “no pain”, “mild”, “moderate pain”, “severe pain”, “very severe pain “to “worst imaginable pain”. It makes it easy for the patient to mark the severity of his pain very effectively. 

  1. Wong-Baker Faces Pain Scale

Wong-Baker Pain Scale with faces uses a combination of pictures and numbers for assessing pain. It involves six faces depicting different expressions. Each face is assigned a number that ranges from 0 to 10.

It is the most effective pain scale for children over the age of 3. Children can easily relate their pain with any of the faces shown in the pain scale. It is reported to be an effective pain assessment method in adults also.

  1. FLACC Pain Scale

It is a pain scale for infants and adults who are unable to communicate verbally. FLACC scale is based on observations of five criteria named: face, legs, activity, crying, and consolability.

Each criterion is assigned a score of 0, 1 or 2.

0: Relaxed and comfortable

1 to 3: Mild discomfort

4 to 6: Moderate pain

7 to 10: Severe discomfort/pain

Periodic analysis of the pain score would help the physician can get an idea about the pain status of the patient.

Proving Physical Pain and Suffering in a Personal Injury Lawsuit 

Physical pain and suffering is one of the claimable damages in a personal injury lawsuit. The most common method to prove physical pain and suffering is through medical records and photographs of injury.

There is no fixed guideline or payout for the pain, an injury survivor has endured. However, settlement may vary depending upon the type of personal injury, medical costs, impact of the injury etc. In this context, the severity and the impact of the injury could be directly assessed by the pain scale assessment of the plaintiff.

Pain Assessment in Personal Injury Using a Pain Scale

 Before pain assessment with a pain scale, it is important for the patient to bear in mind the application of the data derived from the process. When related to a personal injury lawsuit or insurance claim, a pain assessment report could turn out very crucial.

Pain scale assessment would establish the credibility of the plaintiff in a personal injury lawsuit. The assessment report would be included in the claimant’s medical record which could act as proof in his personal injury claim. Pain assessment report would reflect the impact of the injury in the victim’s Activities of Daily Living (ADL). It is also possible that the pain assessment can affect the injury claim negatively when there is a contradiction or bias in the pain description process.

Pain and Suffering Chart

It is an interactive report in a medical record review that provides data on the pain, suffering, and damages suffered by the victim after an injury. Medical record reviews done by expert medical record review companies help the personal injury attorneys in analyzing the severity of the injury and its impact on the claimants’ life.

Pain and suffering chart prepared by skilled medical professionals would aid in determining the extent of the claimant’s injury and suffering. Pain and suffering chart has the potential to act as medical evidence in insurance claiming and personal injury lawsuits.

Pain and suffering chart in a medical record review would accommodate the following data on

  • Date of service
  • Name of the service provider
  • Pain complaints of the victim- location, type of pain and pain scale assessment
  • Pain medication – dosage and frequency of medication
  • Treatment plan
  • Prognosis
  • PDF/ Bates reference

Guidelines for Plaintiffs Using Pain Scale

The following are the tips that would help a plaintiff to describe his pain in a personal injury claim.

  • Do not hide details about the pain from your physician. It’s not just about the claim, but for better treatment too.
  • Never exaggerate your pain and rate it higher thinking that it would help you in a better payout.
  • Always be consistent and truthful when describing the pain.
  • Do not give a contradictory pain scale rating to the physician and the insurance company.
  • Any confusion while describing the pain with a pain scale should be cleared with your physician or medical staff.
  • In case of personal injury claims of children, the child should be accompanied by a parent while doing a pain assessment.
  • Never be influenced by the doctor or the medical staff while assessing the pain in a pain scale.
  • Always describe the pain in words along with a numerical, or pictorial pain scale description.
  • Always keep in mind that the pain scale assessment would be recorded in your medical charts and used in the lawsuit.

Final Thoughts

 The pain scale is undoubtedly a greater tool to assess the intensity of pain in patients suffering from a personal injury. As discussed above, pain being a subjective cannot be assessed up to the mark. An individual’s 10 on the pain scale would be another individual’s 5. It all depends upon the person’s pain threshold and tolerance limits. When it comes to claiming pain and suffering damages in a personal injury lawsuit, a pain scale could be relied upon along with other strategies like pain and suffering calculators used by personal injury attorneys.

Before pain assessment with any type of pain scale, the plaintiff should be educated about the importance of pain assessment data in his personal injury claim. This would encourage the injury victim to provide an unbiased pain description.