Newer Pain Scale for the Military

New DoD Pain Scale Focuses on Function in Addition to Intensity – Sep 2019

This pain scale isn’t actually new – I posted it back in Oct 2017: Defense & Veterans Pain Rating Scale. What’s new is only the increased focus on the functional descriptors below each rating.

In case you can’t read the descriptions, I’ve written them out below:

1. Hardly notice pain
2. Notice pain, does not interfere with activities
3. Sometimes distracts me
4. Distract me, can do usual activities
5. Interrupts some activities
6. Hard to ignore, avoid usual activities
7. Focus of attention, prevents doing daily activities
8. Awful, hard to do anything
9. Can’t bear the pain, unable to do anything
10. As bad as it could be, nothing else matters

The Department of Defense launched a pain rating scale for use in hospitals it believes improves upon older pain assessment techniques, by measuring not only the intensity of pain but also its effect on daily function. 

The Defense and Veterans Pain Rating Scale combines a 0 to 10 pain scale with facial expressions and colors to express pain intensity (Figure). It also includes supplementary questions to determine the effects of pain on a patient’s daily functions such as activity, sleep, mood and stress.

“This is a cultural change that we’re bringing, not only to our patients but also to ourselves as clinicians,” said Chester Buckenmaier III, MD

“The goal of pain management isn’t exactly getting pain down to zero, but optimizing both physical and emotional function.”

Dr. Buckenmaier explained that previously, doctors focused primarily on lowering pain intensity, which often resulted in the prescription of opioids. Although these medications are helpful in curbing pain severity, they do not tend to improve functionality. 

“This is what our patients are telling us,” Dr. Buckenmaier said. “When they became dependent on these medications and their daily functions are actually disturbed, they came back and told us that we need to do something different.”

I want to know who these patients are that are saying that even though their pain levels are down, they are still no more functional. That doesn’t even make sense to me.

When my pain is relieved, it feels like the lead blanket I’ven been under is lifted, I get energy and my motivation comes back and I’m motivated to do all the activities I need to do and even some that I want to do.

My pain relief would be wasted if I didn’t use that time to do all the things my pain usually prevents me from doing.

While treatment steps after diagnosis are important, the initial pain assessment is also integral to properly treat and manage pain. So Dr. Buckenmaier emphasizes communication and education between patients and health care providers.

“It’s far more than just asking the patient about pain. It’s helping the patient understand what the goals are in their therapy and understand what pain management actually looks like.”

-Based on a press release from the Military Systems