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

12 thoughts on “Newer Pain Scale for the Military

  1. Flutterby

    I would like to know who those patients are as well, unless they’re saying, “Well, my pain is reduced, but I still can’t put my prosthetic leg on.” That I can understand. Seems like the rest of what the doctor said comes from a PROP flyer. 🤦

    Liked by 1 person

        1. Zyp Czyk Post author

          It’s outrageous that they would deny pain meds even in the case of cancer – it’s like we’re back in the Middle Ages and being told to use “herbs” or “prayer” to heal ourselves.


            1. Flutterby

              Whoops! Cut myself off there… Then they found a spot on my sternum and possibly my liver, so they did a PET scan. That found all of the above plus a left rib, right iliac, and right femur.
              Mind you, the last three were found after the bone scan, so it could be on the bone and not in it? I don’t know – my mind is still reeling.

              Liked by 1 person

            2. Zyp Czyk Post author

              This must be so disorienting, having your life change so dramatically overnight without warning. And yet, your body is essentially the same as before you found all these problems – the only difference is what you now know. What a terrible gut-punch life has thrown at you.


  2. leejcaroll

    This reminds of those fighting to use CDC guidelines as official rule. They tend to use the anecdote fo the person who had a pain situation and was legitimately prescribed opoids and then became addicted, went to the street/died. They give the anecdote of the few who say they cant function better. There are a number oof reasons this could be so including malingerers, fakers but it is not the vast majority but citing the few helps the cause. Referring to the many hinders it

    Liked by 1 person

    1. Zyp Czyk Post author

      Yes, they must be using a few very odd anecdotal reports of “pain improved after stopping opioids” to bolster the anti opioid cause, because the other 99.9% of patients are helped by opioids.

      Liked by 1 person


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