What’s the score in pain assessment?

Carl von Baeyer explores realistic pain assessment when self-report conflicts with observation and context

Self-report measures of pain intensity provide important primary outcomes in randomised trials of pain-relieving interventions. Scores from numerical, visual analogue, and other scales serve well in comparing group outcomes.1 But in the context of individual clinical treatment, certain catchphrases are commonly employed. Self-report of pain is “the gold standard”. Pain intensity scores are “the fifth vital sign”. Analgesic decisions are sometimes based on an “algorithm” that includes self-report of pain. Although such concepts help to draw attention to pain management, each one contributes to oversimplification of the process of assessing pain.