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My name is Allison and I am a registered nurse. I am going to be writing a weekly blog called “Off The Charts.” This will be a nursing based blog that covers all aspects of the healthcare system. I have the education, knowledge, experience and expertise to write this blog.

After graduating from High School, I received my Bachelor’s s of Science in Business Administration with a Major in Marketing and a Minor in Communications.

I began my career in the business world, selling medical services to nursing homes as well as business services to companies. I realized that sales weren’t fulfilling my desire to help people or making a difference in their lives. I decided to take a leap of faith and make a change in my career.
In 2009 I graduated from Nursing School. I began working in the Pediatric Intensive Care Unit at Children’s Hospital.

After working for many years in the Pediatric Intensive Care Unit, I began to have my own health problems. I had 8 surgeries, spent 6 months confined to a hospital bed and the next 3 years unable to walk. I have the ability to speak not only as an ICU Registered Nurse, but also as a patient.

I also have an enormous amount of experience in substance abuse. This is so prevalent in today’s society. Does the exposure to medication given in the health care system set people up for misuse of prescription medications and other chemical substances?

I welcome any topics, questions, or comments. Thank you for allowing me to share my experiences w you.

  If I asked you to name the 10 most common reasons individuals seek medical care or treatment, do you think you could identify all 10?  

According to a study done by the Mayo Clinic, the top 10 reasons people in the United States go to their doctor are depicted below. 

Skin Disorders

Joint Pain & Osteoarthritis 

Back Pain

Anxiety, Depression, & Bipolar Disorders

Chronic Neurology Disorders 

Head aches and Migraines 

Upper Respiratory Problems (not including Asthma)

High Blood Pressure 


Cholesterol Problems

What fascinates me when I look at the list above, at least half of the most common reasons individuals seek medical care and/or treatment involves some type of pain: 

Physical Pain or Mental Pain

That number is even higher if these conditions in the above chart go untreated. 

I decided to make this blog about pain because it’s something that almost all of us have dealt with personally or know someone who experiences pain in their everyday lives. According to the the National Pain Advocacy Center, “one out of six people wake up in pain daily. 40 million Americans have severe pain, and nearly 20 million Americans have pain so often that it regularly prevents life and work activity”.

Pain is subjective which means even if two people have the same injury, diagnosis, or even the same surgery, the pain they experience is unique to them. For example two patients have a hip replacement. Both patients have pain after the surgery and one patient reports the pain to be a three out of ten and the other patient reports the pain to be an eight out of ten. Neither patient is wrong in regards to their pain rating.

Every person handles pain differently which makes pain also individualized

In this example the patients reporting their pain to be a three out of ten have a higher pain tolerance than the patients reporting their pain to be an eight out of ten.

A higher pain tolerance is not necessarily a good thing

This could mean that some patients have had more painful experiences throughout their lives. If a patient says that he or she is experiencing any type of pain, then the responsibility of that person's doctor is to diagnose a reason for the pain and then to treat the pain, even if the doctor doesn’t believe the patient has pain. 

The definition of pain is-a signal in our nervous system that something may be wrong. It is an unpleasant feeling such as a prick, burn, or ache. Pain may be sharp or dull, it may come and go, or it may be constant. Pain may reside in one area of your body like your hip, or abdomen, or you may feel pain all over your body. 

The scientific explanation of pain is the result of complex brain processes which are influenced by, overlapping physical (nociceptive and neuropathic) physiological and environmental factors. 

There are two types of Physical Pain. These are Nociceptive Pain & Neuropathic Pain


  • Nociceptive Pain-nociceptive is caused by damage to body tissue. This type of pain feels sharp, achy, & throbbing. This type of pain is an external injury like stubbing your toe, spraining an ankle, or having a sports injury. 
  • Neuropathic Pain-is referred to as nerve pain. This pain is usually from a health condition that affects the nerves that carry sensations of pain to your brain, or the brain itself. Nerve pain can affect any nerve in your body and it feels different than other types of pain. This usually feels like a shooting, stabbing or burning sensation.

          Most people believe pain is the result from physical injury or disease,


psychological factors play a huge role in pain perception.

Pain is tied to brain functions that govern behavior and decision making.

When looking into the psychological aspect of pain, factors such as a reward, punishment, fear, stress, & mood alter perceived pain and intensity and affect our choices.

Why is pain so important in our lives? 

Pain is like our built in alarm system that something is wrong in our bodies. Pain is essential for survival because it also protects us from doing something to harm ourselves. For example if you come across a hot stove top, you feel the sensation of heat, and our brain knows if we touch that hot stove, pain will follow. 

Where does pain come from? 

There are specific pain receptors in our bodies which are called  nerve endings. These nerve endings are  present in most body tissue and only respond to damaging or potentially damaging  stimuli. Next, the pain messages are transmitted by specific identified nerves to the spinal cord. After the pain messages reach the spinal cord then the spinal cord relays that pain message thru pathways to higher centers in the brain, including the brain stem, thalamus, somatosensory cortex and limbic system. It is thought that the processes underlying pain perception involve primarily the thalamus and the cortex. 

How do we feel pain?

A pain message is transmitted to the brain, by specialized nerve cells called nociceptors or pain receptors. When pain receptors are stimulated by temperature, pressure, or chemicals they release neurotransmitters within the cell. Neurotransmitters are chemical messengers in the nervous system that facilitates communication between nerve cells. Once the pain reaches the thalamus (which is located in the brain),the thalamus transmits the pain signal to other parts of the brain to be processed. 

When the brain has received and interpreted the pain message, it coordinates an appropriate response. The brain will then send a signal back to the spinal cord and nerves to increase or decrease the severity of the pain.

Research has shown that people possess differing numbers of neurotransmitters possibly explaining why some people experience pain more intensely than others. 

This blog is about pain. Pain is such a small word, but if we look closely at the term(pain),we realize the complexity of this word. Pain is so prevalent in the medical field. It is hard to diagnose and even harder to treat. Since the pandemic there are so many people that are suffering mental pain or in physical pain on a daily basis. If you experience pain daily you have what’s called chronic pain. My next blog will focus on chronic pain, what chronic pain does to our bodies , and how pain was managed and treated 10 to 15 years ago versus how pain is treated now.  


This blog is a continuation of my last blog which primarily focused on pain. I find this four-letter word to be incredibly complex. This blog will cover how we measure pain and the most common pain scales that are used in the healthcare setting, In my previous blog I mentioned that pain is subjective. This means that if two people have the same injury, diagnosis or surgery, the pain they experience, feel, and rate differs from person to person.

Pain is complex and multidimensional which means there are many different aspects of pain. There is no area in or on the human body that is exempt from pain. According to the Centers for Disease Control and Prevention, “during 2021 an estimated 51.6 million U.S adults (20.9%) experienced chronic pain, and 17.1 million (6.9%) experienced high impact chronic pain.”

High Impact Chronic Pain by definition is, (pain that has lasted three months or longer and is accompanied by at least one major activity restriction”. In the medical field activities of daily living are the same thing as activity restrictions in high impact chronic pain. Examples of this include eating, bathing, personal grooming, cooking, and toileting.

How do health care providers actually measure pain? 

In the images depicted above, scales have been used to measure pain. Would you be able to differentiate which pain scale to use as opposed to another?

Multidimensional pain scales are among the most useful and effective when assessing complex or chronic pain. This is because acute pain is something that comes all of sudden and the complex or chronic pain lasts longer than 3 months and the doctor can assess how the current treatment plan is working, or not working.

A pain scale is a tool that doctor’s use to help assess and understand a person's pain. Pain scales are used for people of all ages from newborns to seniors, as well as for individuals with impaired vision, hearing or communication skills. A pain scale could be used in a variety of different scenarios, which could include
but not limited to an admission to a hospital, during physical therapy, a doctor's appointment, or even after a surgery. Pain scales are used by healthcare providers to improve communication between a patient and their doctor, and to measure, manage, and track pain. These scales help doctors make diagnoses, create treatment plans, measure the effectiveness of the treatment plan, and aid in the reduction of pain.

There are 11, that’s right 11 different common pain scales that doctors use to assess pain. I will briefly describe each pain scale. These types of pain scales are used for acute, chronic, and neuropathic pain. When your pain comes on suddenly (acute), lasts longer than 3 months(chronic) or is caused by nerve damage(neuropathic). When using a pain scale they generally fall into one of these three categories.

Numerical Rating Scales (NRS)Uses numbers to rate the pain

Visual Analog Scales (VAS)Asks you to select a picture that best matches your pain level.

Categorical Scales-Primarily uses words, possibly along with numbers, colors, or locations on the body.

The pain scales may provide quantitative measurements, qualitative measurements, or both.

Quantitative Pain Scales-Answer the question, "How bad is your pain”? These scales allow your doctors to gauge your response to treatment over
a period of time.

Qualitative Pain Scales- Answer the question, “What does the pain feel like” These scales can give your doctor ideas about the cause of your pain.

Different Types of Pain Scales:

Numerical Rating Pain Scale-

This scale is used for anyone over the age of 9. This particular pain scale is one
of the most commonly used scales. To use this scale, you say the number that best
matches your pain. Zero is no pain, ten is the worst pain you have ever experienced.
Wong-Baker Faces Pain Scale-
This scale combines pictures and numbers, and can be used for children over
three. There are six faces that depict different expressions ranging from happy to
extremely upset. There is also a numerical rating between zero(smiling), and
ten(crying). To use this scale, you can point to the picture that best represents the
degree and intensity of your pain.

FlACC Pain Scale-

This pain scale is based on observations made by the healthcare providers or
your doctor. This scale was originally made for young children. This scale is now being
used by individuals who have impaired hearing or are unable to communicate.

FLACC Stands For:

Facial Expression
Leg Tension or Relaxation
Activity (still or squirming with pain)
Consolable (whether you can be comforted)

Zero to two points are assigned for each of the five categories/ Then the overall score is added up and tallied. Scores are interpreted as follow:
0- Relaxed and comfortable
1-3- Mild Discomfort
4-6 Moderate Pain
7-10 Severe discomfort or Pain

CRIES Pain Scale-
The CRIES Pain Scale assesses
Vital Signs
Facial Expressions

This pain scale is often used for babies that are six months or younger. As a previous pediatric intensive care registered nurse we used this scale in our unit. So this pain scale is used in NICU(neonatal intensive Care Units) and PICU (Pediatric Intensive Care Units). This pain scale is based on a healthcare provider's observation, and objective measurements in each category.

A rating of zero means you're not showing any signs of pain, and a rating of two means you're showing signs of extreme pain. In this pain scale you give each of the five categories a rating of zero to two, then the measurements are tallied up and you would notify the doctor or healthcare personnel.

Comfort Pain Scale
This pain scale is used for children, adults with cognitive impairments, individuals who are temporarily impaired by medications, and used when people are sedated due to an illness, a medical emergency or in the operating room.

The COMFORT scale provides a pain rating between nine and 45 based on nine different parameters. Each one is rated from one to five.The nine parameters are as follows.

Alertness- one for deep sleep, two for light sleep, three for drowsiness, four for alertness, and five for high alertness.

Calmness-one for complete calmness, higher ratings for increased anxiety and agitation.

Respiratory Distress-This is almost always a problem. Respiratory Distress is a term used when a person's breathing is abnormal. A higher rating for agitated
breathing. Agitated Breathing is something to monitor very closely, because it can turn into a medical emergency within minutes. Respiratory Distress looks like very quick, shallow breathing.

Crying-one for no crying, higher scores for moaning, sobbing, and screaming

Physical Movement-zero for no movement(which is a sign of less pain), one or two for some movement, and higher scores for vigorous movement(which would be referred to as thashing around due to extreme pain)

Muscle Tone-A score of three for normal, and lower scales for diminished muscle tone, and higher scores for rigid muscles. This is also very indicative of a
looming problem. If a person has no muscle tone, this may mean that a child or adult is pretty lifeless. This requires a rapid intervention. If you have very rigid muscles, this also can become an emergency if left untreated. This small but very important detail may be indicative that your brain is not working correctly due to illness, infection,or a bleed.

Facial Tension-one for completely normal, relaxed face, and higher scores for signs of strain.

Blood Pressure and Heart Rate-This is rated according to your normal or baseline heart rate, and blood pressure.

       One if you are below your baseline (abnormally low heart rate and blood pressure),

       Two is baseline, and higher scores are for abnormally high heart rate and blood pressure.

When a person is in pain, the vital signs will increase causing a high heart rate and a high blood pressure. Both of these conditions abnormally low and abnormally high are medical emergencies, abnormally low heart rate and blood pressure could lead to a cardiac arrest or a respiratory arrest.

Abnormally high blood pressure, and heart rate can lead to a stroke and cause havoc within the body.

McGill Pain Questionnaire(McGill Pain Index)-

This scale consists of 78 words that describe pain. You rate your own pain by marking the words that best match your feelings. This scale only works for individuals that can read, so young children will not be able to use this scale. Some examples of words used, Sharp, Dull, Tearing, and Achy. Once you’ve made your selections, the provider figures out a numerical score with a maximum rating of 78 based on how many words you have marked. Individuals have to be able to read to use this pain scale.

Color Analog Pain Scale-
This pain scale uses colors to represent different levels of pain on a pain scale.
Red-Severe pain
Yellow- Moderate Pain

` The colors are usually positioned in a line with corresponding numbers or words that describe your pain. This scale is used for children, and is considered to be reliable.

Mankoski Pain Scale-
This pain scale uses numbers and specific descriptions of pain to ensure that the healthcare provider understands your pain. Descriptions are detailed. Examples of this would be, a minor annoyance, Occasional muscle spasms, and the pain cannot be ignored for more than 30 minutes. After reading all the descriptions, you tell the doctor or nurse which number best fits your pain level.

Brief Pain Inventory-
The Brief Pain Inventory (BPI) is a worksheet that is made up of 15 questions. You are asked to numerically rate the pain you're experiencing and how your pain has affected that particular area in your life,( sleeping, relationships with other people). Each question has the numbers zero to ten. Zero is no pain, and ten is the worst pain you have ever felt. This pain scale monitors your pain in a 24-hour period. Examples of these questions could be, "Please rate your pain by circling the one number that best describes your pain at its WORST over the last 24 hours. This pain scale captures terms of how your pain is affecting your daily life.

Descriptor Differential Scale of Pain Intensity-
This pain scale has 12 lines, each of which has a descriptor-such as faint, strong, intense, and very intense-placed in the middle of it. Each line has a minus sign at the start and a plus sign at the end.

First, you find the line with the descriptor that best matches your pain. For less intense pain, you mark somewhere on the minus side. For more intense pain, you mark somewhere on the plus side. An Example of this scale is depicted below.

Defense and Veterans Pain Rating Scale-
The United States Department of Defense in 2021 announced it was using a new pain scale called the Defense and Veterans Pain Rating Scale (DVPRS).
According to a news release, it's the response to dissatisfaction with other pain scales from both healthcare providers and patients. Rather than a simple scale, it includes:

Faces-Expressions ranging from smiling to highly distressed

Colors-Green for no pain, then moving through the spectrum to red for worst pain possible

Numbers-zero for no pain, and ten for the worst pain possible.

Descriptors-These include “hardly notice pain, avoid usual activities, and unable to bear”.

Combining aspects of many other pain scales may give your doctor more information to work with. Using pain scales can help your doctors or nurses determine how much pain you're in and its impact on you. These scales can also help define your pain in mutually understood terms. There are several kinds of pain scales. Some use pictures, or colors, others use numbers or words, and some of them use a combination of all of these. Your doctor can choose which scale to use based on your ability to read or communicate, and what the doctor wants to know or learn. Some doctors regularly use a pain scale. Some hospital rooms even have these scales posted on the walls. The more severe the pain, the more your pain will be monitored. The scales are a useful tool
for improving diagnosis and treatment,

My next blog will discuss the types, characteristics, classifications, components, mechanisms, and psychology of pain. I will also be covering the intricate process of diagnosing, treating, and managing pain.