That stupid pain scale

You know the one: 

 
I refuse to have my blood pressure taken at doctors’ offices (I’ve gotten no pushback on that one). Next, if I have the opportunity, I’m going to refuse to rate my pain on that stupid scale. (Dr. Brian Mandell, Editor in Chief of the Cleveland Clinic Journal of Medicine, calls the scale “silly.”) There are plenty of reasons for this:

• In the mid-1990s, the rating scale was aggressively pushed as a fifth vital sign by the American Pain Society (now defunct)—a group that was created by Purdue and other opioid manufacturers. They were successful: hospitals now include the pain scale as a vital sign along with temperature, pulse rate, respiration rate, and blood pressure.
• Unlike the four vital signs mentioned above, pain rating is subjective.
• Adoption of the pain rating scale “…has not measurably altered pain outcomes,” according to studies reported in the Pain Management Nursing journal.  
• Pain control can be linked with hospital reimbursements. Hospitals with lower patient satisfaction rates are reimbursed at lower rates by the Centers for Medicare and Medicaid. To increase satisfaction ratings, providers feel pressure to prescribe opioids to ensure patient satisfaction with pain care.
• In 2016, the American Medical Association voted to stop treating pain as the fifth vital sign.

The Cleveland Clinic doc says, “I suspect that most of my peers function in the outpatient clinic as I do, without much interest in what was recorded on the intake pain scale.” If he thinks that scale is silly, why shouldn’t I?

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