“Are you experiencing pain?” and “Where are you experiencing pain?” are two of the first questions asked in a rehabilitation evaluation. Most patients come to seek treatment in some sort of pain, so it becomes necessary to have a tool that can evaluate the severity of a patient’s pain. The most common measurement used for evaluating a patient’s pain is the 0-10 pain scale.

What Is a Pain Scale?

The truth is everyone perceives pain differently. There are people who suffer from chronic pain daily and may appear as if they don’t have a physical problem. Unfortunately, pain can’t be measured the same way in rehabilitation as hand strength, for example, which has an appropriate evaluation tool.

Pain scales were created to give doctors, physical therapists and chiropractors a reliable tool to measure and understand the extent of a patient’s pain. To help compensate for this problem, many doctors rely on pain scales to get a more concrete sense of a person's pain. You might have seen a pain scale in your doctor's office before. The 0-10 pain scale is most commonly included in the written patient history as series of numbered cartoon faces moving from 0 (smiling and pain-free) to 10 (weeping in agony. The patient fills out this preliminary form and is asked to match their level of pain with the corresponding figure/number on the scale.

An article, “The Assessment of Pain” published in the Oxford Journal found that the 0-10 pain scale (or 11-point pain scale) one of the most effective tools for evaluating pain. What’s more, the 11-point pain scale gives practitioners an evaluation tool to help monitor chronic pain conditions and progress throughout physical therapy. In addition, pain scales give voice to patients who have trouble communicating clearly, such as children or people with cognitive impairments.

Using the Pain Scale

The pain scale is subjective, meaning someone who has a high pain threshold may describe their pain as a 1 or 2 on the pain scale, while another person would describe the same pain as a 6 or 7. That’s why when evaluating pain, it’s important that a therapist follows up verbally to provide some context to the patient’s pain score. For example, using a time when they experienced severe pain, such as childbirth or gall stones, can be used as a benchmark for comparison. Since pain isn’t static, it’s also important to establish a pattern, having patients evaluate and score specific activities and times of day during the time period when they experience their pain.

This type of evaluation is valuable both in evaluation and as a tool for keeping track of rehabilitation progress. A study published in the Annals of the Rheumatic Diseases found that the 11 point (0-10) pain scale performs better than other visual methods of describing pain and is now considered the industry norm when evaluating a patient for pain and record keeping of the patients journey through rehabilitation. 

Once a patient’s pain has been scored, the question becomes for the practitioner how to efficiently and effectively reduce the patients pain. The most common types of pain are:

1. Acute pain after injury
2. Post-surgical pain
3. Chronic pain
4. Trigger point pain
5. Radiating pain

There are many modalities used in rehabilitation that are effective pain relievers and provide an alternative form of pain relief for oral-pain medications.

Treating Different Categories of Pain with Physical Therapy Modalities

1. Acute pain after an injury: When a patient sustains an injury, like a sprain or strain, it’s important to remember R-I-C-E, which stands for Rest-Ice-Compression-Elevation. When a patient comes in after sustaining a sprain or strain, equipment like Cold-Compression Therapy devices are useful because it delivers the analgesic benefits of cold therapy combined with the edema reducing results of pneumatic compression.
2. Post-Surgical Pain: Some post-surgical pain is expected, but with most patients, it’s important that they are able to participate in post-surgical rehabilitation in order to regain function. Reducing pain is one of the first goals in order to allow these patients participate in more movement based rehab regimens. A study published in The Journal of Bone and Joint Surgery found that Electrotherapy used in Neuromuscular Electrical Stimulation (NMES) mode has been found to be effective both in reducing pain associated with ACL reconstruction, but also has been found to help aid patients regain strength and functional movement in the femoris muscle when combined with therapeutic exercise. 
3. Chronic Pain: Chronic pain conditions like arthritis or fibromyalgia can be challenging to provide long-term pain relief. While it may not be possible to lower a chronic pain patient’s pain score to 0, with the use of modalities like therapeutic ultrasound, it is possible to greatly reduce it. A study published in The Journal of the Canadian Chiropractic Association found that ultrasound therapy has therapeutically beneficial effects on reducing pain and improving functional outcomes in patients with osteoarthritis. 
4. Trigger Point Pain: A trigger point defined as the presence of distinct tenderness or pain located in a band of muscle which can be found upon palpitation. Trigger point pain is local pain and can trigger a local twitch response. Low-level laser therapy is a great tool to use when treating trigger points, because it offers the ability to treat specific areas of the body. In the study, Efficacy of Low Level Laser Therapy in Myofascial Pain Syndrome, Low Level Laser therapy has been found to provide superior pain relief when combined with therapeutic stretching when treating myofascial trigger point pain. 
5. Radiating Pain: Radiating pain is challenging to treat because it deals with pain that is located in a specific area and refers or radiates to other areas of the body. For example, carpal tunnel can have radiating pain in the hand, fingers and shoulders. Patients with sciatic pain can have local, low back pain that radiates down the back of the leg to the heel. Heat therapy in the form of paraffin therapy and warm water whirlpool therapy are beneficial in reducing the radiating pain associated with carpal tunnel and sciatic pain, respectively.

Reducing pain is one of the most common reasons patients seek treatment. Using the 11-point pain scale in combination with these pain relieving modalities helps to efficiently reduce pain and return patients to full-function in their day-to-day activities. 

Articles Related the Pain Scale and Treatment Options for Chronic Pain

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• Pain Management Options for Chronic Pain
• The Benefits of Physical Therapy vs. Medication When Treating Pain