Watch the video version of this episode on YouTube - https://youtu.be/VDBm4rBt7n8

A 46-year-old patient in an acute care hospital recovering from a serious motor vehicle accident uses patient-controlled analgesia. Each day prior to beginning treatment, the patient’s pain level is assessed using a pain scale. Which pain scale would be the MOST appropriate to administer?

1. Wong Baker Faces Pain Rating Scale 
2. McGill Pain Questionnaire
3. CRIES Pain Scale 
4. Descriptor Differential Scale of Pain Intensity

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A 46-year-old patient in an acute care hospital recovering from a serious motor vehicle accident uses patient-controlled analgesia. Each day prior to beginning treatment, the patient’s pain level is assessed using a pain scale. Which pain scale would be the MOST appropriate to administer?

1. Wong Baker Faces Pain Rating Scale 
2. McGill Pain Questionnaire
3. CRIES Pain Scale 
4. Descriptor Differential Scale of Pain Intensity

Patient-controlled Analgesia
Patient-controlled analgesia allows the patient to manage their pain by delivering an intravenous analgesic dose with preset parameters. Opioids are often the self-administered medication used with patient-controlled analgesia. Consistent pain assessment is a necessary component of evaluating a treatment’s effectiveness.

Let’s explore each of the options:

Option 1 - Wong Baker Faces Pain Rating Scale 
The Wong Baker Faces Pain Rating Scale was created to assist children three years of age and older to convey the intensity of their pain. The scale uses a series of faces and verbal descriptors to categorize the severity of pain. This scale is appropriate for adults as well since the cartoon faces avoid gender, age, and racial bias. 

This scale is often used as a rapid, daily assessment tool when administering patient-controlled analgesia.

Option 2 - McGill Pain Questionnaire
The McGill Pain Questionnaire is a pain assessment tool that is divided into four parts with a total of 70 questions. This tool can be used to establish a baseline, evaluate particular treatment regimens, and monitor progress. 

The complexity of the tool would make it impractical as a rapid, daily assessment tool.

Option 3 - CRIES Pain Scale
The CRIES Pain Scale is used for neonates and infants from 0 to 6 months. CRIES is an acronym for five physiological and behavioral variables related to pain (C = Crying; R = Requires increased oxygen administration; I = Increased vital signs; E = Expression; S = Sleeplessness).

This scale is not appropriate for adults.

Option 4 - Descriptor Differential Scale of Pain Intensity 
The Descriptor Differential Scale of Pain Intensity consists of a list of 12 descriptors describing different levels of pain intensity. Patients are asked to rate the intensity of their pain as being more or less than each descriptor on the list.

This scale tends to be complex, time consuming, and difficult for individuals with motor or cognitive impairments to complete.

The correct answer is Option 1

There are times where applying a bit of common sense can help tip the scales in your favor. For example, this question states that “Each day prior to beginning treatment, the patient’s pain level is assessed”.  Assuming you have basic knowledge of each of the pain scales, I think you can see right away that administering options 2, 3, and 4 on a daily basis would be exhausting and therefore impractical. 

I would rather experience daily pain than even consider completing the McGill Pain Questionnaire routinely.

70 questions – are you kidding me? Perhaps I should clarify that this is only true if the pain is moderate or less since I am a bit soft. 

The ideal pain scale for this purpose has to be a quick hitting valid measure to assess pain. Boom! Wong Baker Faces Pain Rating Scale. Thank you very much!

Let’s explore the all student data:
63% of students selected Option 1, Wong Baker Faces Pain Rating Scale, the correct response
11% of students selected Option 2, McGill Pain Questionnaire
9% of students selected Option 3, CRIES Pain Scale
17% of students selected Option 4, Descriptor Differential Scale of Pain Intensity

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!