A Mixed Methods Exploration of How Hospital Inpatients Understand and Use the Verbal Rating Scale of Pain

Background: The pain experience is a complex integration of biomedical, psychological, social and contextual factors, few of which can be directly observed. Therefore, the assessment of pain is dependent on the patient’s self-report. Hospitals routinely use pain scales, such as the Verbal Rating Scale (VRS), to record a patient’s pain. However, these unidimensional scales are often used in a way that concatenates pain intensity with other pain elements, which makes choosing appropriate interventions difficult. Aims: This study aims to understand how inpatients understand and use the VRS in a hospital setting. Methods: Forty-five participants took part in a semi-structured interview and a task to develop their own personal pain scale. Qualitative data was analysed using Thematic Analysis (Braun & Clarke, 2006). Results: Participants anchored their pain experience in the physical properties of pain, tolerability of pain, and impact on functioning. Their relationship to painkillers, personal coping style, and experiences of staff influenced how they used the VRS. Categories of the measure were not considered equidistant. Conclusion: Participants grounded and explained their pain in semantically similar but idiosyncratic ways. The VRS was used in a way that combined pain intensity with multiple other elements of pain and was often used as a way to request painkillers. Therefore, pain scores need to be explored and interpreted by staff and not only used as the basis for providing painkillers

Exploration of Hospital Inpatients' Use of the Verbal Rating Scale of Pain

Background: Assessment of pain largely relies on self-report. Hospitals routinely use pain scales, such as the Verbal Rating Scale (VRS), to record patients' pain, but such scales are unidimensional, concatenating pain intensity and other dimensions of pain with significant loss of clinical information. This study explored how inpatients understand and use the VRS in a hospital setting. Methods: Forty five participants were interviewed, with data analysed by thematic analysis, and completed a task concerned with the VRS and communication of other dimensions of pain. Results: Participants anchored their pain experience in the physical properties of pain, its tolerability, and its impact on functioning. Their relationship to analgesic medication, personal coping styles, and experiences of staff all influenced how they used the VRS to communicate their pain. Conclusion: Participants grounded and explained their pain in semantically similar but idiosyncratic ways. The VRS was used to combine pain intensity with multiple other elements of pain and often as a way to request analgesic medication. Pain scores need to be explored and elaborated by patient and staff, content of which will imply access to non-pharmacological resources to manage pain