Pain Scale Tests – Part One

Posted on Monday, May 3rd, 2021 at 12:08 pm    

One of the difficulties in workers’ compensation cases is trying to measure the worker’s pain. Many parts of a medical diagnosis are objective. Disorders can be seen on X-Rays, CT scans, and MRIs. Diseases and other medical problems can be seen when doctors read blood test and other lab test results like stress tests. Medical problems can be confirmed when doctors perform surgeries.

Still, for many types of pain such as chronic pain, the medical disorder is very subjective. In other words, no one except you knows the level of pain that you are feeling on a day-to-day basis. One person may be able to return to work with a severe injury while an employee with a similar injury may need continuing medical rehabilitation or pain management

To try to fine-tune how much pain a worker is in, physicians and health care providers often use questionnaires and surveys to analyze the degree of pain a worker has. Workers should review with experienced North Carolina and Virginia work injury lawyers how to prepare for and respond to some of these surveys. 

There are different pain scales for different parts of the body. There are also different pain scales for different injuries and different symptoms. 

What are the types of pain scales?

According to Pain Scale, there are two kinds of pain scales – unidimensional and multidimensional. Some of the common types of scales include the following. These pain scales help when an analysis of pain by objective tests isn’t complete and when pain is expected to vary from patient to patient or worker to worker.

Unidimensional pain scales. These scales focus on the intensity of your pain.

  • The Visual Analog Pain Scale (VAPS) and the Numeric Rating Scale (NRS) are discussed later (or in the second part of this topic).
  • A categorical pain scale uses visual or verbal descriptors to help workers and patients focus on the level and degree of their pain.
    • Verbal pain scale. The descriptors use words such as “mild,” “moderate,” “severe,” “discomforting,” “distressing” and excruciating,” to describe pain levels. A worker who takes this type of test chooses the adjective/word that best corresponds to the intensity of their pain.
    • Visual pain scale. Here the workers/patients respond to faces that show the level of pain. While they’re often used for children, adults can use them too.

Multidimensional pain scales. These pain scales are less common but often provide a more complete analysis of your pain. We discuss the McGill pain questionnaire in more detail later. The two other types of multidimensional pain scales are:

  • Initial pain assessment tool. This survey shows a diagram of the human body. The patient marks where their pain is on the diagram, and then answers “a series of questions regarding the characteristics of their pain, the expressions of their pain, and the effects of their pain on everyday life.”
  • Brief pain inventory. This test examines the intensity of pain you felt or experienced over the past 24 hours.

What is the Visual Analog Pain Scale Test?

VAPS is used for workers and other categories of adults. It tries to measure your level of pain. 

The VAPS test, and many other similar tests, usually use a scale from 0 or 1 to 10 or 100. If you have no pain, you enter the lowest number (0 or 1). If your pain is unbearable, you enter the highest number (10 or 100 – depending on the scale). The VAPS scale is displayed on the written page with a horizontal line for the full scale and vertical lines that correspond to the numbers on the scales. 

The VAPS test is simple. There’s just one question and one answer. Workers can either enter a number or just mark the spot on the scale the fits with their amount of pain. For example, if your pain is right in the middle, you’ll answer with a 50 on a 0-100 scale or mark the midpoint of a graph that has the 0 at one end and the highest number at the other end.

What does the score mean?

The VAPS score uses these general guidelines for analyzing the severity of your pain:

  • 0-4. No pain.
  • 5-44. Mild pain.
  • 45-74. Moderate pain.
  • 75-100. Severe pain.

These classifications make a difference. They can be used to determine:

  • What type of medical treatment you require;
  • How long you might reasonably need the treatment
  • Whether you can return to work
  • Whether you have a permanent disability.

Some of the issues involved with the VAPS scale and other pain scale tests

Workers need to understand that their answer doesn’t exist in a vacuum. Your medical provider will know the results of your imaging tests, lab tests, and any other tests. The doctor will have conducted a physical and oral examination.

If your answer as to your level of pain is not consistent with other tests and reviews, your answer affects your perceived credibility. On the other hand, everyone has different levels at which they respond to pain. The objective tests are generally given much more weight than the answers to surveys and questionnaires.

Patients need to understand issues such as:

  • Am I answering how much pain I have – when I’m medicated or when I’m not medicated?
  • Am I answering the question – just after I’ve had physical therapy or when I haven’t had physical therapy yet?
  • Am I answering these questions relative to other types of injuries or just this injury?

Of course, if your doctor has not ordered the proper kinds of diagnostic testing, then there is no way to match the symptoms to the findings. 

For example, if you should have had a lumbar MRI, but your doctor never ordered one, then your doctor may be unaware that you have a severely herniated disc in your lumbar spine from your work injury. This may lead the therapist or Functional Capacity Evaluator to assume you are exaggerating your symptoms (in other words lying to make yourself look worse) and say so in his or her report. We once had this situation. 

In this particular case, the Functional Capacity Exam evaluator assumed the client was faking when she said she had severe shooting pains as well as numbness down her leg, and severe back pain. He of course stated there was “no objective testing” to support these severe symptoms, resulting in an opinion that she was “malingering,” (i.e. faking), which in turn, lead to a very unfavorable report. 

Fortunately, the client had health insurance which allowed her to “work around” her treating doctor and go to a different physician, who ordered a lumbar MRI, which revealed a herniated disc which required surgery. The client was vindicated, underwent surgery and we ended up obtaining a very good settlement for her. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller has helped thousands of injured workers through the work injury claims process. He does more than assert your legal rights and document your injuries. He guides workers through the tests and strategies that insurance companies  and employers may use to try to limit or deny your claim. To discuss any questions you have about the workers’ compensation process and to speak with a strong advocate, call lawyer Joe Miller, Esq., at 888-667-8295. or use my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.