By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
The rise in micro-management associated with Obamacare and changes in Medicare regulations has made mandatory the use of the Numerical Pain Scale (NPS) in all branches of daily healthcare practice. You would be hard pressed to enter a healthcare office and be able to exit without being asked, “On a scale from 0-10 please rate your pain; 10 is the worst pain and 0 is no pain at all.” It is important for the patient to rate their pain correctly on the first visit since this will be used to measure progress throughout their treatment. As a healthcare provider it is intriguing how many people respond with, “I don’t like that scale” or “I never really understood that scale” or “That scale confuses me”. Patients are also confused about the difference between sore, achy muscles and joints versus a painful condition. When mixed together, these two areas can not only lengthen an office visit but also prevent the provider from getting a patient the help they need.
The American Physical Therapy Association (APTA) differentiates soreness from pain as follows: “Soreness is a healthy and expected result of exercise (or activity). Pain is an unhealthy and abnormal response that may be indicative of an injury.” These definitions take into account several criteria: the character of the sensation, onset, duration (how long it lasts), particular location on your body, what makes it better or worse, and how you should treat it.
Muscle soreness is usually associated with an act such as recent exercise, yard work, or even cleaning the house. The affected area is tender to the touch, fatigues easily, and feels tight with movements that lengthen the affected muscles or tissues. The onset of the soreness is generally between 24 and 72 hours of the insulting activity. This is termed delayed onset muscle soreness (DOMS) and commonly lasts between 2-5 days, depending on the intensity of the activity that caused it. Originally thought to be the result of lactic acid accumulation, delayed onset muscle soreness is actually the result of micro-damage to the muscle fibers. When the soreness follows an activity that requires use of the entire body, the aches are “everywhere”. If the activity is specific, such as running a marathon, then the legs usually hurt the most. The soreness reduces with low level movement, such as walking and light stretching exercises. It may worsen with sitting still or trying to exercise heavily. Ultimately, time is what heals delayed onset muscle soreness the best. Increasing your water intake, gentle movements, stretching, and use of a foam roller can help get you through the 2-5 days it takes to heal.
Pain is associated with a specific act, like exercising excessively or lifting something heavy, and it prevents you from continuing the activity. The character of the pain is sharp or a deep boring ache. The sensation usually comes on during the activity and will often prevent the continuance of the activity. It may also linger longer than 7-10 days. It may involve the joints as well as the muscles, tendons, or ligaments. It feels better with rest, ice, and immobilization. Attempts at activity worsen the pain. If the pain lasts longer than 10-14 days or if it is greater than 5/10 on the NPS, you should seek an opinion from a healthcare provider. Generally speaking, pain that is between a 1-4/10 does not prevent you from performing your chosen activities. Pain of 5-6/10 will alter how you perform your activities. For example, if you are running, you would run with a limp. If the pain is over a 6/10 it will prevent you from performing the chosen activity. Pain in the 9-10/10 range limits mobility, prevents you from going to school or work, and in many cases, may make you nauseous or even lose consciousness.
Communicating the NPS accurately to the best of your ability is extremely important if you want to give the provider the best opportunity to help you. The NPS is specific to each individual patient and is used to track each patient individually. It is not used to compare different patients in similar situations. Giving specific answers to the provider’s questions is also helpful. There is a tendency for patients to avoid the NPS. Using phrases like, “I have a high pain threshold”, “I’m not bad today”, or “I don’t know, it’s hard to give it a number”, etc. This only prolongs the visit and prevents the provider from doing their job, which is to help you. We still need a number, whether you give it to us immediately or we have to pry it out of you. Remember if you are vague with your responses, the provider will have a difficult time trying to assess your problem, formulating a diagnosis, and developing a treatment plan to resolve your issue. Help your provider help you: have your pain scale number ready when they call you in for treatment.