A New Alternative to the Pain Scale

Michelle Hopkins

Concentra® has launched a new approach to pain that improves the quality of injury recovery and helps accelerate return to work. In developing this new approach, it was necessary to re-examine the traditional pain scale. 

The pain scale was developed after the Joint Commission on Accreditation of Hospitals launched a campaign in 2001 to treat pain more vigorously. Believing pain was being undertreated, the commission advocated including pain as the “fifth vital sign” (the other four being respiration, body temperature, pulse rate, and blood pressure). People were soon being asked to rate their pain at every medical visit, and the pain scale was used as an indicator of recovery. 

But research has shown that pain isn’t always a reliable indicator of healing status. A person may report pain on the pain scale when asked, even after tissues have healed and function has been restored.

How is this possible? Additionally, if a pain scale rating isn’t accurate, how then is recovery assessed?

Using the Pain Scale Can Increase Perception of Pain

Our brains are not passive computers that receive and register pain signals, but are actively involved in either shrinking or growing pain. Repeatedly asking patients to rate pain severity can increase the perception of pain and delay recovery.

That’s in no one’s interest, explains Dr. Maja Jurisic, MD, who is board-certified in emergency medicine and occupational medicine. Dr. Jurisic currently serves as vice president and medical director of strategic accounts at Concentra. She is a leader in her field, a prolific author, and a leading contributor and editor of Concentra’s Clinician Manual. 

“We don’t want to cause injured employees to entrench pain pathways by asking them to think about pain at every visit. Even when there is no longer tissue damage in the body, the brain’s learned pathways can create feelings of real pain,” Dr. Jurisic says. 

“The goal of treatment is to help the injured employee return to work smoothly and safely, not eliminate every vestige of discomfort. Concentra clinicians listen to and acknowledge complaints of pain and then focus attention and our conversation with the individual on function. We document functional ability – an objective measure of recovery – and our goal is to get the injured employee back to normal as soon as possible.” 

The pain scale not only is a poor measure of recovery, but also can be fed by a person’s negative emotions, such as anxiety, anger, and fear. Those emotions may amplify feelings of pain, and a patient mired in negative emotions might well feel unable to actively participate in the treatment plan. Patients’ active participation in their own recovery and objective measures of progress are critical to normalizing a patient’s life after injury. 

Objectively Measuring Functional Recovery

Concentra replaced the pain scale with our FReSH scale, an acronym for Functional Restoration/Status of Healing. Concentra physicians and physical therapists collaborate to reframe the injury recovery experience for the injured employee. Physical therapists determine objective measures that take consider the severity of the injury, the individual, and a functional analysis of the job the individual was performing at the time of injury.

Clinicians use these measures – instead of pain complaints – to assess recovery and gradually reduce restrictions on the employee’s activity status. The focus is on function, not pain.

Replacing the Pain Scale Conversation

With FReSH, Concentra clinicians have a more positive and productive conversation with injured employees – one that doesn’t focus on the pain scale, but on physical abilities, progression on objective measures, high quality nutrition, and restorative sleep that help heal tissues. 

Concentra has seen FReSH produce many positive results, including:

  • Reduced prescribing of opioids. Not repeatedly asking the individual to think about pain can help quell pain by not reactivating those neural pathways.
  • Increased productivity. By showing a person how much he or she has improved at each visit and how much is possible, FReSH helps create an “ability mindset” that can increase productivity and reduce anxiety, which accelerates progress in getting life back to normal.
  • Improved outcomes. By setting tangible recovery goals, FReSH can encourage faster recovery and reduce case duration.

To learn more about FReSH and Concentra’s approach to work injury care, contact a Concentra expert today.