Measuring a patient’s pain is an essential part of the chiropractic assessment prior to treatment. However, unlike objective measures such as the degree of spinal curvature or the range of joint movement, the amount of pain cannot be determined directly. Instead, doctors infer pain level from the patient or from associated signs. Together, patient self-reporting and inference by examination, constitute the basic tools chiropractors use to assess a patient’s pain level.
While self-reporting is a useful tool for doctors, it’s important to remember that experiencing pain is subjective. In other words, each patient will have a different level at which they call pain mild, moderate or extreme. Likewise, patients will all have varying degrees of verbal and physical reactions to each level of soreness. For this reason, it’s crucial to pair self-reporting with examination.
When measuring pain, most chiropractors will use a detailed assessment form. Each form includes information about the kind of problem the patient is experiencing and how much pain it causes. The doctor may also use a basic diagram of the body to mark locations and levels of pain. In addition, the chiropractor will ask a series of questions to ascertain frequency of pain and the nature of movements and activities that trigger or worsen the pain.
Next, the chiropractor will introduce a pain scale to the patient. The scale ranges from 0 (no pain) to 10 (extreme pain). On the pain scale, the patient will select a figure that matches their level of discomfort. Although this exercise is subjective, most patients demonstrate great internal consistency when it comes to selecting relative pain levels. In addition to helping doctors understand the patient’s level of pain, the pain scale helps show how pain levels fluctuate over the course of the day or in response to certain kinds of activity or medicines. If the pain scale is not the best method for a patient, however, chiropractors may introduce another pain reading method. For example, they have questionnaires specifically designed to assess the degree of pain and disability associated with spinal injuries, like the Quebec Back Pain Disability Scale.
With chiropractors using a variety of assessment forms and pain scales, measuring pain may seem like a calculated, scientific measurement. However, pain assessment actually begins the moment a patient walks in the door. A chiropractor will assess by observing the patient’s posture, how they walk, facial expressions and involuntary verbalization. While being examined, palpation and movement of problem areas will often give rise to further articulation and tensing against painful movement. This provides further clues both to the location and degree of soreness. A chiropractor may use pain scales during the examination so that patients can communicate in a more focused way. Marking these pain levels on a chart provides a baseline measurement that a chiropractor can use to judge the treatment effectiveness over time.
Although pain measurement is only one method of assessing both the degree of injury and success of treatment, it is an important one. Pain is both a clear sign that something is wrong and an impediment to normal daily activity. In contrast, a reduction in pain following chiropractic therapy increases feelings of wellbeing and provides subjective evidence of improvement. For the chiropractor too, this is an essential indication that they are doing something right. Together with other signs such as increased strength, range of movement and endurance, reduced pain is a welcome indicator that a patient is making progress.