Beyond the Pain Scale: A Patient’s Guide to How Nurses Can Improve Pain Management & Combat Stigma

Last weekend (October 2024) I had the incredible opportunity to speak at the 2024 American Society of Pain Medicine Nursing conference about the importance of communication between patients and their medical providers. I’m no medical pro, but as a chronic pain patient for over two decades, I’ve experienced firsthand the transformative power of compassionate, patient-centered nursing care and how much nurses can improve pain management treatment. I’ve also felt the weight of stigma, disbelief and “not my problem” that too often accompanies a chronic pain diagnosis.

Don’t worry, I won’t inflict the whole hour-long Q&A on you. But here’s a little bit about what I’ve gone through, what I’ve learned, and some guidance on how nurses and other medical professionals can improve pain management, making a profound difference in the lives of patients with chronic pain.

The Problems: Pain, Stigma, and Mistrust

A recent survey by the U.S. Pain Foundation (where I work, mostly writing and editing our INvisible Project magazine) revealed some troubling statistics:

• 63% of chronic pain patients felt stigmatized by their healthcare providers
• Only 35% reported high trust in their provider’s ability to manage their pain
• 36% had little hope of achieving their pain management goals
• 59% said their providers rarely or never listened to and validated their concerns

And when it comes to education, we’re not doing much better. As of 2018, 96% of U.S. medical schools did not require students to take courses on pain medicine.

These numbers paint a picture of a healthcare system failing those it’s meant to serve. But within this challenge lies an opportunity for nurses and other medical professionals to step up and become agents of positive change.

Moving Beyond the 1-10 Pain Scale

The 1-10 pain scale, while useful in some ways, is a vast oversimplification of the chronic pain experience. As a teenager, I used to joke that instead of 1-10, they should ask what you’d happily give up to be rid of the pain – “Chocolate? Your left leg?” While I don’t recommend this exact phrasing, there’s wisdom in the need for a more nuanced scale.

Nurses can go beyond the numerical scale by asking open-ended questions that paint a fuller picture:

• “Can you describe how your pain affects your daily life?”
• “What does your pain keep you from doing?”
• “How has your pain changed your relationships with family, friends and romantic partners?” (This explores the social impact of chronic pain.)
• “What activities or strategies have you found that help make your pain more manageable?” (This acknowledges the patient’s expertise in their own condition and whether they’ve investigated complementary approaches like acupuncture and biofeedback, or at-home treatments like heat therapy. It can also reveal other self care and coping mechanisms and just generally paint a picture of how they deal with pain conditions like fibromyalgia or chronic migraine.)
• “If we could improve one aspect of how your pain affects your life, what would be most meaningful to you?” (This helps prioritize treatment goals based on what matters most to the patient.)
• “How does your pain vary throughout the day, and what patterns have you noticed? How is your sleep?” (This provides insight into pain patterns and triggers that might not be captured in a simple 1-10 rating.)
• “When you have a good day with your pain, what does that look like for you?” (This helps establish realistic treatment goals and provides a personal benchmark for improvement.)

These questions not only provide valuable clinical information but also show patients that you see them as whole people, not just a collection of symptoms.

The Power of Active Listening

One of the most impactful things a nurse can do is to truly listen. Use reflective listening techniques, paraphrasing the patient’s words to show understanding– but make sure you’re actually listening, and not just parroting. (We can tell, I promise.) Pay attention to nonverbal cues, using your own body language to convey empathy. Sometimes a pat on the shoulder means everything.

When getting a patient history, be patient and avoid interrupting, allowing the person with pain to express themselves fully. (I know we ramble sometimes, but it’s hard to know what’s important!) And look for opportunities to connect on a human level, even over small things. Local sports. A button or sticker. Anything to give you an in to interact with them like you’re both, y’know, just people!

Never underestimate the power of simply believing your patients. When a nurse validates our pain experience, it combats the stigma and self-doubt that often accompany chronic pain. Sometimes, hearing another person say “Yeah, that doesn’t sound right” can be the most important part of a medical interaction.

Remember, these strategies aren’t just about gathering information – they’re about building a base of trust and empathy, showing patients that they’re truly seen and heard.

From background to quarterback, nurses are crucial

It’s not just about what’s in your patient’s medical chart – one integral aspect of how nurses can improve pain management is working to understand each individual’s unique story, circumstances, and challenges. For instance, their cultural background might affect how they talk about (or don’t talk about) pain. (Waves in “raised AFAB in the south to be polite to my elders.”) A person’s genetic background might affect how they actually feel pain or metabolize pain medication. Their work schedule might make it impossible to make it to physical therapy. Maybe they’re a single parent who can’t take certain medications because they need to stay alert for their kids. All of these factors matter enormously in how they experience and manage their pain.

Equally enormous in its impact is when and how nurses share these insights with the rest of the healthcare team. A nurse who really gets you and can speak to not just your symptoms but their effect on your whole life is an important advocate, helping ensure everyone involved in your care understands the full picture of your life, not just the medical stuff. Even the most perfect treatment plan won’t help if it doesn’t fit into your actual day-to-day reality! Nurses can serve as the quarterback of the entire medical team, making sure everyone is on the same page.

How can nurses improve pain management? Speak up & out!

But I also have to ask you to speak up. Your education and experience give you a platform to speak about medical policy and have people listen. We are about to enter into an election that will decide the fate of many, many people’s healthcare, treatment, and disability status. This is not a “both sides have a point” election, it’s a “the fate of so much is riding on this” election, so SPEAK UP. Speak out. Each of your individual voices are powerful, but together they can do so much more. Use groups like the ASPMN to speak louder, together. This is the time.

Concluding with the biggest “thank you” possible

To all the pain management nurses (and doctors, and physical therapists, and OTs, and and and) thank you for all that you do. Even if the current state of medicine makes you feel like you’re stuck between a rock and a hard place, please know that your work makes an enormous difference in the lives of your patients and can have an enormous impact on the way they approach pain.

Remember, each time you show compassion and understanding, you make a lasting impact on someone’s life and illustrate just how much nurses can improve pain management treatment. A small gesture can make a world of difference to a person who really needs it.

You remind us that we’re not just patients – we’re people, deserving of compassionate, individualized care. Sometimes that’s hard to remember! Sometimes we need a kickass nurse to remind us of it.

Is there anything important about how nurses can improve pain management & reduce stigma that I left out?

Or anything about going beyond the damn 1-10 pain scale? Leave a comment below or shout at me on social media! Sign up for next year’s ASPMN conference if you possibly can. And pin these so you remember this info is here!