Academy of Chiropractic’s Lawyers PI Program

Narrative #52

From the Desk of :

“Reporting Pain & Visual/Verbal Analog Scales”

Too many of you are consistently not reporting your patient’s pain accurately. In addition, there is a lack of consistency in the profession when reporting pain and this becomes acutely problematic at the legal level and when creating relationships with both medical primary care providers and specialists. 

It is most accurate to report pain per reported symptom. Many of you are reporting pain in multiple regions or body parts and at the end of the section stating the pain is a 6/10. Clinically, I have rarely in my 34 years have encountered a patient with multiple reported areas that all have the same pain scales in every area. Although possible, usually there are primary, secondary, etc… areas of complaints. In addition, the body usually “gaits off” the secondary area for the primary region and the levels of pain are perceived differently. This is also usually not indicative of less bodily injury, only less perceived pain necessitating all regions be diagnosed thoroughly. 

Procedurally, you must list the pain scales per body part or region injured in your documentation. This also must be accompanied with a reference to a scale. 

Most of you utilize the visual analog scale, but don’t have 1 picture that your patients look at. Therefore you have perjured yourselves by utilizing the VERBAL ANALOG SCALE. In addition, some of you use a scale from 1-10, while others use a scale of 0-10. Furthermore some of you report this as VAS. Is that visual or verbal?

In testimony even a mediocre lawyer can make you look the fool and many plaintiff lawyers know this. Therefore, if you don’t accurately document the pain scales, it can prevent a lawyer from wanting you to care for their clients and destroy a relationship over a very small, but powerful issue.

In addition, intensity of pain as reported through pain scales is a critical factor for the Colossus algorithms. As much as I hate to create more paperwork, it is suggested that you give the patient a copy of the scale on paper and have them circle the number of pain intensity. This removes you form the process and gives you a level of insulation should the patient be exaggerating the facts. To resolve the time-consuming problem, the handout below is a skeletal graphic of the human body. Have the patient write the pain number next to the effected body joint and ensure a copy of the scale utilized is in your records that the patient was asked to use to grade their pain and have the patient sign or initial the graphic they completed. Without the signature, this raises questions about it being a legally admissible document.

The following is a report from the National Institute of Pain Control that explains the use of pain scales for most conditions that grace our offices: