- Introduction: A Top-Level Look at the Future of Federal Medicine
- Military Health System in Time of Transition as Conflicts End
- Army Medicine: Redefining Its Role in the Generation of a Ready and Resilient Force
- Air Force Medicine: Averting an Identity Crisis
- Moving Forward with Reforming the Indian Health Service
- The Clinical Pharmacy Specialist's Growing Provider Role in VA
- Public Health Service Pharmacy: Accelerating Transformation
- Military Pain Management’s Future: Less Invasive, More Data-Driven Techniques
- Navy Medicine: Strong, Agile and Ready
- Telemental Health in VA: A New Source of Support for Veterans
Defense and Veterans Pain Rating Scale (DVPRS)
The most commonly used pain-rating scale in the military is the standard, 0-10, numeric rating scale (NRS). This scale is easily administered, well-known throughout the military care community and has been extensively validated as a clinical research tool to monitor and track a patient’s pain. One of the findings from the PMTF Final Report was the general negative feedback expressed about the clinical utility of the NRS by physicians, nurses and other clinicians. Common issues with the NRS included inconsistencies in its clinical use, its subjective nature with no functional anchors and the perceived minimal value of recorded NRS values actually observed in the clinical management of patients.
In response to these criticisms, the PMTF was tasked with developing a new pain-rating scale that would measure pain intensity, as well as pain’s impact on mood, stress and bio-psychosocial and physical function. The result was the Defense and Veterans Pain Rating Scale (DVPRS — Figure 1, Available at: www.DVCIPM.org/training.html).
This scale was designed to be useful in a variety of clinical environments and diverse patient encounter situations. The DVPRS faces, for example, can be used for pediatric or non-English speaking patients. The red-yellow-green colored bars should be useful for medics interested primarily in the need to treat pain (red), need to provide supplement treatment (yellow) or need to move on if the patient is “good to go” (green). The ascending bars work for the colorblind and those not culturally tuned to red-yellow-green symbolism.
Most importantly, the functional language provides anchors to the NRS numbers and a common definition useful for treatment comparisons. Finally, the four supplemental questions about the impact of pain on a patient’s general activity, sleep, mood and level of stress provide the clinician insight into the often-overlooked psychosocial aspects of pain.
The scale has been integrated into daily acute-pain medicine rounds at Walter Reed National Military Medical Center, Bethesda, MD, and already has enhanced quality of care. DVPRS data now are collected as a routine part of clinical rounds, and the information informs patient, family and caregiver discussions. In the first validation study of the DVPRS, a convenience sample of 350 veterans identified both functional-language statements and pain ratings to describe their pain. Excellent alignment was obtained between the functional language anchors by respondents matching the language correctly with pain scores.2
The tool is open source and available for clinical or research purposes.