In 2016, my niece Blair, handed out copies of our original story book teaching pain help words to families in the pediatric neurology waiting room, as well as, in her urban neighborhood, saying “try this.” It had worked for her frequently-in-pain preschooler. Maybe it could help others. The results were shockingly good: less stress, easier urgent care decisions, a shortened hospital stay for one, and resolution of a long term issue for another, a preschooler. The method for learning pain care communication for these children appeared to stick. They “got” My Pain Alert Scale, and they ran with it.
So, why isn’t MPAS a common well-known medical tool? The question I asked first was: Why am I doing this? It didn’t make sense that U. S. A. acknowledged the need for support for less-abled individuals 20+ years ago with the Americans with Disability Act, yet consistent accessible support for communicating pain needs and other life needs is still not there. Why?
Neither communication disorders, nor pain are instantly visible. If one is made aware of the problem, it is individual and personal, so the fix is definately not one-size-fits-most or easy.
The professionals who use pain scales everyday are doctors, nurses, physical therapists, pain researchers, and first responders, not speech language pathologists. So, no professional skill set to see possible alternate approaches to the communication flaws in a faces type scale, and no time to do anything about it. The professionals know faces type scales are problematic. Consequently, there are a lot of variations on Faces, but no scale like MPAS which, with the story training and multiple response modalities, could be a valid research tool for the age 1-7 population. As my contact has been limited with leaders in pain care research, I cherish the little exposure MPAS has had.
Honestly, I am a “nobody,” an ordinary Speech Language Pathologist, living in rural Kentucky which is not a hotbed for research.
When I decided to leave working in public schools, I had the local hospital, nursing homes, neighboring home health, day programs for developmentally disabled and a private school needing speech therapy services. I walked into a lot of places that had no speech or language materials. Once, I had to find chairs for an empty room. That experience had me thinking outside the box as an innovator. Because some of the techniques I used were great for the local people, but not typical for SLPs, I presented research at ASHA’s national convention. The research, results of 400 consecutive patient evaluations, could be described as “covering one’s a**.”
Given the pain scale problem, medical providers need something that can be understood by the target population – people who don’t have adult comprehension and working memory. Faces expects those people to rank order their current pain in their personal pain history. The patient using faces type scales may be talking with a provider who has never seen them before. The pain patient, no matter their age or ability, needs to be heard, and taken seriously.
Many providers are like a nursing home administrator I talked with. She told about a patient who always said their pain was a “10”. The implication was that the patient was a drama seeker. I’m guessing that the instructions given orally to the patient were too much to hold on to for processing, but the pain was very real.
Leave a Reply