Bosdet, Luke; (2017) A Mixed Methods Exploration of How Hospital Inpatients Understand and Use the Verbal Rating Scale of Pain. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Background: The pain experience is a complex integration of biomedical, psychological, social and contextual factors, few of which can be directly observed. Therefore, the assessment of pain is dependent on the patient’s self-report. Hospitals routinely use pain scales, such as the Verbal Rating Scale (VRS), to record a patient’s pain. However, these unidimensional scales are often used in a way that concatenates pain intensity with other pain elements, which makes choosing appropriate interventions difficult. Aims: This study aims to understand how inpatients understand and use the VRS in a hospital setting. Methods: Forty-five participants took part in a semi-structured interview and a task to develop their own personal pain scale. Qualitative data was analysed using Thematic Analysis (Braun & Clarke, 2006). Results: Participants anchored their pain experience in the physical properties of pain, tolerability of pain, and impact on functioning. Their relationship to painkillers, personal coping style, and experiences of staff influenced how they used the VRS. Categories of the measure were not considered equidistant. Conclusion: Participants grounded and explained their pain in semantically similar but idiosyncratic ways. The VRS was used in a way that combined pain intensity with multiple other elements of pain and was often used as a way to request painkillers. Therefore, pain scores need to be explored and interpreted by staff and not only used as the basis for providing painkillers.

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