J0600: Pain Intensity

J0600: Pain Intensity

Steps for Assessment

1. You may use either the Numeric Rating Scale item (J0600A) or the Verbal Descriptor Scale item (J0600B) to interview the resident about pain intensity.

• For each resident, try to use the same scale used on prior assessments.

2. If the resident is unable to answer using one scale, the other scale should be attempted.

3. Record either the Numeric Rating Scale item or the Verbal Descriptor Scale item. Leave the response for the unused scale blank.

4. Read the question and item choices slowly. While reading, you may show the resident the response options (the Numeric Rating Scale or Verbal Descriptor Scale) clearly printed on a piece of paper, such as a cue card. Use large, clear print.

• For the Numeric Rating Scale, say, “Please rate your worst pain over the last 5 days with zero being no pain, and ten as the worst pain you can imagine.”

• For Verbal Descriptor Scale, say, “Please rate the intensity of your worst pain over the last 5 days.”

5. The resident may provide a verbal response, point to the written response, or both.

Coding Instructions for J0600A. Numeric Rating Scale (00-10)

Enter the two digit number (00-10) indicated by the resident as corresponding to the intensity of their worst pain over the last 5 days, where zero is no pain, and 10 is the worst pain imaginable.

• Enter 99 if unable to answer.

• If the Numeric Rating Scale is not used, leave the response box blank.

Coding Instructions for J0600B. Verbal Descriptor Scale

• Code 1, mild: if resident indicates that their pain is “mild.”

• Code 2, moderate: if resident indicates that their pain is “moderate.”

• Code 3, severe: if resident indicates that their pain is “severe.”

• Code 4, very severe, horrible: if resident indicates that their pain is “very severe or horrible.”

• Code 9, unable to answer: if resident is unable to answer, chooses not to respond, does not respond or gives a nonsensical response.

• If the Verbal Descriptor Scale is not used, leave the response box blank.

Examples for J0600A. Numeric Rating Scale (00-10)

1. The nurse asks Resident T to rate their pain on a scale of 0 to 10. Resident T states that they are not sure, because they have shoulder pain and knee pain, and sometimes it is really bad, and sometimes it is OK. The nurse reminds Resident T to think about all the pain they had over the last 5 days and select the number that describes their worst pain. They report that their pain is a “6.”

Coding: J0600A would be coded 06.

Rationale: The resident said their pain was 6 on the 0 to 10 scale. Because a 2-digit number is required, it is entered as 06.

2. The nurse asks Resident S to rate their pain, reviews use of the scale, and provides the 0 to 10 visual aid. Resident S says, “My pain doesn’t have any numbers.” The nurse explains that the numbers help the staff understand how severe their pain is and repeats that the “0” end is no pain and the “10” end is the worst pain imaginable. Resident S replies, “I don’t know where it would fall.”

Coding: Item J0600A would be coded 99, unable to answer. The interviewer would go on to ask about pain intensity using the Verbal Descriptor Scale item (J0600B).

Rationale: The resident was unable to select a number or point to a location on the 0-10 scale that represented their level of pain intensity.

Examples for J0600B. Verbal Descriptor Scale

1. The nurse asks Resident R to rate their pain using the verbal descriptor scale. They look at the response options presented using a cue card and say their pain is “severe” sometimes, but most of the time it is “mild.”

Coding: J0600B would be coded 3, severe.

Rationale: The resident said their worst pain was “Severe.”

2. The nurse asks Resident U to rate their pain, reviews use of the verbal descriptor scale, and provides a cue card as a visual aid. Resident U says, “I’m not sure whether it’s mild or moderate.” The nurse reminds Resident U to think about their worst pain over the last 5 days. Resident U says, “At its worst, it was moderate.”

Coding: Item J0600B would be coded 2, moderate.

Rationale: The resident indicated that their worst pain was “Moderate.”