Misinterpretation of the Faces Pain Scale-Revised in adult clinical practice

Background

The Faces Pain Scale-Revised (FPS-R) is commonly used for measuring pain intensity in paediatric and adult populations. When applied in a clinical setting, this scale may not always be used correctly as a patient self-report.

Methods

A sample of 99 nurses was selected at random from medical, surgical, critical care and aged care units over a 1-week snapshot period in 2002. This group of nurses was surveyed via open-ended questioning to assess their knowledge about applying the FPS-R, when measuring pain in adult patients who are able to communicate. Following the survey, a range of ongoing education strategies was implemented. Three years later, the survey was repeated using the same process (n = 101).

Results

In the initial survey, 52% of respondents gave a correct answer, stating that they would ask the patient to choose the face representing their level of pain. The second survey yielded a similar result with 55% of answers coded as correct by the investigators.

Conclusion

A substantial proportion of surveyed nurses were unable to describe the correct use of the FPS-R at either point of knowledge canvassing. In practice, it would appear that these nurses, if using the FPS-R, would not ask the patient about the intensity of their pain in situations when the patient is capable of a self-report. Implemented education strategies did not contribute to the correct application of FPS-R tool. Clinicians need to be aware of the possibility of misinterpreted application of self-reporting pain intensity measurement tools which employ a facial expression.