Nursing Explained™

Lessons / Safe care

Why isn't a pain score of 4 enough to go on?

Short · 1:45 · with Mia · Last updated

Kip's still colouring this one in.

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The question

Your patient says her pain is a 4 out of 10: is that fine, and what do I ask next?

Understand

Your patient says her pain is a 4. The number mostly tells you how strong it is, like the volume on a radio. It doesn't tell you what kind it is or whether it's new, and it may not show what it stops her doing. So ask, and check her pain when she moves, not only when she lies still. A student tells the supervising nurse, so the team can review the plan.

  1. Pain is a subjective experience, so what the patient says is the main measure: believe the number.
  2. A 0 to 10 score mostly rates how strong the pain is, not where it is, what kind it is or whether it's new.
  3. After surgery, ask at rest and on moving. Pain experts say what the patient can do should guide care, not the score alone.

Key takeaways

  • Believe the patient's score: self-reporting should be used whenever appropriate.
  • Ask what kind of pain it is, whether it's new, and what it stops the patient doing.
  • After surgery, check pain at rest and on moving, such as sitting or coughing.
  • Report new or unexpected pain: it needs a fresh look. New calf or chest pain could be a clot, so call straight away. Follow your local policy.

In practice

  • Believe the number, then ask what kind, what's new, and what it stops them doing.
  • Ask at rest and on moving. Some patients don't like to ask, so ask them.
  • New pain? Tell your nurse. In the calf or chest it could be a clot: stay and call straight away.

In one line

The number is the start: ask what kind, what's new, and what it stops her doing.

Check yourself

A patient says their pain is a 2 lying still, but won't get out of bed because it hurts too much. Is the pain under control?

Show the answer

The number alone can't say. What they can do guides care, so tell your supervising nurse.

Got it? Nice. Kip's proud of you.

Words to know

Self-report
the patient's own account of their pain
Numeric rating scale
pain rated from 0 to 10
Static and dynamic pain
pain at rest and pain on moving

Transcript

Read the narration

It's a four, love. Your patient's pain is a four. Is that fine? Alex, a student, writes it down. The physio's coming soon to sit her up.

If pain keeps her still, her recovery can slow, and slow blood in her legs can clot. Then Sam, Alex's supervising nurse, asks one question. A four doing what?

Why ask? Think of pain as a radio only she can hear. The number is mostly the volume: how loud, not which station.

You can't listen in, so believe her four. But don't stop there. Alex goes back. What kind of pain is it? Anything new?

What does it stop you doing? It's an ache, love, nothing new. I just keep still. And when you move? Oh, I can't.

I didn't sleep either. Didn't like to bother you. Pain experts say check pain at rest and on moving. What she can do guides care, not the score alone.

Sam, it's a four lying still, but she can't move, and the physio's coming. Now the team can review her pain plan. And if the pain's new? Same volume, new station: a new kind of pain, or a new place.

Tell your supervising nurse: it needs a fresh look, whatever the number. In her calf or chest, it could be a clot. Stay with her and call that nurse straight away.

So is her four fine? The number alone can't say. The number is the start: ask what kind, what's new, and what it stops her doing.

Sources

  1. ANZCA and FPM, Acute Pain Management: Scientific Evidence, 5th edition (2020): self-report, intensity scale, pain history, rest and movement, function over scores alone, reassess unexpected pain, older adults (read 5 November 2026)
  2. ACSQHC, Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, Quality statement 2, Acute pain assessment: pain intensity and its impact on function (read 5 November 2026)
  3. healthdirect, Deep vein thrombosis: pain and swelling near the clot, usually the calf or thigh (read 5 November 2026)
  4. healthdirect, Reducing your risk of developing a blood clot: tell your doctor straight away if you think you have a DVT (read 5 November 2026)
  5. Grace Hospital NZ, Total hip replacement booklet: blood flow slows when people cannot move about freely; pain in the legs or chest to report (read 5 November 2026)

Checked against these sources at the time of publishing. Sources change, so check the date above and your local policy. Spotted an error? Tell us and we'll correct it.

General education, not clinical advice. Check your local policy.