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New DOD way to evaluate pain

Your pain on a scale of 1-10 explained

The DVPRS pain scale is being rolled out across the Military Health System and in civilian health care organizations as an improved way to determine pain levels. Photo credit:

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If you receive care in a military medical treatment facility, you might notice your health care team is using a new method for assessing your pain.

The Military Health System is rolling out a new pain management strategy known as the Defense and Veterans Pain Rating Scale, or DVPRS

Most people are familiar with the traditional way of assessing pain during a medical appointment. Patients were usually asked to "rate your pain on a scale of 0-10." While for many years this seemed to make sense, there was growing evidence that both patients and providers were not satisfied with this approach.

The 0-10 scale often resulted in a superficial discussion of pain with a single focus on getting the pain to zero. Military health experts say the traditional scale was often associated with an overreliance on medication and a negative impact on a patient's quality of life.

"It was clear from our discussions with patients and clinicians that the standard 0-10 pain assessment needed to be improved, said Dr. Chester Buckenmaier, director of the Defense and Veterans Center for Integrative Pain Management, which is the DOD's center of excellence for pain management located at the Uniformed Services University of the Health Sciences.

"We needed a way to expand our pain assessments beyond just looking at pain intensity," Buckenmaier said.

In response to this challenge, a DOD pain management task force developed the DVPRS, which combines several previously validated pain assessment tools with some important additions.

To start, the DVPRS incorporates functional descriptions for each of the 0-10 levels of pain so that successful pain management is associated with improved function rather than what Buckenmaier called "chasing zero intensity."

The DVPRS also includes an assessment of the patient-reported impact of pain on four specific quality of life indicators: activity, sleep, mood, and stress. This provides clinicians with a deeper understanding of the patient's pain condition and a better way to measure the progress and effectiveness of pain management treatments.

The DVPRS was developed at a time when the military health system was increasingly attentive to pain management issues, as many Iraq and Afghanistan veterans were facing chronic pain conditions and health experts have sought ways to avoid heavy medication or overreliance on narcotics.

Beyond the military community, the DVPRS has been gaining attention in numerous civilian health care organizations. For example, the West Virginia University Health System recently designated the DVPRS as its pain assessment tool.

A DVPRS information video is available at

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