Improving Patient Care One Face at a Time

How did your widely used scale come to be?
I met Donna Wong, the late co-author of the scale, in 1981. We shared a concern about pediatric patients being able to communicate their pain levels with the numeric rating scale. We gave children a piece of paper with six circles in a straight line and asked them to draw faces in the circles, from "not pain" to "worst pain." We did that with about 50 kids, and a clear pattern emerged. From there, we had an artist recreate the children's drawings, and that's the scale you see today.

How has the usage of the scale evolved?
It was first included in one of Donna's books (1983) and has grown steadily since. Around 2008, we noticed people modifying and using the scale inappropriately. Facilities even tried to use it on unresponsive patients in comas. We established the Wong-Baker FACES Foundation to protect the integrity of the scale and give providers confidence they're using a tool with reliability and validity. Last year, our website had visitors from 172 countries, and the scale has been translated into more than 60 languages.

Do any stories about the scale stand out to you?
Two. A mother emailed to say the scale saved her son's life. He's on the autism spectrum and used the scale to express the pain he was experiencing, which led to a life-saving surgery. I had tears in my eyes as I read that. Then, a large pharma company used our scale in a multinational research project and hired a company to translate it into numerous languages. On the day translations were completed for the Afrikaans, Southern Sotho, Xhosa and Zulu languages, a nurse in a remote South African clinic emailed me to ask if the scale was available in those very languages. It was a true global connection.

How should surgical professionals utilize pain scales?
Whatever scale they use should be shared with patients before surgery and explained in detail. Donna was passionate about "atraumatic" care, and there are simple ways to make surgery less stressful for patients. Anxiety can impact outcomes, and clearly communicating pain control plans with patients is a huge anxiety-reducer. Also, expressing pain is a vulnerable experience, so providers have to be truly present and focused when patients are discussing their discomfort level.

What's next for your Foundation?
We just collaborated with Cornell University and created five new scales, two based on our scale for anxiety and anger, and new scales for depression, fatigue and brain fog. For more info on the project, visit: osmag.net/X8NkdX. OSM