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How painful is pain?



How painful is pain?


A child falls from her bike and hits her head. Through tears, she says, “It hurts real bad.” A builder hits his thumb with a hammer and says, while hopping and holding his thumb, “Ooooh, it hurts like the dickens!” Meanwhile, a WW1 British officer shoots a 303 bullet through his foot in trench warfare and says to the medic through clenched teeth, “I say, this is rather uncomfortable.” All expressions of pain, all laden with cultural, contextual, and linguistic subjectivity.


Nurses have faced this problem and cracked it, and we could do well to learn from them. The NRS-11 rating scale is a commonly used tool for assessing pain intensity. It is a simple and easy-to-use scale that allows patients to rate their pain on a scale of 0 to 10, where 0 represents no pain, and 10 represents the worst pain imaginable. Here are some of the merits of the NRS-11 rating scale:

  1. Easy to Use: The NRS-11 is a simple scale that is easy for patients to understand and use. They can quickly rate their pain on a scale of 0 to 10, without the need for additional explanation or training.

  2. Reliable: The NRS-11 has been found to be a reliable tool for measuring pain intensity, with good test-retest reliability and inter-rater reliability. The NRS-11 has been validated in a number of studies and has been shown to have good construct validity, convergent validity, and discriminant validity.

  3. Sensitive to Change: The NRS-11 is sensitive to changes in pain intensity over time, making it a useful tool for tracking changes in pain levels over the course of treatment.

  4. Applicable to a Wide Range of Patients: The NRS-11 can be used to assess pain intensity in a wide range of patients, including those with acute and chronic pain, and those with different cultural and linguistic backgrounds.

  5. Comparable: The NRS-11 can be easily compared across different patients, settings, and time points, making it a useful tool for research and clinical practice.

However, we don’t write this because we're in the patient care business. We're in the executive education business, and the NRS-11 rating scale, as a simple and easy-to-use tool for assessing pain intensity, has been successfully adapted by us for reviewing meetings.


In our course called Tactical Meeting Review, we ask participants to rate the meeting against a range of qualitative criteria, but we ask them to express that rating as a x/10 (NRS-11). This allows fellow participants to compare with others in the same meeting, compare with prior meetings, seek out gaps by pursuing the question “where were the missing points?” and to give proportions to areas of success and failure.


So out of a single application of the NRS-11 rating scale in the workplace, we get a standardized, quantifiable, and easy-to-use tool for measuring subjective experiences, such as meeting reviews.

When you couple it with qualitative analysis, it is indispensable.


While we have been using and teaching NRS-11 formally for six years, we want to acknowledge the first place we learned of it, "The Checklist Manifesto" by Atul Gawande, where it forms an example of Gawande's argument in favor of using checklists in healthcare. We also want to thank Chat-GPT for providing writing structure ideas for this post. About 1/3 of the substance here is from AI.

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