Are there reliable objective assessments of severe pain

What are the vital signs that we need to see to know that the patient has severe pain?

Here are the vital signs from a study comparing treatments for severe pain.^[1]

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These patients had an average pain level of 8, but –

Average heart rate was normal – 80 in one group, 84 in the other.

Average respiratory rate was normal – 18 in one group, 20 in the other.

Average systolic blood pressure was normal – 136 in one group, 138 in the other.

Average diastolic blood pressure was normal – 80 in one group, 83 in the other.

Average SpO₂ was normal – 99 in each group.

These averages are over 54 patients in each group.

Why do we believe that the patient is lying if the vital signs are in the normal range, rather than extremely elevated?

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Image credit.

Are we that bad at assessment?

Is our memory that selective?

does pain have to produce significant increases in vital signs to be severe?

According to the vital signs documented in this study –

No.

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Footnotes:

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^[1] Sufentanil is not superior to morphine for the treatment of acute traumatic pain in an emergency setting: a randomized, double-blind, out-of-hospital trial.
Bounes V, Barthélémy R, Diez O, Charpentier S, Montastruc JL, Ducassé JL.
Ann Emerg Med. 2010 Nov;56(5):509-16. Epub 2010 Apr 10.
PMID: 20382445 [PubMed – indexed for MEDLINE]

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