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Whenever I go in to see the chiropractor or therapist they always ask me if I'm "better," "same," or "worse." I don't really have any idea how to tell. Isn't there some kind of pain measurement I could use to gauge how I'm doing?

Using the "better," "same," or "worse" method is actually a good tool if you think of these three places on a line or a continuum from left to right with 'better' at one end, 'worse' at the other end, and 'same' in the middle. It gives the health care professional an idea if you are headed in the right direction (better) or not.

There are many other tools available to use. One is called the numerical pain rating scale or NPRS. It's a line just like the better-same-worse scale. On the left of the scale is the number zero (0) indicating no pain. The numbers go up as you move to the right with the number 10 at the far right showing "worst pain" imaginable.

The NPRS has been tested many times and found to be reliable and valid for use with patients in the clinic or with research. You may have seen a similar scale using faces to show how the patient feels. At one end is a happy face. At the opposite end is a sad, painful face. There are several faces in between. This scale was always used with children but it's become very popular with adults, too.

The real key is to use the same scale each time to assess for change. Moving in the wrong direction (worse) is a signal that something isn't right. Moving two points toward higher pain or worse function should be examined more closely.

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