Wednesday, February 17, 2016

You're Not a Ten...and Other Helpful Ways to Look at the Pain Scale

I've spent some time despising the 1-10 pain scale that doctors use.  Here's the deal.  They know that if you spend several minutes whining about your pain and then say it's a 10 that you're really just a whiner and probably a 6.  They know that if you've been screaming at the top of your lungs for the past hour and then say 8 that you're actually at a 10.  And they know that if you wince dramatically and say 11 that you don't know how numbers work and you're actually a 5.  So I'm not entirely sure why they continue to use the damn thing.

And you may have seen this helpful graphic:

Take a minute to soak it in.  Ready?  Let's just move past the fact that the guy for 0 and 1-3 look like good things are happening in their underpants areas.  And the level 4 guy is mostly just confused.  Notice how the person with severe pain is frowning ever so slightly, the person with very severe pain is frowning a tiny bit more, and it takes the worst pain possible to cause tears.  I don't know who they based this on, but give me a couple hours at "very severe" and there will be massive quantities of tears, and that's just from whoever is dealing with me at the time.

This also doesn't take time into account, which is a major problem.  I sometimes have shooting pain with certain motions that hits the 8 or 9 on the pain scale.  This is the stuff that makes you gasp and stand motionless and then sloooowly sit back down.  But a few seconds at a 9 is not a big deal.  This is basically what happens when you stub your toe.  We hop around and curse the coffee table, but then we get over it and move on with our day.

In contrast, think about pain level 5.  It's not too bad.  You can probably still go to work, although you may be popping some pain pills to get through the day.  You can still do some fun things if they're interesting enough to keep your mind occupied.  Your day was a little rough, but you're proud of yourself for sticking it out.  But day after day after day of that compounds into a much more severe problem than you started with.  Living with pain level 5 for an entire year is more likely to make you look like #9 or 10.  Living with pain level 8 for a year is going to make you look like this:

Also added to this are the types of pain.  There's aching, burning, sore, stabbing, dull, weak, strong, stiff, numb, and others.  And locations of pain.  Having one hand at a 5 is much different than having your whole body at a 5.  Having one foot at an 8 is completely different from having your back at an 8.

I think that doctors need to pay more attention to the words that patients use to describe their pain.  They need to delve deeper into these discussions and create a common framework for understanding the severity and type of pain.

Over the past few years I've created a mental test to help me determine what number I am on the pain scale.  This helps me to stay consistent over time rather than to underestimate or exaggerate based on my feelings that day.  When my doctor asks what pain level I'm at, I answer with the number and part of the description, as in "7, because I can't read or care about tv" or "5, because I was able to work for a few hours but then I had to leave."

This pain scale is based on the average of a single day, although it may be more helpful to label a day with a range as in "4-5" or "5-8."

Sometime around midnight I decided that it would be funny to use a bunch of pictures from Supernatural because they have such amazing pain faces.  I could apologize but we both know I wouldn't mean it.

0  Technically this number doesn't exist on the 1-10 pain scale, I guess because it's assumed that if someone is asking you to rate your pain that you're at least a 1.  So ignore this.

1  What pain?  Oh that...I guess you could call that pain...or maybe a butterfly is sitting on's hard to tell.

2  I can definitely feel something - like the very beginning or end of a headache - or like I'm trying to do calculus in my head.

3  I feel slightly uncomfortable.  I might take some tylenol or ibuprofen.  I can do pretty much everything I want to, it's just less fun than normal.

4  I just don't feel good.  I can still go to work and do fun stuff that I want, but I kindof feel like I'd rather just hang out and watch tv tonight.  I just feel shitty.

5  I might leave work early.  I don't quite feel bad enough for that...but I don't feel good enough to stay either.  I guess if I have something important to do I can stick it out, otherwise I'm going to go home early and spend the afternoon with Netflix.

6  This is really not good.  I don't think I can go to work.  I mean, if there's an emergency or something I can go in, but it's not going to be my best work and I am out of there the moment all the urgent things are done.  I don't want to do fun stuff either.  I can maybe read a book if it's really interesting, or I can lay on the couch and watch tv.

7  Work is pretty much out of the question.  I can't concentrate anyway.  It's hard enough deciding what show to watch.  I can't read because the pain is too distracting.  I can't make myself anything to eat so I'm depending on whatever's in the cupboard.  At this point, I'll take just about any pill available to make myself feel better.  If this gets any worse I'm going to need to call someone.  This is pretty much when the tears and self-pity really take off.

8  OK...time to call the doctor.  Or head to urgent care if it's the weekend and hope they don't assume I'm an addict and turn me away.  I can't read or watch tv or carry on a conversation.  I'm mostly spending my time sitting or lying places staring at walls and trying not to moan.

9  If I'm not already in a doctor's office, this is emergency room time.  This is I can hardly walk or talk or think territory.  Feeling very desperate.  Can basically only speak in grunts at this point.  Hate everyone who isn't injecting me with morphine.

10  I mostly reserve this one for things the Vikings did to people they hated.  Or, like, this situation.

So here's how I imagine it:  Screaming from pain.  Or grunting.  Can't communicate.  Willing to do anything to make it stop.  Seriously anything.

And finally, because it's as helpful as it is humorous, the pain scale as created by Allie of Hyperbole and a Half.  Her post on it is way funnier than mine, so promise you'll read mine first, ok?

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