October 08, 2014 — Blog Post
My Pain Is Always Going to Be a 10
Full disclosure: I am not a fan of the pain scale. While I understand the need for trying to objectively evaluate a subjective topic, this method of “rate it on a scale of 1 to 10, 10 being the worst” is, in my opinion, terrible. Rare is the person in any amount of pain who’s going to say “I feel like stigmata is happening in five places in my body, but I guess I’d rate that a 7.”
Nope. Most people are going to call it a 10 because it feels AWFUL and 10 seems like an appropriate choice for awful. This is particularly true for acute pain patients, many of whom may be otherwise healthy people not used to feeling or evaluating their pain.
When I first dove into learning about pain, both acute and chronic, the Wong-Baker pain scale popped up all over the place. All I kept thinking was, “Those faces are super misleading.” (I’m not alone: a wildly amusing reinterpretation of the Wong-Baker scale can be found on Hyperbole and a Half’s blog site.) So I started to think about how I could describe the pain scale to patients for our acute pain programs. I wanted it to make sense but also still match up with the information they were going to be presented with in a healthcare setting. For this, I figured we needed to give examples of what kind of pain might be expected at certain pain levels.
My thought process went a little like this:
1 on the pain scale: easy. “You’re feeling great.” Done! Line ‘em up again – I’m knocking ‘em down like a pro.
3 on the pain scale: OK, this one’s a little more difficult. But perhaps something along the lines of “It feels like a sprained ankle – painful and uncomfortable but not causing an inability to think straight or anything.” Still feeling good, though starting to doubt my ability to really explain all these numbers.
7 on the pain scale: Hmm. Things are starting to get a little dicey. How do I explain really bad pain without making it seem like the WORST pain? Gar. Now I’m beginning to see the challenges pain clinicians face on a daily basis. Hopping on the phone with our medical advisory panel, we come up with something like “This feels like something along the lines of a blinding migraine – pain so intense that you can’t concentrate.”
10 on the pain scale: Alright. I need something that really caps off the scale in a grand-finale-of-fireworks kind of way. I bat around several options (for example, “a 10 is like giving birth while on fire”) but eventually settle on this example: “a 10 is the worst pain you could possibly imagine – like if a shark was ripping off your arm while a train ran over your legs.”
After discussing the last one with our advisory panel, we all agreed it was ridiculous enough to convey the extremity of a 10, but also vivid enough to evoke the kind of pain that might genuinely be a 10. After all the idea is not to keep people from saying their pain is a 10, but rather to get them to say it only when it truly is a 10.
During this project, one thing I discovered for sure was how hard it is to objectively evaluate something as subjective and personal as pain. So I’m still interested in figuring this one out – got any ideas?