The Dreaded Pain Scale

Jun 26, 2019 | Oludare (Dare) O. Olatoye, M.D. | @oludareolatoyemd | Comments (31)

pain scale

Nearly every medical appointment you go to these days will ask if you are experience pain. If you say "yes" the next question is likely "please rate your pain on a 0 to 10 scale." This can be confusing to you as a patient and you might be wondering, "how do I put a number on my pain?" "What is my provider really asking?"

There are several types of pain questionnaires that clinics use which are slightly different in content, the number of questions and the actual scale used. We have developed some Frequently Asked Questions (FAQs) to help makes this a meaningful part of your next visit.

Why is rating your pain so important?

The purpose of the pain scale is to provide a standardized means of measuring pain intensity and severity. Everyone experiences pain differently and each of us has a difference tolerance for pain. Therefore, your pain score is unique to you. You might provide an explanation for your pain score. For example, "on my best day my pain is a 0, but at its worst it is a 6."The goal of asking a number is to identify how pain is affecting your routine daily activities. By giving the numbers some definition, we hope to help you assign a number.

  • Pain Free = 0
  • Mild Pain = 1-3 (nagging or annoying but doesn't interfere with daily activities)
    • Ranges from "barely noticeable" to "distracting" because you are somewhat used to it and have learned to live with it
  • Moderate Pain = 4-6 (interferes with daily activities)
    • Ranges from "distracting pain that can only be ignored for periods of time" to "difficulty concentrating"
  • Sever Pain = 7-10 (disabling or unable to carry out normal daily activities)
    • Ranges from "impacts your social relationships, or sleep" to "being bedridden or even delirious."

What shouldn't I do when talking about my pain?

Do not overstate your pain. While you want to convey that your pain is severe, saying your pain is a 12 out of 10 while sitting upright in the doctor's office may not be to your benefit. Consider that natural childbirth (no epidural or medication) is generally thought to be an 8 which means that your physical activity is severely limited and talking requires effort.

How can I make the score mean more?signs pointing you in direction of better, same, or worse

Give your pain more than just a number. Being able to describe your pain will help your care team better understand how it may be impacting your daily activities. Consider the following:

  • Does the pain come and go or is it always present?
  • What makes it better?
  • What makes it worse?
  • What word best matches how it feels? Stinging, penetrating, dull, throbbing, achy, nagging, gnawing...
  • Does the pain stay in one spot or does it travel to different parts of your body?

Just as important as pain scores is your functional status in response to the treatments or interventions you have already tried.

  • Have you been able to walk farther?
  • Is the pain less which allows you to do more for yourself (i.e. get dressed, go to the bathroom independently, brush your hair)
  • Can you sit upright and working on your knitting (or other meaningful hobby)?
  • Are you able to go to your local worship service  (or other meaningful activity)?

What is the difference between acute vs chronic pain?

In general, healthcare providers divide pain into two categories - acute and chronic

Acute Pain: acute pain is temporary, related to the physical sensation of tissue damage. It can last a few seconds to a couple months, but generally subsides after normal healing occurs

Chronic Pain: Chronic pain lingers long beyond the time of normal healing, lasting from a few months to many years. It may range from mild to disabling and change frequently.

You may already have chronic pain and are now experiencing, acute pain. Your care team will ask you specific questions to help determine whether this pain is new (acute) or whether it is related to your chronic pain. Understanding how to use the pain scale and communicate your pain to your care team will help determine the best treatment options for you.

Helpful Links

 

 

Interested in more newsfeed posts like this? Go to the Adult Pain Medicine blog.

The pick a number to rate your pain is not understood the same by everyone. When I first was injured, the medical facility asked me to rate my pain. I actually told them I did not understand the 1-10 number and how to rate my pain. I initially refused to answer this question as no one could really explain it. They were like 10 is the worst pain you've ever had and 1 was little to no pain at all. Well, that really did not help.
I don't recall what the "worst" pain I ever had. I just cannot remember what that may have felt like. Im sure there is reason for this???? Ok so it must be bad. I have gone to all the trouble and expense of going to see a medical professional for help. If I could have toughed it out, I would not be here, right. Hmmm ( 8 ), yea that sound good, (8) is my pain level.
Couple days later I am back on the job. Here comes the boss, are you ok, do you need to sit down or take a break. No, I tell him, I'm ok. He replies easy does it ok. I ask; What the hey is going on here. This is construction. We don't take it easy. He tells me he was contacted by HR and that I have a pain level of (8) and everyone is concerned. OMG, what did I do? Yes, it hurts and has been given me problems doing certain things lately, but now I am being diminished on the job. I am so embarrassed and all of a sudden concerned about keeping my job.
Back to the crux of the what's your Pain 1-10. After many visits to the doctor's office and many times trying to understand the 1 - 10 and many guesses at what my pain level was. I discovered the US dept of defense has a pain scale chart with emojis and a description under each. As a matter a fack there seems to be as many of interpretive pain (Happy to Sad) face charts are there are doctors. I chose the US Dept. of Defense pain chart because to me it was more descriptive and also offered a pain range. Took a picture of it with my phone and every time someone asks me now I look at this picture and pick one accordingly. I figure at least this way I am consistent. I'm not sure the medical personnel have any consistency or standard it which to interpret my numbers.
In short, the 1-10 is garbage as no one understands what it means.

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@theconfessor

It's unfortunate that you avoid mentioning pain and have stopped looking for solutions. I understand that attitude. Long before my pain issues cropped up, I was in treatment for bipolar disorder. There were feelings I had to keep quiet about because revealing them would lead to being labeled suicidal, when in fact, I wasn't. I know that's a different topic but I mention it to assure you that I know what you're going through. One important thing I learned during mental health treatment was that the patient has to take control of the patient/doctor relationship, not let the doctor dictate treatments that you know haven't worked for you. In other words, the patient actually hires the doctor, and can fire the doctor and find another who is more compassionate and knowledgeable about the need for whole person (mind, body, and spirit) analysis and treatment. I'm not advising you to fire your doctor and/or medical providers, you might not have an alternative choice. But I am attempting to inform your attitude. You say: "I always feel like if I tell them about my pain they will think I am looking to feed an addiction." Do they really? Are you sure? It's human nature to make assumptions like that when you experience trauma, debilitating pain, and other conditions that can diminish your reasoning and thinking processes. It's nothing to be ashamed of if that is happening. Please consider that possibility. If you come to the conclusion that what I've said may be interfering with getting the best possible care, write down some notes that explain your pain; where it is, how intense it is, how you feel about revealing it, ideas for better outcomes. You might make 5 notes to yourself on some days, you might make 1 or 2 over a weeks time.As you continue doing this, things may become clearer in your mind about your assumptions and why you've made them. You could be 100% right about your assumptions. But what if, yes, what if you start to see a flaw in your viewpoint? What if your notes open you up to a more positive attitude about your medical providers? Review your notes between doctor visits and try to improve them by summarizing them, condensing thoughts that you've repeated during the process into one coherent sentence or a short paragraph. you have nothing to lose. Then, during a week or 10 days before your next doctor appointment, put those notes into the form of a letter that you can ask your doctor to read. Myself, I get distracted and overwhelmed trying to explain some things, and end up forgetting everything I intended to talk about. I've been with my doctor for about 8 or 9 years now, we've established a trust, I don't have to repeat things I told him 3 or 5 years ago unless they've gotten worse, or better. We discuss how some issues could be a result of some event or that they could be temporary. I'm lucky to have a very compassionate and knowledgeable doctor, I know not everybody does. So just think about what I've written, OK. Believe in yourself, keep your cool, and try to open up better ways to communicate. Maybe it will help, maybe it won't, but as I said, you have nothing to lose. There just may be a solution out there that can be found if you set aside your fear about talking about pain and are able to communicate it in a different way. Good luck auntieoakley.

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I am lucky to have a physician experiencing extreme pain himself. So, we are both empathetic to each other's condition, even though my experience is caused by a different ailment. He has never asked me to rate my pain. He accepts the fact that it is severe.

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@theconfessor

The pain scale doesn't work for me, it's meaningless in describing my pain level. I'm very, very rarely a 0 (zero), if ever. I think we adapt to chronic pain such that a 3 or 4 for someone less pain tolerant doesn't even register for us chronic pain sufferers any more, I'm very, very rarely a 10. I base my 10 on the 60+ days of constant debilitating pain I felt during misdiagnosis for gall stones, especially the last 48 hours before emergency surgery to remove my gallbladder, that had gone gangrene, For a woman, that 10 might be an especially painful, many hours long childbirth. Since everyone has a different pain threshold, and different sensitivity, I see no way to establish a 10 scale pain descriptor. The smiley faces, frowning faces, red faces, etc don't account for the curled up in a fetal position pain many of us experience, whether for several hours or a few days. Even the pain scale descriptors in the 8 - 9 range that totally interfere with my daily functioning feel more like a 4 or 5 in my own personal pain scale. I'm just venting here. I'll bet many of you can relate to this conundrum.

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Yes. I can relate. And I hope you find the things and people who will help you live better.

Venting is entirely acceptable in my world. I vent to my dog all the time. No harm done.

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@meanderson

I am a young 81-year-old woman who had both knees replaced two months ago July 29, 2019 I’m having some problems with IT band syndrome any information you can send to me would be appreciated extra exercises and whatever

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Hi meanderson,
Do you do Instagram? There is a guy on there who shares Really Easy, Beginner Friendly Exercises almost every day. I don't buy from him or know him personally, but have been following him for a long time and he is Great! He is @justinagustin What he shares on Instagram almost everyday is Free. He does have a program you can buy but just 'following' him is So Helpful! 🙂 Becca

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@emil

Yes. I can relate. And I hope you find the things and people who will help you live better.

Venting is entirely acceptable in my world. I vent to my dog all the time. No harm done.

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Until your dog gives you that OMG 😲 look then it's time to stop 😆

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I’m amazed that natural childbirth is considered an 8 on the pain scale. Maybe mid-process is what’s being referred to?

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Must be a dozen different pain scales. Everyone I have seen describes their interpretation differently. Being the pain sufferer, I have never been able to pick what I thought was the correct number. Also, the pain I am in changes by the hour. And then the sharp shooting pain on top of the pain that can last for 2 to 20 minutes. Does that get a separate number?
The number system left me feeling like I was in a land of make believe.
The Department of Defense has their own pain chart (of course). So, I took a picture of it and saved it on my cell phone. Now whenever I am asked my pain number. I show them my pain chart. (Everybody else has one why not me). This helps me feel like my number is more consistent.
No one really knows how to measure pain so guessing at numbers is what we do.

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By the way the ankle pain that is kick your ______. That sort of pain barely bothers me at all. And well what's a little back ache. You want to know pain you should feel my shoulder pain! Thats sort of a joke. Some of us can tolerate more of one thing and that of another. Kind of like your burden is not as heavy to me and vice versa.
Making all the more difficult for me to understand pain and limitations associated with it.

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The pain 0 to 10 when you are taking pain medications what do you use. With the meds I am at a 3 to 4, So when I am asked I always have to tell them that score is because of the medications. Too remind them that without them I would be at a 7 or 8. I have numerous issues, neuropathy, needing a knee replacement, torn rotator, and chronic neck pain. I am 70 years old, I would need surgery on every pain issue and I don’t want too do that, the meds keeps it low enough for a somewhat ok life. I do believe however if you have a doctor who simply believes all narcotic pain meds are bad get another doctor. I have MRIs on all ailments so they can see the issues. I take Gabapentin 300mg twice a day and 15 mg of MS Contin twice a day and Percocet for breakthrough pain.

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I need to say define your numbers. All seem to interpret the scale differently. I go to the doctor when pain is intolerable. What number is that, I ask?

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