The subject of pain

Actually, the subjectivity of pain.  It's very tricky to talk about pain, because we all experience it so differently.  Doctors and hospitals always want you to rate your pain, and this practice is always funny to me.  There seem to be three kinds of reactions in people when you present them with a standard-issue medical pain scale:  1) People who just want good pain meds and rate their pain as high as possible to acquire them; 2) people who have no idea how to evaluate their pain and guess randomly in the middle, typically between 4 and 6; and 3) stoic types who have either had serious pain in the past that forever influences how they rate other pain or else don't want to seem complainy and so rate their pain low.  

I love it when people - even women who have experienced childbirth! - rate their pain at 10 even though they are sitting calmly, perhaps reading a book or watching television, periodically smiling or laughing when something humorous happens, and just in general appear to not be screaming or passing out.  I'm sorry folks, but you are not experiencing level 10 pain.  Even the ones who have experienced childbirth seem to have forgotten that they were yelling and crying at the time.  If you're not yelling and crying now, hmmm, maybe this isn't actually as bad as childbirth, eh?  I had pancreatitis a couple of years ago.  That's an illness where something makes your pancreas really mad, so mad that it tries to kill you.  From the inside.  Seriously.  The pain from pancreatitis, in addition to making me vomit and wonder if my recent surgery incisions were ripping open on the inside, perhaps causing me to bleed internally, also caused me to feel like I was becoming detached from my body, and floating away, as though the pain were literally killing me.  That experience has forever defined pain levels for me, and I call that level 9.  That's right, 9, not 10.  Because I figure that level 10 really would have killed me.  And because I can imagine things that would hurt worse.  By definition, 10 really needs to be the worst possible pain you can imagine, right?  I think being on fire, perhaps getting shot, certain types of complex fractures, and maybe childbirth, among other things, could all be worse than what I felt with pancreatitis.  Not just any fracture though, because I've broken my arm before, and that didn't hurt anywhere close to as bad.  

So when I have pain that's constantly on my mind, inhibits my movements and forces me to seek relief with medications, I call that from 5-7, depending on how restrictive it is, whether I cry, and whether the medications relieve it much.  If I have pain that's tolerable even though I don't like it, and I can get by mostly okay without medications, that's typically a 2-4.  Anything less than a 2 means it's either not constant, or hurts so little that I can often forget about it or ignore it.

But that's how I rate pain.  The problem for medical personnel is that the next person won't rate pain the same way I do.  There have been some rather funny attempts to make better pain scales. I enjoyed this one especially, along with its helpful drawings.  I think perhaps a pain scale that uses analogies we've all experienced or can imagine would be more helpful for medical personnel than the one they're using now.  If I were to give a go at creating a new pain scale, it would be something like this:

0 = Oooh, I found a quarter. Happy day!

1 = Oh darn, I have a hangnail.

2 = This headache just won't quit. I need some over-the-counter sized doses of ibuprofen, acetominophen, or naproxen sodium.

3 = I fell down and bloodied both my knees.  The scrapes sting constantly and I'd really like to find something to get my mind off it.

4 = This is a pretty serious sunburn.  Blisters form, and everything is so tender that I'm careful how I move and would rather not be touched.  

5 = A broken arm or sprained ankle.  Definitely would appreciate some hydrocodone, or maybe the big 800mg ibuprofen pills, and body movements are visibly altered by the pain.

6 = I can't think of anything else but this pain.  I am willing to beg for pain relief.

7 = I can hardly speak because of this pain.  I just gesture wildly for you to bring me morphine. I may also be nauseated by the pain.

8 = Having regained the ability to speak, I now scream for morphine.

9 = A medically induced coma is looking like a really good option here.  I will do anything to escape from this pain, including having an out-of-body experience.

10 = Just let me go toward the light...

Perhaps this will help you the next time you're sitting in your doctor's office being asked to rate your pain.  Maybe don't go straight for the 10, eh?  Try on a 6 for a change, or maybe even a 5!  And of course, the most important part of any pain scale is for it to start a dialogue between you and your medical team.  Give as much detail about the pain as you can, how it limits your activities, whether you feel sick or like your heart is racing, can you breathe through the pain, has anything worked to relieve it, etc.  The more they know, the better they will be at helping you with your pain.

One more thing:  not everyone will reach these pain scale levels at the same level of pain.  It's important to be honest about your pain, and don't assume you should be able to "handle" as much pain as someone else.  When you reach your personal level 6, and you're ready to beg for medicine, you'll know.  It's okay if you reach your 6 earlier or later than the next guy.  It's supposed to be customized to what you need.