Demystifying The Pain Scale

Ever go to the hospital and they ask you to rate your pain on a scale of 1-10? That is an example of the pain scale at work.

This is common practice throughout the medical community to assess pain in patients. There is a lot of debate among practitioners about these type of assessments and their effectiveness. Unfortunately, it is the standard at the moment, and we’re stuck with it.

If you are not familiar with the pain scale it can be very confusing. Putting a number to something without context is impossible. And on many occasions the only context is a line up of faces ranging from happy to grimacing, which was intended to help children articulate pain. For most of us, this only seems right for labeling a routine headache, not a medical condition or injury.

The inherent flaw in the scale is context. If your doctor is using it to keep tabs on how your pain today compares to your pain previously, it is a great tool. It can then allow the patient and doctor to track the ups and downs of their treatment and progress. It gives them a common language.

Lack of Context Causes Misunderstandings

Unfortunately a lot of the time, this scale is used in situations that lack this context, such as emergency rooms.

If I asked 10 people across the country to label how expensive their home town is on a scale of 1 to 10, how would I understand the results? A doctor might find Manhattan to be a 7, where a fast-food worker may find Des Moines to be an 8. Does this mean Des Moines is more expensive?

This often happens in hospitals. If you have not experienced a lot of pain in your life, then it stands to reason that you will rate pain from an injury as an 8 or 9. Someone else, with chronic pain, will rate a similar injury as a 5 or 6. So someone with a sprain may rate their pain as more severe than someone having a heart attack.

Most of the time, hospital staff know the inherent flaws in the system and compensate by asking questions to better understand the situation. More than one triage nurse has admitted to a mental eye-roll when a patient calmly says their pain is an 8 and proceeds to sit down and laugh and joke with their neighbor.

Not Every Practitioner is Equal

But not always. Sometimes they enter your number into the system and move on without even making eye contact or thinking about what they are doing. So now you are in a queue behind Mr. Chuckly because you said 5 and they think that it must be no big deal.

When I was a kid I dislocated my knee. I was downtown on a Sunday night in a small town, so I had to walk home. When I got there, my mother said she would take me to the doctor in the morning, because if I could walk on it, it was probably fine. When they sent us to the city for treatment and put me in a cast for 8 weeks, she was shocked. She had suffered a similar injury 10 years earlier and could never have walked on it. She said the difference must be my medical history and the pain tolerance I had developed.

So what do you do when they have no context for your answer?

Provide Context

Offer them some. You don’t need to give them your medical history. It wouldn’t do much good anyway; one chronic pain sufferer is not like another any more than one athlete is like another.

Answer in terms of their own scales. The problem with a number is that it lacks information. They will insist that you give one, but you are better off to expand on your answer. For example, you could describe it as a 4 when you are sitting, but an 8 when you put any weight on it. Or make sure they understand what you mean when you say 6. Tell them that you would rate it a 6 because you can’t sleep and have completely lost your appetite.

Giving them these types of descriptions is more helpful than a number without context. They need to label you because of their processes, so you need to help them do it more accurately.

Keep Providing Context

The biggest mistake I have made over the years is failing to realize that people need to be reminded. Like most people with a chronic condition, I get tired of talking about it. Sometimes it just feels like complaining. But it has usually been to my detriment, your caregivers have many patients and can forget your situation, especially early in the relationship.

After one of my knee surgeries, I was in physiotherapy, trying to bend the knee. Every week my physio would ask how much pain I was in 1-10. I would answer 7 and she would tell me to try harder. I assumed, after taking my medical history that she understood 7 was a big deal. Then finally one day she gave up on me and sent me back to the surgeon.

He didn’t even ask to see me, he booked an Operating Room, knocked me out and bent the knee himself; the joint had fused from the scar tissue. When I went back to the physio the following week, she apologized.

But it was my fault too. We just weren’t communicating well enough. After that things went a lot better and she started looking for signs I was pushing myself too hard. I learned to warn people that my problem was overdoing it, and they might have to hold me back, not the other way around.

So, make sure to build that relationship with each new health provider. Give them all the information, even if you are totally bored by it. Make sure they know who you are as well.

Would you rather experience some of the pain than deal with how the medication feels? Would you rather not feel anything? Something between? Knowing how you feel pain and how you handle pain is very important to your medical treatment.

Pain Scale Definitions

Below I have a few of the common pain rating systems the medical community uses. As you can see, there is a lot more to your number than you may realize.   This site has a great overview of the various pain scales and their definitions and uses. I have found that knowing what they mean helps me a lot to communicate.

Faces Chart

(based on the standard Visual Assessment Scale)

Diagram of pain assessment tool. VAS

Numeric Ratings

(based on the standard Numeric Rating Scale (NRS-11))

0             No Pain

1–3         Mild Pain (nagging, annoying, interfering little with Activities of Daily Living, such as bathing and eating)

4–6         Moderate Pain (interferes significantly with Activities of Daily Living)

7–10       Severe Pain (disabling; unable to perform Activities of Daily Living)

Pain Scale Definitions

(based on the standard Mankoski Pain Scale)

0  Pain Free No medication needed.

1  Very minor annoyance – occasional minor twinges.

2  Minor annoyance – occasional strong twinges.

3  Annoying enough to be distracting.

4  Can be ignored if you are really involved in your work, but still distracting.

5  Can’t be ignored for more than 30 minutes.

6  Can’t be ignored for any length of time, but you can still go to work and participate in social activities

7  Makes it difficult to concentrate, interferes with sleep You can still function with effort.

8  Physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain.

9  Unable to speak. Crying out or moaning uncontrollably – near delirium.

10  Unconscious. Pain makes you pass out.

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