If you have fibromyalgia, suffer from migraines, or have some other chronic pain illness, I think you can develop a skewed view of pain. Then when you go to the doctor because of some new or acute pain, and they ask “What’s your pain level on a scale of 1 to 10?”, I wonder if the answer is the same as it would be from someone who is otherwise healthy. I think that it may not be. I think when you deal with chronic pain what level of pain you consider tolerable – because there is no choice but to tolerate it – is much different than the person who is accustomed to living with a zero pain level.
It used to frustrate me when doctors would ask what my pain level was because I had no frame of reference for what was a 3 and what was a 9, or anything in between. Finally, several years ago, a pain specialist gave me a pain chart that I found very helpful in that it provides a description of each number on the pain scale. (I had to chuckle that they include “0 – No Pain” on the chart because I have no idea what that is like and wondered what the point of including this on the pain scale, except maybe to torment those of us who can never honestly say we are at 0.)
Anyway, I thought I would share this pain scale here, for those of you who have never had a doctor who was kind enough to give you a somewhat objective frame of reference. (I say somewhat objective because, as I said above, I think chronic pain can skew your view of what is tolerable pain.)
- Minimal = Pain is hardly noticeable.
- Mild = Feel a low level of pain; aware of pain only when paying attention to it.
- Uncomfortable = Pain is troubling but can be ignored most of the time.
- Moderate = Constantly aware of the pain but can continue normal activities.
- Distracting = Pain is barely tolerable; some activities limited by the pain.
- Distressing = Pain preoccupies thinking; must give up many activities due to pain.
- Unmanageable = Constant pain that interferes with almost all activities; often must take time off work; nothing seems to help.
- Intense = Severe pain makes it hard to concentrate on anything but the pain; conversations difficult.
- Severe = Can concentrate on nothing but the pain; can do almost nothing; can barely talk.
- Immobilizing = Pain is excruciating; unable to move except to seek immediate help for pain in emergency room, etc.; bedridden.
I recently experienced a pain in my side and abdomen that was different than and in a different place than any pain I have ever felt before. After talking to an advice nurse on the phone, I went to urgent care because she said I needed to be seen right away. She was concerned that it might be appendicitis or gall stones.
Once at urgent care, the doctor asked me the million dollar question, “What’s your level of pain on a scale of 1 to 10, with 10 being the worst pain you’ve ever felt?” I really wish I’d had my handy pain scale with me. If I compared the pain I was in that day to the worst pain I’ve ever experienced (which happens to be a 10 on the above scale), it really wasn’t that bad. I think I told him it was a 3 or 4. But based on the above scale it was more like 6 or 7.
It turned out I don’t have appendicitis, though they still haven’t figured out what is wrong. But as I thought about my experience with this urgent care doctor, a guy who didn’t know me at all, I wonder how seriously he took my complaint of pain since it was only at a level of 3 or 4. I wonder if someone else coming into urgent care whose “worst pain ever” was only a 5 on this scale would have answered his query much differently.
Reducing pain to a number doesn’t seem that helpful to me. Does a subjective number that is skewed by the patient’s prior pain experience really help a doctor with a diagnosis? I don’t know that it does. So I think I’m going to print off this pain scale on a small piece of paper that I can easily carry in my purse so that the next time I’m asked that question, I can pull it out and have an objective description of my pain for the doctor.
Broken Believers 