Pain scale Dr.'s use -is it any good?

You go to the doctor and complain about a pain, he tells you: “rate that pain on a scale between 1 and 10”

does this really do any good?

So many people have different pain levels, and maybe your worse pain was when you hurt yourself when you were six, if you’re forty now and did the same thing you did when you were six, then wouldn’t it make sense that the pain level isn’t the same?

I suspect it at least helps the doctor/nurse assess how well you’re tolerating the pain you’re in. My 3 may objectively hurt more than another person’s 3 (if it were even possible to measure that sort of thing) but I rate it as a 3 because I’m no where near the point of “make it stop!” Another person might rate it as a 7 because they’re less able to tolerate it for any amount of time.

All pure conjecture of course.

It’s not going to be the major factor in their diagnosis, but it’s useful information. There are certain conditions that are almost guaranteed to produce agonizing pain; there are certain ones that usually don’t. It just gives them a rough guide of the level of pain you’re experiencing, which is a relevant symptom, and there’s no other way to gauge it.

Motorgirl: Exactly my point.

But how does it help at all when there can be someone in the other room with a splinter in their finger saying: ‘it’s a ten, it’s a ten!’ and then you could be there with a sprained ankle shrugging and saying ‘I guess it’s about a three or a four’. ?

Isiah: Ok… I get that. Something like a broken leg would have to be agonizing pain - but isn’t it possible that someone could be there with a broken leg and have little or no reaction? But that guy with the splinter in his finger sounds like a holler monkey?

I was a normal control (guinea pig) in a dehydration study decades ago. I was rewarded handsomely for my discomfort. I had to rate my thirst on a 1 to 5 scale. Midway in the test I said 5. Things got worse, so I had the researcher bump all previous answers back one notch. Then things got even worse, so we notched back again. I never realized how thirsty a person could be. And the numbers are all relative to your prior experience.

Happily, I no longer have to endure mild torture for $$.:smiley:

Well, it’s one way to be able to write down the patient’s perception of pain. Considering that you can’t just hook up someone to a machine and have it assess pain levels, asking the patient is your option. Ideally whoever is charting the pain would also add things like the patient’s statements about how the pain does/doesn’t affect ability to perform tasks, etc.

There are always people who will screw up a rating scale in one way or another*, but for most it’s more or less useful as a simple gauge - at the very least to track how their pain is now compared to last visit.

  • I’m talking to you, Mr. “my current overall health is always 100 on the 0-100 scale, with 100 being the best health you can possibly imagine.” You have high blood pressure, are under major stress constantly, and your vision is at risk of permanent damage and gradual loss due to the serious eye conditions you have. If you hate answering extra questions, don’t be in research studies.

The use of the number helps doctors in a whole bunch of different ways that you’re not considering.

It doesn’t matter to them what objective level of pain you’re in. They care about what the appropriate response should be. If a person with a splinter is yelling 10, the appropriate response is to DO SOMETHING. That may be a shot of morphine, it may be to take the splinter out, that may be just some TLC. That the pain is getting a response is probably enough in and of itself to be helpful, whether from a placebo effect or actual doctoring.

And they never ask you that question just once. They ask it over and over. Having a series of pain levels gives them lots of information. They have experience with other people in your predicament, so they know what the likely progression of pain is. Therefore they can compare your progression and see if it’s on course or whether something needs to be done. A sudden spike in a series would also be a trigger that something’s wrong.

They also have experience with the whole range of how people answer the question. They’ll get familiar with stoic types who don’t like to admit to pain, conscientious patients who try to seriously estimate where their pain falls, nervous patients who needs constant attention, and numbskulls who think that six is smaller than four. If they’re any good at their jobs at all, they’re looking at you the patient and seeing your whole history and personality. The question itself seldom means what the patient thinks it does. And they want to keep it that way, so that patients don’t try to game the system.

This is true for any question by any expert in any field, for the most part. You don’t know what the game is any more than a football knows the rules.

A person who rates their pain at 8-10 is probably unlikely to be able to identify any other problems or be a reliable reporter of their medical state. The pain masks their ability to be a good judge of their own bodies. It’s important for diagnostics if nothing else.

For me (and a LOT of other docs) It’s just another subjective way of assessing the situation. If a guy tells me his pain is a 9 as he sits there calmly and walks around easily, it’s a very different message from the guy who tells me his pain is an 8 as he sweats bullets, rocks back and forth, and bites his own knuckle to distract himself from the pain as he tried to get up on the exam table.

The old “pain is the 5th vital sign” way of thinking never really caught on, fortunately. Pain is too varied an entity to be summarized so succinctly.

QtM, who has been paid to lecture to physicians on pain management.

Not paid a lot, I admit. :slight_smile:

Hyperbole and a Half weighs in on the subject.

A doctor is going to know when your pain level is a 10 because there are physiological signs that are hard to alter or fake. Less than a 9 becomes subjective, but still valuable because the doctor seeks to bring your perceived level down as far as possible. He can prescribe drugs for the physical aspects and others for the emotional side if he senses that plays a role. Valium might reduce the perceived pain without changing anything physically while Motrin could reduce inflammation and change the physical side. Doctors have to guess sometimes and this helps.

I’ve had to do this twice, and was completely uncertain when presented with a number system. The second time I was presented with a scale of ten smiley and frowny faces, which I had no problem with.

I think doctors should switch, since the numbers can be totally subjective. A picture of a slight frown is easier for the patient, especially one in pain.

Smileys are well and good, but Punoqllads already linked a superior scale.

As others have suggested, I think the question helps at triage to identify how reliable the person is at reporting their own symptoms.

I went to the ED about fifteen years ago with what turned out to be acute appendicitis. I said my pain was 8, although in reality it was about 43. I was in a daze, sweating, and unable to mask my distress. The nurse could tell, and I think my inability to provide a more accurate response said more than any of my words. As QtM suggests, a person who says “10” while they’re fiddling with their cell phone speaks volumes as well.

FWIW, I got a bed very quickly, and a shot of demorol, and when the doctor came in five minutes later to ask about my pain, I said “what pain?” That demorol is good stuff.

Are you me? :smiley:

Also appendicitis, and although I didn’t get a bed quickly, after the shot of demoral I don’t really remember much

If the pain really is a “10” that person would not be in a doctor’s office, but in the ER, and it would be quite apparent to everyone that (s)he is really suffering.

There actually are some objective methods to evaluate a person’s rating of his pain. These are done if “secondary gain” could be a motive, as someone who has filed for SSA disability benefits. “10” is obvious malingering. The person is asked to perform certain simple tasks and his expressions are noted, along with his ability to so perform. Certain other parameters are also used.

That said, and has been said, everyone’s pain threshold is different, but the objective testing can give a fair gauge of the person’s subjective pain.

Obligatory xkcd link: xkcd: Pain Rating

I just went through this while sitting in the ER on Christmas Eve. I had slipped on the steps and twisted my ankle and the pain was sufficient to motivate me to seek medical assistance. I was asked frequently to rate my pain level and I usually told them that it was a ‘four or five, I guess’. Thing is, there’s a psychological component at work here. While I was sitting at home, stressed and anxious, I would have rated the same level of pain as a six or seven, higher when I attempted movement. But in the ER, immobile in a wheel chair and secure in the knowledge that I was in a place where ‘they’re going to fix me!’ - that pain level was suddenly much more tolerable.

After the x-rays, the doctor came in and told me that my ankle was broken in three places. He said they were going to splint the leg and refer me to an orthopedic surgeon. And he asked me if I wanted something for the pain. I said, ‘no, I’m good…’ His eyebrows shot up and he repeated ‘No?’ in apparent astonishment. I quickly reconsidered. ‘Well, as long as I don’t attempt any movement at all, the pain is tolerable - but I guess I’m going to have to move here soon, so maybe some pain medicine would be a good idea…’

They gave me a percocet along with an Rx for more - and it was a good idea. It’s almost four days later and now my ‘at home’ pain level is down to about a four…

When I was in basic in medhold every single annoying time we went to some kind of doctor or whatever they were we had to answer this question.
One time I went was for my knee, I had hit it hard on the floor in our latrine and couldn’t put weight when knelling (‘take a knee’).
Apparently I has also caught… some kind of illness because when I went to ‘mini-reid’ and the guy took my temp it was, if I remember correctly 100.3 and I remember the guy asking me if I felt sick at all. I told him with a shrug: ‘I feel like I have a cold or something’ which was entirely true, I did not at all feel like I had a fever or anything more than the normal aches and pains of a cold.

Anyways, I also remember in mini-reid that they would ask: based on the worse pain you’ve ever had. So for some, the worse pain would be getting your finger slammed in a car door, or others maybe childbirth (maybe for some that had drugs child birth really wasn’t so bad… and isn’t it true for some women that they have little or no pain even without drugs?) for others maybe there worse pain was just getting that horrible splinter in their thumb (I keep going back to that don’t I?)
Or think about this, when a paper cut hurt more than when you sliced your finger with that knife while chopping veggies?

I’ve had headaches, really bad toothaches where I don’t want to open on mouth it hurts too much, and I’ve had menstrual pains that have me doubled over (tmi? sorry) but I don’t think I’d ever call those a ten. :dubious:

I must admit though that when I was told I wrong that once, I was mad and annoyed so I purposely went too high. (I was being forced to go get my foot looked at and I didn’t want to which is another story for another time) But I was told by that person that I was wrong and that she knew “fresh amputees that their pain wasn’t any higher than a 5” :rolleyes:
But then again, after thinking about it much (this was nearly six years ago, mind you) if you’ve been amputated wouldn’t that deaden what feeling you have? (serious question). And thus the pain rate they use would be subjected?

But I must say I did like when they had us judge between a worse remembered pain better than when they just came out and said: ‘what’s the scale between 1 and 10?’ oh and I liked the little smileys too with the scale much easier to use.

Pain can be subjective. I broke my nose last winter skiing. We went to the ER because it would not stop bleeding and I was in a lot of pain. If you had asked me what my pain level was when we were driving to the ER, I would have said 5 or 6 on the scale. Once we got to the ER, my perception of the pain changed.

First, the young man in the gurney across from me had a broken collarbone and was green with pain until they got an IV into him. Second, they wheeled in a kid (11 or 12) who landed wrong off a jump and screamed bloody murder as they attempted to remove his ski boots. My pain diminished when I saw these two. As they were getting ready to let me go, they asked if I wanted something for the pain, I declined as long as they were giving me a script I could have filled in town. Once we got in the car, my pain went back up to 5. Waiting in line at the pharmacy, it became a 6.