# Pain scale Dr.'s use -is it any good? **URL:** \ **Category:** Factual Questions\ **Created:** [December 28, 2011, 4:54pm UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636 "2011-12-28T16:54:29Z")\ **Posts on this page:** 11\ **Page:** 3
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 31, 2011, 4:04pm UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/41 "2011-12-31T16:04:16Z")
> [@KarlGauss](#): > > Getting back to the original question in the OP, according to [this recent review](http://www.jpsmjournal.com/article/S0885-3924%2811%2900014-5/abstract) it seems as if numerical pain rating scales are as least as good and probably better than other ways of rating pain. Meh. All that review states is that when used in a post op setting numerical scales were used more consistently (“better compliance”) and easier to use. That’s pretty much all you can say: the staff will be more likely to consistently ask “What number would you rate your pain out of 10?” than “How bad is is your pain? Does it fit this description, or this one, or this one …?” or than pulling out the visual analog scale. Yes it is a scale that the staff will actually use: writing down “8” is quick and easy. It sort of like looking for the keys under the lamppost exclusively because that is where the light is good. But yes, looking at all is better than not looking at all. Pain is a difficult thing to study because we really cannot measure pain directly; we can only measure the responses to pain and assume that they are good proxies. The study I’d be curious to see is how well the various pain scales correlate with _physiologic correlates_ of pain, such as heart rate change, systolic blood pressure changes, and use of a patient controlled analgesia pump made available after the rating is administered. ---
**Author:** ![barbitu8](https://avatars.discourse-cdn.com/v4/letter/b/839c29/32.png) [@barbitu8](https://boards.straightdope.com/u/barbitu8)\ **Post date:** [December 31, 2011, 9:23pm UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/42 "2011-12-31T21:23:27Z")
> [@WhyNot](#): > > I am an unbeliever. At least, in the limited amount of time given to nurses and doctors, there is no such thing as objective testing for pain. Heart rate, blood pressure, sweating, pallor - all once believed to be objective signs, but actually correlate very poorly to pain. Guarding and muscle tension correlate a little better, but are easy to fake. The testing I had in mind is not done by nurses or doctors. IIRC, the testors are psychologists or vocational experts. This is used by SSA, and perhaps insurance companies. The person is asked to perform some mental and physical tasks, such as lifting 10 pounds. If the person tries, but is unable to lift it because of pain, his guarding, muscle tension, grimacing, etc. is noted by the testor. The lack of appropriate objective signs in attempting minimal work indicates little effort and malingering. SSA does this to evaluate for disability insurance benefits, as a person’s functional capacity must be evaluated to determine if (s)he is “disabled.” Of course, the medical profession is not concerned with that aspect, except that an applicant for disability benefits would see a doctor and might exaggerate the pain experienced. If a person has an impairment that can reasonably cause the pain alleged, SSA must either accept that or try to refute it. Opinion by a treating physician as to what a person can do is _prima facie_ evidence and has controlling weight unless it can be refuted. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [December 31, 2011, 9:34pm UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/43 "2011-12-31T21:34:38Z")
> [@barbitu8](#): > > The testing I had in mind is not done by nurses or doctors. IIRC, the testors are psychologists or vocational experts. This is used by SSA, and perhaps insurance companies. The person is asked to perform some mental and physical tasks, such as lifting 10 pounds. If the person tries, but is unable to lift it because of pain, his guarding, muscle tension, grimacing, etc. is noted by the testor. The lack of appropriate objective signs in attempting minimal work indicates little effort and malingering. SSA does this to evaluate for disability insurance benefits, as a person’s functional capacity must be evaluated to determine if (s)he is “disabled.” Of course, the medical profession is not concerned with that aspect, except that an applicant for disability benefits would see a doctor and might exaggerate the pain experienced. If a person has an impairment that can reasonably cause the pain alleged, SSA must either accept that or try to refute it. Opinion by a treating physician as to what a person can do is _prima facie_ evidence and has controlling weight unless it can be refuted. We’ve just been through Disability application, denial, appeal and approval on appeal for my SO. Nothing like this was ever done, and one of the conditions which (with others) added up to “disabled enough for disability” for him was chronic pain. Functional capacity was determined by patient interview and doctors’ filling out forms with detailed checklists of what he is and is not capable of doing. (“The patient can lift \_\_less than 5 pounds \_\_\_5-10 pounds \_\_\_more than 10 pounds,” kinds of things.) He saw SSA doctors and his own doctors were also asked to submit forms, both by their lawyer and ours. At no time was he evaluated for pain in any way other than a simple pain scale and descriptive terms. Are you sure this is happening? Are you sure it’s STILL happening, and isn’t something that was done a decade or two ago when they thought there were objective ways to identify pain level? ---
**Author:** ![barbitu8](https://avatars.discourse-cdn.com/v4/letter/b/839c29/32.png) [@barbitu8](https://boards.straightdope.com/u/barbitu8)\ **Post date:** [December 31, 2011, 10:04pm UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/44 "2011-12-31T22:04:44Z")
It wasn’t done too often. After 25 years of working at SSA examining disability claims, I saw less than a handful. But it can be done. A TP’s opinion as to RFC has great evidentiary weight, and the opinion of SSA’s own physicians cannot override that opinion. I don’t see why it could not continue to be done. A person with disabling pain would not be able to do much without outward signs of that pain. Also, the examiner will note the way the person walks into the examining room and his other demeanors before the actual examining in help assessing malingering. I was surprised that it wasn’t done more often. “Disability” is based on RFC (residual functional capacity), age, education, and vocational factors. When the unemployment rate rises, the number of applicants for disability rises dramatically. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [January 1, 2012, 12:50am UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/45 "2012-01-01T00:50:54Z")
One interesting research venue is [the use of fMRI to evaluate pain](http://www.springerlink.com/content/133045q23812j57u/). ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [January 1, 2012, 2:52am UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/46 "2012-01-01T02:52:05Z")
> [@barbitu8](#): > > It wasn’t done too often. After 25 years of working at SSA examining disability claims, I saw less than a handful. But it can be done. A TP’s opinion as to RFC has great evidentiary weight, and the opinion of SSA’s own physicians cannot override that opinion. I don’t see why it could not continue to be done. A person with disabling pain would not be able to do much without outward signs of that pain. Also, the examiner will note the way the person walks into the examining room and his other demeanors before the actual examining in help assessing malingering. I was surprised that it wasn’t done more often. “Disability” is based on RFC (residual functional capacity), age, education, and vocational factors. When the unemployment rate rises, the number of applicants for disability rises dramatically. Heh, I got thrown and broke an ankle and still had to finish the ride I was on … when you are out in the ass end of nowhere, no roads within 5 miles the only way to get back is to get back on the horse and finish the course. I fear that I would be refused disability, so I don’t even bother trying to get it. I figure it will take both my hip sockets blowing out and both my knees being beyond PT modification to even get considered seriously by SS. [I think my ortho decided the reason that the only joints south of my waist that aren’t hosed is because of all the PT I did on my [weak] ankles. ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [January 1, 2012, 4:44am UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/47 "2012-01-01T04:44:37Z")
Not to be harsh, but when we say 1-10, we mean 10, that’s whatever’s the worst pain you’ve ever had, and it’s the highest number my charting software can record. If you tell us 12 or 20, or 43, I’m going to record 10/10, and eyerolling will ensue. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 1, 2012, 10:44am UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/48 "2012-01-01T10:44:43Z")
> [@Motorgirl](#): > > 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. And it’s a lot more useful for repeat patients than for those you see for the first time. My mother’s usual doctors may not know exactly how much she hurts when she says “damn, I hurt all over” and rates it a 5, but they do know she’s the kind of person who views hurting all over as routine - if she groans “an 8,” it hurts a bloody big lot. A doctor who doesn’t know her will take my own evaluations of her pain into consideration, even though I’m not medically trained, because I do know her and he doesn’t. ---
**Author:** ![barbitu8](https://avatars.discourse-cdn.com/v4/letter/b/839c29/32.png) [@barbitu8](https://boards.straightdope.com/u/barbitu8)\ **Post date:** [January 1, 2012, 12:06pm UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/49 "2012-01-01T12:06:55Z")
> [@aruvqan](#): > > Heh, I got thrown and broke an ankle and still had to finish the ride I was on … when you are out in the ass end of nowhere, no roads within 5 miles the only way to get back is to get back on the horse and finish the course. I fear that I would be refused disability, so I don’t even bother trying to get it. I figure it will take both my hip sockets blowing out and both my knees being beyond PT modification to even get considered seriously by SS. [I think my ortho decided the reason that the only joints south of my waist that aren’t hosed is because of all the PT I did on my [weak] ankles. Your impairment must last at least one year before SSA will consider your “disability.” ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [January 1, 2012, 1:39pm UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/50 "2012-01-01T13:39:10Z")
> [@Nava](#): > > And it’s a lot more useful for repeat patients than for those you see for the first time. My mother’s usual doctors may not know exactly how much she hurts when she says “damn, I hurt all over” and rates it a 5, but they do know she’s the kind of person who views hurting all over as routine - if she groans “an 8,” it hurts a bloody big lot. A doctor who doesn’t know her will take my own evaluations of her pain into consideration, even though I’m not medically trained, because I do know her and he doesn’t. Absolutely. And people say strange numbers for all sorts of reasons. We can all imagine the drug seeker screaming, “10!”, and the narcotic-averse gritting their teeth while they whisper, “2.” But I had a patient recently who was post op for some pretty complicated shoulder surgery. He started out rating his pain at a “10”. He’d taken his Vicodin, so I asked if he would like me to call the doctor and find out what else we could to for his pain, since (obviously), he’d want to go down from a 10, right? Nope. He was fine with a 10. He just wanted his girlfriend to know precisely how much pain he was in and to notice how stoically he was enduring it. 😃 Four days with him and his pain was never less than a 7, but he wasn’t interested in fixing it. Still, at least I knew the pain was reducing over time, indicating healing was happening. ---
**Author:** ![Lizzyerd](https://avatars.discourse-cdn.com/v4/letter/l/3ec8ea/32.png) [@Lizzyerd](https://boards.straightdope.com/u/Lizzyerd)\ **Post date:** [January 3, 2012, 10:15pm UTC](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636/51 "2012-01-03T22:15:52Z")
Senegoid: Way too much, I’ll keep this way but thanks 😉 The part about: ‘and if someone say a 32 or a 50 when we ask 1-10… eye-rolling will ensue.’ I hate that. The reason most people say that is we’re so afraid of someone rolling their eyes when we answer or saying we’re ‘wrong’ (I speak from experience by the way). And that’s probably the only way -or so we think- that people will believe us that it hurts. Of course from what I keep reading, this is a double edged sword. Anyways, this makes me think of another question that coincides with this one, or so I think. When you have something wrong that you can _feel_, you just know there is _something_ wrong, even if it doesn’t seem that way to other people (doctors) who is more reliable, the person or the doctor? [Previous page](https://boards.straightdope.com/t/pain-scale-dr-s-use-is-it-any-good/607636.md?page=2)