The 1-10 scale is also good for tracking one person’s progress, such as someone above with acute appendicitis who responded well to a shot of demerol, or someone with chronic pain from one office visit to another. Hopefully, the number will be trending down, but it doesn’t matter specifically if their “7” is more like your “4” or my “10.”
Nigel Tufnel’s pain is an 11.
mmm
There have been attempts to develop more objective scales of pain, or ways to measure same. Dolorimeter - Wikipedia. Apparently none has ever really caught on or worked out very well.
The one that I read about once in some long-forgotten book, in some detail, was the “dol” scale, where “dol” was the unit-of-measure coined (from dolor) for a just-noticeable-difference (jnd) in level of pain.
The book gave a dol scale from 1 to 12 or so, and claimed that it was some kind of logarithmic scale, like pH levels for acid/base, or decibels, or Richters, where each unit of the scale corresponded to a ten-fold increase in pain level.
A variety of sources of pain were mentioned as examples, showing their position on the dol scale. I couldn’t imagine that such a listing could be highly reliable, but perhaps maybe kinda-sorta. What really stood out, though, was the wide gap between the “run-of-the-mill” pains and the “shrieking bloody murder” pains. Most typical pains had dol levels from 1 to 5 or 6 or so. Then there was a wide gap from about 6 to 10, where there was nothing. Then there were some really serious pains – heart attack, serious burns, and stingray stings – that were up in the 10 to 12 area.
So that really scares me.
(Question for Lizzyerd: We know from another thread nearby (about twin suns with planets) that you are getting into sci-fi / fantasy writing. Is the current thread another research project to get background information for the stories you are working on?)
There is a phenomenon called “phantom pain.”
The only sort of objective measure of pain that I’m sort of familiar is the one I described above: measuring the actual functional capacity of the individual, as to his ability to stand, walk, lift, carry, etc., and note any signs of pains, such as grimacing. If there were better ones, I’d think I’d have run into them before in my previous life working for the SSA.
I’d like to know why they asked me this while I was in labour. It’s supposed to hurt. I wasn’t asking for pain relief, and they were monitoring my contractions so they knew exactly what was happening in there. Anyway, I said 4. I hope I got it right.
Then you run into people like me. Between the menstrual pain, migraines and chronic back pain I have an insane chronic pain tolerance, and a pretty high acute pain tolerance. Thankfully my PCP has 5 years experience with me and understands this. I rarely ask for pain meds other than the ones I already have. When I roll in with an injury and ask for 3 or 4 days of something different, I have no problem arguing with him as he knows I wouldn’t be asking for something if I didn’t really need it. [I might need a med change 2 or 3 times a year, I have 1 more day on different meds, I fell 4 days ago and stressed my back in a place I normally don’t have issues. Crutches and water spatters on a floor don’t mix well 
]
This is how I used it when I was responsible for monitoring and responding to a patient’s pain. It didn’t so much matter where it started, so much as whether the number was going up or down, which, combined with other factors, told me if the patient was improving, if things like meds were working, etc.
As an aside, I’m super happy that I don’t have to do that anymore. Nowadays, when a patient says they’re in pain, I respond, “Okay, I’ll get anesthesia!” or, alternately “Hey, (anesthesia provider), did you hear that?”
When I had a kidney stone attack and was wheeled into the ER on a stretcher, doubled over in pain, a kind triage nurse with a clipboard asked me to rate my pain on a 1-10 scale. I rated my pain by barfing on her shoes*. I was quickly given a shot of painkiller that finally allowed my to unfold my body a little and take a deep breath.
*Not on purpose. I was as mortified as a person can be when she thinks she’s being stabbed to death from the inside.
I agree with other posters that the point is to follow one person with the scale and see how it changes. It’s similar to mood questionnaires - it’s not so much what the score is, but whether it’s improving.
But this doesn’t completely help me when it’s a first time patient going in for what will probably be the first and only time.
When I went in when I was having terrible headaches (apparently not migraines but stress headaches, could have fooled me) the Dr. I don’t remember even asked me to rate the pain he only asked: “Is this the worse headache you’ve ever had?” My answer was yes, but as I had said before in another post I don’t think I would have rated it a ten. But then again, the entire fact that I was AT the doctors at all indicated to my mom that this pain was more than a little ‘one’ or anything.
But I’ve had it other times, first time going in, only time going in ‘rate your pain’ I can see where it would help with chronic pain, and it makes sense that it’s a gauge to see if the treatment (if any) was working, but how does that help with first/only visits?
And since this doesn’t seem to really have any precedent for most Doctors would it really matter if you told the a number or if you just shrugged helplessly and said ‘i dunno’?
( Answer for Senegoid : getting into? No, I’m already way into and deep through. But no, this isn’t for any play, song, poem, novella or novel just a question I’ve wondered about through my own experiences)
Because the benefit of the patient is not the entire reason for rating pain. The consistent use of pain scales is a requirement of the Joint Commission (formerly JCAHO) and other credentialing bodies.
mmm
Hey we medical people are just number folks. The scales are another of many attempts to objectify the subjective, and works, perhaps, a little bit better than saying it hurts “a little” or “a lot”. It is not as complete of a picture as “It hurt bad enough that I could not focus on my work” vs. “I had to walk hunched over and would moan out loud” and most often I get 5 to 7 as reports, but in a history (even one told by a first time patient) in which pain is a symptom it does both tell how significant the pain was/is as a symptom to the patient and how the severity of the pain evolved over the course of the illness. Important aspects of the story to know.
In the case of a headache, having the “worst headache of your life”, or, as it’s sometimes abbreviated on charts “WHoL”, is actually a diagnostic sign independent of the pain level, and can indicate a life threatening condition, such as meningitis, stroke, aneurysm, etc. Someone who’s having the “worst headache of my life” needs to be evaluated as a possible medical emergency.
Heh, worst migraine of my life had me almost incoherent, vomiting, severely dehydrated and a BP of 210/190 and immediately admitted with the planned operation cancelled until they could stabilize me. GoLytely and I don’t quite play well together …
((Sorry guys, I haven’t quite figured out the multi quotes yet))
Mr. Mustard: Oh whoa, I had no idea, you/they have to ask? That’s really interesting.
Desied: So, is it better to say “the pain in my hand is a seven.” or is it better to say: “It hurts so much I can’t move or even think about moving my hand to even brush air out if my way?”
Lucreta and aruvgan: I had a CAT scan when I told him that… but he didn’t admit me immediately. I think he said my BP was high, but to be honest I don’t really remember I wasn’t exactly having an easy time focusing.
But I will say that I’ve had the headaches more than one time and all the times after, yeah they hurt, a lot mind you, but now I wouldn’t call them WHoL’s. Of course that may be because I know what it is and not that I might but a tumor pushing my grey matter out of it way. (I apologize if anyone doesn’t find tumors funny at all… but they’re ugly so they have to be at least ugly-funny :dubious:) 
I prefer the second as it tells me more … but then again “pain is 7” takes less time to type into the record!
When I had me appendectomy, I requested stronger pain relief a few hours after the operation (all they gave me was paracetamol). The nurse asked how much pain I was in on a 1-10 scale.
On my scale a 10 would be the worst kind of torture – i.e. I would say or do anything to stop this pain. Some of the martial arts tap out holds I’ve experienced would probably be about an 8 or 9 out of 10.
The pain I was in was just below that level. My answer of 7 didn’t warrant stronger medication in the nurse’s opinion. Yet I believe that if I made a fuss or had a different pain tolerance the outcome may have been different.
[tangential side-track]
There’s something about multi-quotes… and quote-within-quotes too for that matter.
I have two mochines, side-by-side here (one Linux, one Win XP), and using Firefox 3.whatever on both. On the Linux mochine (which I use 98.6% of the time), I have never succeeded in getting multi-quotes to work. And quotes-within-quotes don’t work either. But on the Win XP mochine, they work fine. I haven’t yet figured out what the difference may be.
Lizzyerd, you can still do multi-quotes and quotes-within-quotes if you’re willing to put some work into it (as I do occasionally). Open a plain text editor (like Notepad or whatever you like) in a separate window. Back in the SDMB window, start a quote, and simply cut-and-paste whatever part of it you like into the Notepad window. Then back out of the reply window. Then go to another post and start a quote of that. Repeat.
Finally, to post your big composite reply, just click on the Reply button, then cut-and-paste the whole shebang into there. Kind of a paininthearse (obviously), but it works.
[/tangential side-track]
ETA: Do that enough times, and you will know what pain is! 
You don’t need notepad. Just copy and paste the quoted material in your reply (with the appropriate coding) and copy and paste the poster’s name first.
Getting back to the original question in the OP, according to this recent review it seems as if numerical pain rating scales are as least as good and probably better than other ways of rating pain.
Pain is subjective, right? I think we all know that. So the pain scales give us a way to share subjective information in a language we can more-or-less agree on.
There is no “right answer” to this, but a lot of patients struggle with that idea. There is no magic number that will get you pain meds if you want them or spare you pain meds if you don’t want them (if you don’t want meds, just say so; we can’t force you to take them). All there is is a way you can tell me whether this pain is acceptable for you, and a way we can track if what we do to reduce the pain is working or not.
I don’t particularly care if your 7 is better or worse than my other patient’s 7. What I want to know is: are you okay with a 7, your current level of pain, or do you want me to try and help you reduce that pain? More importantly, how *much *do you want me to help you reduce it? Do you want to bring it down to a 5 (whatever “5” mean to you), which we can probably do with some relaxation exercises and a warm compress, or do you want it down to a 2 (whatever 2 means to you), which may require narcotics? Again - all relative, but it’s *your *relative, no one else’s. All I know, because we’ve agreed on a scale together, is that 7 is now, 5 would be some less pain, and 2 even less pain.
Huh. I hate the FACES. Haven’t had a patient yet who liked it, either. But I guess I’ll keep dragging it out, since apparently it does work for some people! 
(<----FACES 0)
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.
Labour is a weird time - it’s the one time we, as a culture, pressure patients to NOT take pain medication when we know - even objectively 
- that they’re in pain. Still, it’s on the chart, and we have to ask often, even if you don’t want medication. It’s got to be documented that we asked, or it looks on paper like we ignored your pain, and that’s not acceptable medical care these days.
EVERY patient (on every floor, not just labor and delivery) must be assessed for pain at least once a shift, and the response must be documented. Doesn’t matter if there’s a string of zeros in the chart, it *must *be asked and answered, even if the patient isn’t in for a painful condition. I’ve been told I need to ask it even of unresponsive patients, like those in a coma or heavily sedated. You never know when they might be able to respond for the first time.
Both. I can put “7” in my chart, so that an hour after your painkiller when I ask you again, I know whether 4 is improvement or not, and I also know that movement worsens the pain, which is important information.