So you go to a doctor and are asked “On a scale of one to ten (or one to five), how much pain are (or were) you in?”, sometimes showing you this cute little cartoon chart that starts with a happy face and goes all the way to a frowny face with tears in the eyes. To me, that is like asking “On a scale of one to ten, how tall is that telephone pole?”, and that cartoon chart is next to useless. I asked my doctor, “Do you have a cartoon depicting a happy face with leg cramps so bad the character can’t even think in words, can only see waves of red, white and black and is using everything it has got to fall into the bathtub and turn the hot water on?” and she said, I swear to ghod, “So…close to nine or ten, then?”
How does your health provider handle this question, and how do you respond?
I figure the scale of 1 to 10 means no pain (1) to passing a kidney stone (10).
I usually explain that to the Doctor and then answer.
Recent example, for my hernia I was in the ER and I was asked that question.
My answer was roughly. “Well if 10 is passing a kidney stone, only in the 7-8 range.”
The Nurse Practitioner gave a polite laugh and went on to the next question.
“A better pain scale”:
I usually hear a 10 as the worst pain you can imagine. You are not capable of any sort of function at that point.
Between sciatica and migraines, I’ve learned to estimate my pain levels pretty well. It’s less useful as an objective scale, and is more meant to be subjective. It helps to quantify, on a relative scale, if pain is getting better or worse, whether over time, after an incident, or due to treatment.
Comparing your 6 on the pain scale to my 6 on the pain scale really means nothing. Comparing my 6 on the pain scale yesterday to my 4 on the pain scale today means that we are making progress(or vice versa). Also how it progresses through the day, after activities or after some sort of treatment.
There are a lot of useful diagnostic questions where the question doesn’t actually make that much sense if you really think about it and the answers don’t logically map to things, but they’re still useful diagnostics because people answer in predictable ways.
There are a few Vulcans among us (overrepresented on this board for sure!) who can’t turn pain into a single number, but for like 99% of humanity, if they say 8 or above, something is really wrong, and if they say 4 or below, it’s pretty minor, and there’s some weird stuff in the middle.
Either way, it’s a great jumping off point to generally calibrate the doctor’s next question.
Finding myself in the ER with my first kidney stone was the only time I’ve been asked the question, glanced at the chart and declared that I was at a 10 (though some of my migraines have gotten up there).
I assume medical staff understands everyone interprets them differently and if it’s a patient they see regularly, at least they have some type of metric to track pain trends.
I remember when I started PT after shoulder surgery. I could hear the person next to me. Sounded like it was her first time in PT (hip or knee replacement, IIRC) and the therapist was asking a bunch of questions. When he asked her about her pain level she said it was a 9. I kinda mumbled to my therapist ‘she’s at a 9? I walked in with her from the parking lot. If she’s at a 9, she’s awfully good at masking it’. I don’t think I ever went over 4 or 5 from before the surgery all the way through the end of the PT.
Having debilitating migraines on a weekly basis starting when I was about 6 or 7 years old has somewhat skewed how I rate pain though.
“The worst pain you can imagine.”
Right! They really need to define 5 as something specific, and then we’d be somewhere.
Some people are tougher than others; the amount of bitching and moaning I heard out of the other PT patients after my knee surgery was surprising, and I had the most drastic injury of any of them. It’s hard to be able to tell if your 5 is their 8, or vice-versa, and I imagine it’s equally imperfect for doctors.
And they’ve asked me that question before- the last time I recall was in the hospital after a different knee surgery- I was kind of nonplussed; it hurt, but not like white knuckle/sweating kind of pain, but not a mild headache from getting slightly dehydrated either. I really had wished they had more to compare it with so I could give a better answer.
I suppose maybe it doesn’t matter since it IS relative- if they’re perceiving something as an 8, they need to be treated as if it’s an 8, even if for most people it’s a 6.
Yeah it’s not a great diagram. One person’s perception of pain can be very different from someone else’s and their own perception may change over time. If the metal bar sticking out of their leg is only a rating as a ‘4’ the doc knows he can prescribe less extreme pain meds than someone rating it an ‘9.’
Personally, I’d rate 10 as stuck in the fetal position and unable to move. If you asked me in my teens what 10 was there’s no way I’d have thought of that. I didn’t know feeling that much pain was possible back then.
Yeah, if answered honestly, there is no way a patient should be able to verbally answer “10.” Only pain of, say, 1-8 should be answerable.
A 10 would be someone engulfed in flames, shrieking or flat out slipping into unconsciousness due to agony.
Though, “How much pain were you in?” would still be possible to answer in that fashion.
Schmidt's pain scale of Hymenopteran stings is organized into levels, ranging between 1 and 4, with 4 being the most painful. However, insect stings that feel very different can be put into the same level. Thus, later versions of the scale always include a brief description of his experience being stung by each type of insect.[…]
Feeling only slight pain, Schmidt has described the sting of an urban digger bee, categorized into Pain Level 1, as “almost pleasant, a lover just bit your earlobe a little too hard.” Also rated into Pain Level 1, Schmidt has described the sting of a sweat bee as “light, ephemeral, almost fruity. A tiny spark has singed a single hair on your arm.”
[…]
Some ants are also rated at a Pain Level 3, including the giant bull ant and the Maricopa harvester ant. Schmidt considered the sting of the Maricopa harvester ant as having a pain level of 3, describing it as such: “After eight unrelenting hours of drilling into that ingrown toenail, you find the drill wedged into the toe.”
[…]
Pain Level 4 is the highest level in the Schmidt sting pain index. Schmidt’s original index rated only one such example, the sting of the bullet ant. Schmidt has described the sting as “pure, intense, brilliant pain…like walking over flaming charcoal with a three-inch nail embedded in your heel.” …
Schmidt later gave the sting of the tarantula hawk a rating of a 4, which he described as “blinding, fierce [and] shockingly electric”, though the duration of pain from the sting is short-lived, lasting only approximately 5 minutes…
Schmidt also rates the sting of the warrior wasp as a 4, describing it as “Torture. You are chained in the flow of an active volcano. Why did I start this list?”
I once came upon something like the below pain scale and found it to be reasonably helpful as it gives some kind of qualitative means of assessment (eg: if the pain is annoying enough to be distraction, it’s at least a three). I wish more medical providers would use it:
This was not in a “pain killer” context, but in a mental health context, and it helped me to realize my constant, stabbing chest pains that made it nigh impossible for me to focus on work and were keeping me up at night were far beyond a one or two on a scale of ten.
I also hate the 1 to 10 chart and feel it’s rather useless, so I have my own scale, worst to least:
AAAAAAAGH! (I can’t even think or respond over the pain. Only been there twice.)
I can think over the pain but can’t concentrate.
I can think over the pain, but it’s difficult to concentrate.
The pain doesn’t affect my ability to think or talk, but I’m always aware it’s there.
The pain is mild enough that I forget it’s there.
What pain?
Granted, those are longer answers than they want, but they’re what I use and I think are more accurate. For one thing, ask me on a scale of 1-10 when I’m IN pain, and I may respond that it’s, say, at 7. Ask me when I’m not having pain at that moment, and I’m likely to say it’s a 5.
One time, at the hospital, a nurse asked me what my pain was on the 1-10, and I replied, “probably a 0.5.” She chuckled a bit, then went back to taking notes.
By the way, why is it that as we grow older, literally every single other faculty diminishes – you see less well, hear less well, digest less well, etc. etc. etc. – yet the ability to feel pain remains unchanged? Absolutely untouched by age, no diminishment at all, till you’re dead. Lovely.
I had a nurse ask me about my pain level this very time last year when I was in the hospital and I told it was a three. Then she asked how long I’ve had this much pain and I told her since I fell out of the cradle. She got a good chuckle out of that one.
My WAG is because since pain is meant as a warning, the threat is the same as ever, so it isn’t diminished. I.e., touching a hot stove is just as harmful to the body at age 70 as at 7.
Ninja’ed!!
I wonder if it’s also a way to gauge a patient’s tendency toward histrionics (likely sprained ankle is LEVEL 10 AGONEEEEEEE while most people would rate it a 5).
I was asked this question the other day. Didn’t have that chart handy, so I just answered “Uh, maybe a 4 when I’m walking?” (broken toe. Annoyance but by and large the least painful orthopedic injury I’ve ever had).
And an alternate way of asking might be geared toward “what can’t you do now that you could do yesterday?”. Er, “stand up without puking?” “Bend my elbow this way”. I was once asked if I was OK, when checking in at an orthopedists office, to which my answer was “Yeah, I’m not cussing in English yet” (broken foot. “scheisse” is really useful for such occasions).
Did you misplace the decimal point? It’s a common mistake.