I had a gall bladder infection with two stones blocking my bile duct and I’d say it just beats out childbirth, because with the gall bladder thing I vomited 19 times that day (I counted) and I can’t stand vomiting or nausea. Childbirth hurt like a sonofabitch but it was all a blur to me as there are certain hormonal things going on that are supposed to prime you to forget. The epidural helped but I had also been induced with pitocin which is supposed to give you monster contractions. At one point the epidural was disconnected and it took them a while to figure that out. I’ve asked my husband how much pain I seemed to be in and he said, “moderate.” He contends that the gallstones were worse.
In both cases morphine couldn’t touch it.
So gall bladder is my 9. I never say 10 because I assume there are pain levels I cannot imagine.
One of the most demeaning medical experiences I ever had came while I was pregnant. I had pretty bad pain in my side and was vomiting (not in the typical morning sickness way.) It reminded me of the gall bladder pain even though it wasn’t quite as severe. I was freaked out enough to call my OBGYN and they had me come in.
When asked to rate my pain, I said “7.” (with gallstones, you may recall, being a 9.) And Jesus Christ did this woman give me a hard time about it. “If it’s really that bad you should go to the ER. You don’t seem to be in that much pain. If it’s really 7/10 pain…” Just shut the fuck up lady, I’m in pain. I don’t tend to broadcast it.
Then I asked her if it could be constipation, because I’d been constipated and that’s a new experience for me.
" Oh, no, that could never cause 7/10 pain. "
And that’s when I realized she was full of shit and had never experienced IBS in her life, because I have easily hit 7 or 8 with that condition. IBS hurts like a motherfucker. I’ve often marveled at how bad it is possible to hurt without bleeding internally or dying or something.
Anyway, I went home, and yes, it was constipation.
I always say that I calibrate 10 as the worst pain I’ve ever experienced, rather than my imagination of something I’ve never experienced.
And my personal 10 is a dental abscess that caused trigeminal nerve pain. It was like an electrical shock with a stabbing heated needle into my face and jaw, at random intervals, with a lower level constant throbbing pain underneath. I couldn’t speak or move during the shock part of it. I would just freeze in place.
I later read that some people have a chronic version of trigeminal nerve pain, and it’s known as the suicide disease. I can understand it. I spent two days with it, taking strong pain meds, and knowing it would be resolved with a root canal. I cannot imagine going through it without knowing it would soon be over.
I guess it would only be about an 8.5 on ASL’s scale. I think while I was having my final gallbladder attack that led to surgery, I might have said it was the new 10, but in retrospect, I think the dental pain was still much worse. The gallbladder attack was no more than an 8.5.
I have a friend with this condition. My only experience with trigeminal nerve pain was when I did transcranial magnetic stimulation (TMS) for depression, and it hurt, a lot, until the lady realized she was positioning the zapper to trigger that nerve. Can’t imagine living with that.
The pain question is fair, useful and important. I could live without the chart, but it is really meant for kids or those of limited language or mathematical facility. The chart has been validated by studies. Quantifying the degree of pain should be followed by many other questions: location, timing, descriptive words, things which make it better and worse, associated symptoms and so forth.
Your doctor cannot tell your degree of pain. People experience different things in different ways. Although a few responses do suggest drug seeking (my pain is 20 out of 10!), taking pain seriously and treating it are fundamental to medicine. This can be a challenge, since there are many causes of, and different types of pain. Medicines useful for inflammatory pain may not help much with neurogenic pain. Even “drug seekers” should be offered pain medicine and are likely seeking relief from pain, but addiction is a thing and some pain medications should be prescribed cautiously.
Things like stones can be very painful, but this depends too on their size, number, location, movement and whether they are blocking urine. Lots of people have painless stones. The question would absolutely help your doctor diagnose appendicitis, ischemic gut, heart attack or other things - but it is only a question. It needs to match the physical presentation and lots of other questions are as important.
I wonder how much the answer to this question is affected by false macho bravado. I know a man who cannot bear to be thought of as “a wimp” and I wouldn’t be surprised if that influences his pain calibration. “My arm is still mostly attached, so I’ll say maybe 5??”
I don’t say this to be snarky - I really wonder to what extent a fear of appearing weak influences what someone will say. Or similarly, if someone was overly concerned about getting hooked on any painkiller stronger than a baby aspirin, would they minimize rather than risk getting an opioid?
The question is difficult for me to answer because I am a bit of a wimp when it comes to pain, but I don’t want to exaggerate. Fortunately, it’s not an issue all that frequently.
I think it would be more accurate to say it CAN be fair, useful, and important.
I’d like to believe the majority of practitioners are responsible. Unfortunately, I encounter no shortage of hacks who are happy to say, the patient complains of pain, I’ll diagnose fibromyalgia and opine that they are disabled. With NO effort to rule out differential diagnoses, or to even apply the rheum guidelines.
Perhaps the worst practitioners I see are the pain management practitioners. Who wants a shot? How many will your insurance cover?
I imagine the cases I see may not involve the HIGHEST level of medical practitioners.
I don’t find the pain scale useful as a patient or a counselor. It’s insufficiently anchored. I agree that context matters a lot–I’d go to the hospital for some degrees of pain, but if I already know what’s causing it, and that hospitalization won’t help, I wouldn’t go. In addition, I have a high pain threshold, so I always have to say, “I’m likely under-reporting severity.” From the clinical end, almost all of my clients are in pain, and I get better information interviewing them more thoroughly.
But you weren’t thinking about being depressed for a minute there, right? (totally kidding, that sounds terrible, as do some of the other pain stories here).
I feel lucky that the worst I had was a cyst in my spine that meant 4 years of agonizing sciatica… but only an 8 1/2 (and barely walking, with a cane). Imagine my relief when they exploded the cyst and I immediately started dancing.
It’s useful as a placebo. Some patients will feel as much improvement from the pretend ritual of collecting information as they do from actual diagnostic and treatment procedures.
Yes, of course it’s subjective. It needs to be, because pain is inherently subjective. The fact that people have different pain thresholds doesn’t make a scale like this useless-- It’s what makes a scale like this necessary.
If you tell the doctor “This hurts about as much as it did when I fell out of a tree and broke my leg”, that doesn’t help. They can already see how severe your injury is, compared to a broken leg. What they can’t see is how much pain that’s causing. Is that “It’s like when I broke my leg, but toughed it out, no big sweat”, or is it like “It’s like when I broke my leg, and ohmygod, that was horrible, and I never want to experience anything like that ever again!”?
If you rate your pain low, it doesn’t matter if that’s because it’s not very much pain, or just because you’re really tough and can handle it: The conclusion is that you don’t need painkillers. If you rate your pain high, it doesn’t matter if that’s because you’re at the point of death, or just a wimp: The conclusion is that you do need painkillers or other treatment.
A pain scale is not the best question to ask when trying to figure out a problem. Pain is a symptom of a problem. I almost lost my leg because a specialist just wasn’t listening to the description of pain I was giving. It wasn’t a 1-10 conversation. It was how it manifested itself. I had to figure it out myself which is another story.
Obviously if you’re in serious pain and you go to a doctor for relief then that’s often the problem above the problem. You need relief of pain first and then a solution to it’s cause second.
With that said I’ve answered pain questions with lifestyle reference. my arthritis in my hands hurts so bad I have trouble typing. My legs hurt so bad It takes 4 hrs to fall asleep using OTC medicines. These things are affecting my ability to work. The kidney stone didn’t need much explanation. They had to bring a gurney out to the hospital parking lot because the pain exceeded my ability to drive or stand upright. That pain needed immediate attention before any tests could be run.
As an emergency doctor with over fifteen years experience, the pain question is absolutely important, if not much use as a single isolated question. It absolutely helps figure things out - ruptured aneurysms are painful, trigeminal neuralgia is painful, ischemia is painful, not everything bad is painful…
Yes but the question as I understand it is “how much”. If someone who has a ruptured aneurysm tells you it’s a 4 out of 10 it’s an arbitrary number. As you said, it’s not an isolated question but the answer leaves you having to weigh the response.
Now if Festus comes in and says “Doc, it’s hurts powerful to where I’m haven to concentrate to blink” then there’s context to the level of pain.
It’s the scale that’s confusing. When I had a kidney stone the questions went as follows: are you hurt? Yep. Can you stand up? Nope. Where does it hurt? left side back. Feels like a back spasm that doesn’t change with position.
I have no idea what number I would have given on a scale of 1 to 10 but I think the ER people got a good read on how much pain I was in because I referenced it to something.
I think it’s not just about painkiller need. Some injuries can’t be seen on initial exam, or even with imaging.
My head hurts could mean ordinary headache, or brain bleed. I hear that in the latter case, people often say it’s the worst headache they’ve ever had. (I wonder what people tend to give it on the pain scale.) So the relative amount of pain can be, in part, diagnostic.
Similar with spinal issues. My understanding is that they often can’t be seen in ways that are very useful. People can have very similar imaging, but have different symptoms and pain levels. It could be that they are experiencing the same injury differently, but it could also be that the imaging doesn’t capture some difference between the injuries.
When someone is in a lot of pain, there are often but not always other physical clues. I have diagnosed dozens of stones by the way the person moves (although obviously confirmed this with history, exam and appropriate tests). It’s not an isolated question, quantifying pain, but it is important and gives useful information which is indeed taken as an arbitrary and not an absolute number.
But why not give some kind of guide to calibrate the scale? Either in terms of commonly experienced pains, or how it’s affecting you (can’t work, can’t sleep, can’t walk etc). The completely arbitrary scale just turns it into a guessing game - too high and you sound hysterical, too low and it’s dismissed as trivial.
The question I never know how to answer is “What is the level of your pain, right now?” Well, I’m sitting here, not moving, so I’m not in any pain right now. But I could barely make it into the seat. And I know that as soon as I get up to leave, the pain will return, in spades. But you did ask about right now, right?
As a retired emergency room physician, I can say that I never asked the question. Any answer was going to be way too subjective to be useful to me. It was easier and more informative to talk to the patient and assess their level of distress. And if I was sending them home, I often just asked if they wanted/needed pain meds. But that’s just me. The only possible value I can see in the rating scale is to evaluate whether the pain is increasing, decreasing, or unchanged. That usually wasn’t a big concern in the ER setting.
And just to be clear, I certainly asked patients about their pain (quality, duration, intensity, radiation, etc.). I just never asked them to rate it on a scale of 1 to 10.