This reminds me of a question my doctor asked me when I told her my blood oxygen level was 50 in my leg. She asked me if my leg was cold. Didn’t know how to answer that. The real question was: is it cold compared to the other leg?. Which makes sense if you understand the question. My leg didn’t feel cold per se but if I touched it and then touched the other leg it was noticeably colder.
I didn’t understand the question.
The question I usually ask is “if ten is the worst pain you have ever had, and one is a pain you barely notice, what would you say this pain is now, on a scale of one to ten? What is the worst it has been recently?”. This does use a standard, but it’s still a pretty arbitrary answer - and should be interpreted as such.
Again, the question is useful but very incomplete. The functional limitations are obviously very important and the doctor should inquire of these when applicable - along with the many other qualities of pain mentioned above, necessary for accurate diagnosis.
The visual scale is meant for children, ESLs and those who find the math of “a scale from one to ten” too daunting. Remember, patients often might include immigrants, different age cohorts and the confused.
I’ve passed nine kidney stones, and it is comforting to know that it will never get any worse than that – there is no eleven on the scale.
Sciatica is not so bad, you can quickly relieve that with activity.
ER docs differ a fair bit in their approach. But one thing they do a lot of is treat pain. There is research suggesting acceptable pain treatment involves a reduction of pain on the subjective pain scale of at least 50%. So if someone answers their appendicitis is causing 8/10 pain, one wants to know their pain is improving after treatment. A minimal goal might be reducing the pain to the same patients 4/10. Obviously getting rid of all the pain is better, although not always possible. This is a main reason of asking the question in the ER setting despite it being subjective.
In the ER, proper documentation is also a thing for legal reasons.
The only time that I have been asked that question is when I have been been treated for some sort of chronic condition. In that regard, I do think that there is some value in tracking how something is progressing.
This is a big concern in the ER setting. People who need, say, hip or abdominal surgery present to the ED. They need pain medicine. It is better to know that the pain medicine is working - the right medicine at an adequate dose. Headaches, car accidents, falls, ischemia pain - lots of ER patients require pain relief.
But in fairness, this question is not the only means of assessing pain medicine efficacy.
Yes. It seems to me that people’s experience of pain is very, very subjective, and influenced by a host of factors that even the person suffering may not be aware of. Personal factors, the desire to appear tough, even cultural factors.
I remember once being in the ER and hearing a couple of physicians talking to each other about another patient, who was in a lot of pain and giving high numbers in answer to the 1 to 10 question, and one of them said “well, is that a Hispanic woman 8, or an Asian woman 8?”
The point being that, for those doctors, Hispanic women and Asian women were the opposite ends of the stoicism/pain threshold scale, with Hispanic woman being most likely to express strongly their level of pain, and Asian women being the toughest and least likely to express high levels of pain.
And, by the way, it was clear that the scale included men – the patient they were discussing was male. The docs just thought that these two groups were the extremes of the spectrum.
Now, that’s an unfortunate way of describing the scale, and it may indicate that these doctors couldn’t see past ethnicity to really assess a patient’s pain, but there’s a grain of truth in there, which is that perception and experience of pain may be influenced by (among other things) culture.
Absolutely. From your lips to God’s ears, as they say.
So very true.
You all have probably heard of the comparison between gallstones and childbirth - with people who have done both swearing they’d have all their kids, all over again, at once, without an epidural, rather than go through another bad gallbladder attack.
Whereas, I made my doctor’s jaw drop when I said my gallbladder pain was not, relatively speaking, all that bad. She said “Really???” to which I replied “Oh, don’t get me wrong - the pain sucked. But far worse was the intolerable ITCHING” - see, I think the gallstones caused a backup of something that caused high levels of bilirubin, which led to intractable itchiness of hands and feet - for 48 hours. Nothing helped - not hot water (made it worse), not pain killers (itching supposedly is similar to pain and I thought it might help), not lotion. And the itching made sleep basically impossible.
So while I might have rated the pain as a 6 or so, it was constant versus stabbing or random, and I could sort-of ignore it. The itching… had it not improved, I could see it driving someone to suicide, seriously.
But childbirth… well, when you’re having induced labor, and they take 3 hours to get you pain relief, and the epidural doesn’t work, and they DO NOT BELIEVE YOU when you say it doesn’t work… easily a 9. Comparing that to the gallbladder-induced itchng, and it’d be a tough choice between which was the most misery-making.
The two times I can think of where my pain might have hit a 10, I can’t say for sure that it did because they were both so fleeting.
First time: Sitting down on a chair at the office cafeteria. The seat was a sheet of somewhat flexible plastic, bolted to 4 vertical chair legs. Only, some of the chairs were defective, and the seat wasn’t fully bolted down. So when I grabbed the chair by the edge of the seat, and used my hand to scoot it forward while I lifted my weight just enough to enable such scooting, three things happened: 1) the chair seat lifted up a little bit, 2) my finger somehow slipped forward, between the top of the chair leg, and the seat surface, and 3) my full, not-inconsiderable weight came back down on the seat. This is the only time I have experienced pain that nearly made me throw up (and I’d just sat down at a crowded table with a bunch of people I did not know - woulda been a hell of an introduction)
Second time: the first root canal I ever experienced. Just the initial novocaine shot. I don’t really remember the pain itself - my mind has blanked, mercifully - but I do remember screaming, and the endodontist saying he could give me an oral sedative but I would have to call someone to drive me home. I was shaking so badly I couldn’t dial the phone for a few minutes. I think the procedure itself hit 6-7 several times - see, novocaine doesn’t work all that well for me…
The “how much pain are you in now” definitely needs to be couched in terms of “OK, maybe not this second, but in general, like if you try to walk or turn over” to handle the scenario others have described.
For me, the pain itself isn’t as bad as the wonder of whether it is going to get worse.
When I slipped down some stairs incurring a trimalleolar fracture of my ankle. Then I walked back up the stairs and, when my wife drove me to the ER, into the hospital.
I remember the doc looking at the xrays and saying, “You WALKED IN HERE on THAT?!” 