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Dialing Back the Pain Scale: towards a more effective conversation for pain management.

There I was, sitting in an exam room in a medical office thinking, can I just say fuck you? Because the medical professional taking my history responded to my complaint of unusually pernicious pain with this question: “On a scale of one to ten, how would you rate your pain, with ten being that you just got hit by a truck?”

I have been described as highly sensitive, with a visual imagination. If you ask me to think I've just been hit by a truck, then I am immediately traumatized by seeing myself too broken, bleeding, and unconscious to be able to answer at all. Why aren't you dialing 911!?! Encouraging me to imagine being hit by a truck is an absurd way to rate my pain. My sympathetic nervous system is so alarmed that it is hard to think. I need a minute to reset my well-o-meter and dial the scale back to a range I can handle. And, I need to make it sound bad enough to warrant the tests I am about to request, how confusing.

“Well, ten is set at a place I never want to experience so let's call it a seven, or a five.”

And already, because the scale is set with trauma at the top, they have no idea, nor do I, what my actual pain level is. I hate being asked to rate my pain on a scale of 1 - 10. They want the quantifier that will communicate the range of discomfort I feel, and I want the magic number that gets the help I can afford as fast as I need it.

Asking a patient about the worst pain they can remember may open a cascade of sensory memory for them! For chronic pain patients it is a little like poking their ptsd. What is gained from comparing pain today to that worst-ever pain? I know it doesn't work well for me because my worst pain was way worse than a 10.

Instead, what if your health practitioner put the pain, and the meaning derived from it, in the range of possible ordinary things? What if they ask “tell me how bad your pain is on a scale of one to ten, when ten is hitting your thumb really hard with a hammer and instead of the hurt receding it stays right there and sustains as if you had just hit it?”

I can imagine that pain. I can hold it out at arm's length. I can look at my thumb and see it is not smashed even when I am imagining it is.

As a seasoned chronic-pain-manager I am concerned that this out of whack pain scale where 10 = trauma, if uncorrected, causes miscommunication and unintended harm. The question has to be asked: If ten is equivalent to life-threatening trauma, how is that helpful to the understanding medical professionals and patients need to reach together in order to make sensible care decisions?

Practitioners, please dial back the pain scale!!!


photo: Miles Bellamy

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