#61 Talking About Pain

What are pain scales?

On a scale of ONE to TEN how bad is your pain? This is a question most all of us will have heard from someone or another and it is usually when we are in a lot of pain. We all have a general idea of how to respond to this: “zero” means no pain at all and “Ten” means the worst pain we have ever felt, and then there are the numbers in between.

But it isn’t that simple.

There are actually many different types of “pain scales” developed over many years. Different scales have different purposes, from communicating to children, to finding out the impact of pain on our day to day lives. Affirmhealth.com has a list of the different pain scales and their uses. We will focus on the numbered scale.

Overall, pain scales are used as tools to help us communicate what we are feeling to others. Pain is highly personal, and everyone feels it differently and handles it differently. But a scale is measurable and easy to understand for everyone. Scales help us to explain how we feel to family, friends, and medical practitioners. They also help us to track our pain over time which can identify trends or triggers. More about that later. They are not a perfect solution, however.

The Scale Problem

Pain really is very personal. Originally, 10 pain scales were used for general study surveys and research, so they were not created to be used by regular people and doctors (Creaky Staff, 2018). The fact that everyone feels pain differently is not taken into consideration when these scales are often used. Not only that, but there are so many numbered pain scales that have variations to them that change our understanding of a number. Some scales have 10 listed as “the worst pain you have ever experienced” while others declare 10 means “the worst pain imaginable”.

This is a pretty big difference. One describes something that we have lived through, and the other is so extreme, thankfully most of us will never experience it. So not only is the pain scale different from person to person, but also between different pain scales. The numbers in between are even more subjective: One person’s 4 is another person’s 6. Each doctor has their own perspective of what a number means which will be different from their patient’s opinion. The difference from person to person is something to keep in mind when using the pain scale in conversation.

We all know someone who likes to exaggerate, either the world is ending or everything is rated in millions or billions. This is not the time to be that person. Avoid misusing the scale. You will not be taken seriously if you say your pain is 12 out of 10. People will treat you accordingly if they believe you are not taking it seriously, and over exaggeration can make you appear that way so don’t risk it! Be reasonable. Because 10 is seen as an extreme level of pain, you will also not be taken seriously if you are smiling (for example) and declaring your pain to be a 10 (Richards, 2019).

Make the most of pain scales

Even though they are not perfect, pain scales are still incredibly helpful. They provide the basic level of information that gets the point across and they can be tracked and analyzed to help find common patterns or trends. There is a lot of potential to using the scale when using it well.

Here are some helpful tips on how to use the pain scale to your advantage:

1. Keep Consistent

There are a lot of different scales out there trying to declare what each number means, and they all vary, so instead, declare your numbers on your own, and make it clear when you talk about it. If you decide that a broken arm felt like a level 7 to you, and someone else says that a broken arm felt like a 6 for them, do not change your number to fit theirs. Remember, we all experience pain differently.

2. Provide a comparison

If you are trying to explain how bad your pain is, give something that others can compare with

For example:  

• “If a broken arm is a 7 then this pain is a 4.”
• “Last time I saw you it was a 3, right now it’s at a 6.”

3. Add a description

There are different types of pain and descriptive words will help. Would you rate these kinds of pain differently? Would you use some, all or few of these descriptions? Ache-like pain, tingling pain, thumping pain, throbbing pain, dull pain, stabbing pain, stinging pain, numb pain, hot pain, and stiff pain. If you add a description you can even use the pain scale for other symptoms such as dizziness, focus, fogginess or anxiety.

4. Other Symptoms

This provides another piece of important information. How the pain affects you. How your body and mind react to pain as it gets worse is significant when working with pain management. It also puts the pain itself into perspective. When doctors only hear a number, they are not able to see how the pain affects your day to day lifestyle.

            For Example:  

• “When the pain is at a 3 I can tolerate it, but when it reaches a 5 my hands will start shaking and it is harder to focus.”

5. Tracking

Tracking your pain over time is very useful if you are suffering from chronic pain. It helps to show trends such as the pain getting better or worse. If you add in other symptoms that you feel at the time when tracking, you may discover if they are related. You can also add lifestyle information such as what you were doing at that time, if you ate anything specific, if there was something unusual that happened that day. This may expose other things, called triggers, that could make the pain better or worse.

It is important to note: do not change your numbers after! It is tempting to want to compare pain today to the pain of yesterday, but this can actually warp your results if you actively change the information that is put in before. The goal of tracking your pain, is to track the pain you are feeling at that time, not after you have thought about it and are no longer experiencing that same pain.

If you are unsure how to start with tracking your pain, here are some digital and printable sheets that can get you started:

In Conclusion

Pain scales are not perfect, but they provide us a way to reach a common understanding, so always keep in mind that pain will always be extremely personal. Because pain scales very from use to use, be sure to read if it is differs from your personal preference and use and be open to the other person if it is different (the 10 being imaginable or unimaginable for example). Take steps to make it easier for you to communicate, and for the other person to understand, by using additional information such as: comparisons, descriptions, and accompanying symptoms. When tracking pain, keep consistent and open minded to other possible factors such as triggers. Lastly, do not be afraid to use the pain scale for friends and family as well as medical practitioners.

References

• Creaky Staff. (2018). Describing your pain with a 0-10 Pain Scale May Be Messing With Your Treatment. Retrieved from https://creakyjoints.org/doctor-patient/pain-scale-not-best-way-communicate-pain/
• Ramirez, M. (2020). Pain Scales: From Faces to Numbers and Everywhere in Between. Retrieved from Affirm Heatlh: https://www.affirmhealth.com/blog/pain-scales-from-faces-to-numbers-and-everywhere-in-between
• Richards, K. L. (2019). The Pain Scale Chart: What It Really Means. Retrieved from Pro Health: https://www.prohealth.com/library/what-the-pain-scale-really-means-34982