The "pain scale" question

Post Reply New Topic

Does anyone else struggle to come up with a number in response to the question "on a scale of 1 to 10, how severe is the pain you're feeling"? Doctors and nurses, especially in emergency departments, tend to ask this. When I ask "what's 1 and what's 10" they usually explain "1 is barely noticeable and 10 is the worst pain you've ever felt". Well, firstly, different kinds of pain are difficult to compare. But leaving that aside, what really makes me wonder is: how meaningful is the answer to them, given that they don't know the worst pain you've ever felt? Even if you told them about that, they still wouldn't know how you actually perceived it. So how much does your answer really tell them? Has anyone been on the other side of this question? If so, how do you use the answer?

It seems to me like this is wide open to confusion. You might have never felt strong pain before and your current pain might not be that strong either, but according to the scale it might be 10. Or you might have felt some really extreme pain before and your current pain is still very high, but less than that, so it might be an 8. This isn't just being pedantic, either - if they misinterpret your answer you might not get treated as soon or as effectively, so it makes a difference. So what do people do with this question? Luckily I haven't been to emergency departments too often, but I was just asked the question today (not by a doctor) and it reminded me.

Last edited by FMX on 16 Jan 2013, 7:47 pm, edited 1 time in total.

Yes. I do not know what a "1" or a "10" would feel like, nor would I be able to assign any other number to a sensation I don't quite comprehend to begin with. All I know is that a sense of discomfort defined by the dictionary as being "pain" either is present or not. There are no gradations.

I have trouble with the pain scale which wasn't good when I was in the hospital a few months ago. I did have a nurse tell me that you have to tell them 7 to get 2 pain pills though.

Here are a couple of alternative pain scales not used by hospitals that make more sense to me.

I think they know it is subjective. A sensitive person may put a broken finger at "9", while a less sensitive person could rate it a "3". They know very well the experience of a tough old guy being dragged in by his wife, insisting they're "making too much of a fuss", only for it to turn out the guy's having a heart attack or has broken his arm in three places. And they also know that some people are so overwhelmed by relatively minor illness that they come in with a tension headache convinced they're having a migraine, or their worries about appendicitis turn out to be just intestinal gas. A few jerkwads will assume that having a low pain tolerance makes you a wimp, but most doctors are okay about it. I went in for dehydration due entirely to menstrual cramps which caused nausea and extreme pain (which did peak at a 9 for me, believe it or not--the point at which you think you will pass out, and then wish you would), and they treated me decently. All I needed was a saline IV and a double-dose of pain medication. Nobody ever called me a wimp.

The thing with pain, though, is that it IS subjective--the severity of the injury may be less or more than somebody else's injury, but the pain you experience, your subjective "7"--is the same as the other person's subjective "7", even if their injury is worse. So it is entirely possible for someone to suffer just as much from a mild injury or illness as his less-sensitive friend suffers from his more severe injury or illness. Some people need more pain management than others--but pain management is important for both groups because it lets you get rest so you can recover more quickly.

If you know you are more or less sensitive to pain than most people, say that straight out. "This is a three. But I am autistic and I'm usually not very sensitive to pain, so it could be worse than it seems." If you're so hypersensitive that a relatively minor injury can cause communication shutdown, you should probably be carrying a wallet card or wearing a medical bracelet to alert paramedics/ER docs that you tend to shut down in response to pain and may not be able to communicate effectively. List a contact who knows you well so they can bring that person in to explain things. Once the pain is brought under control, you can explain it yourself.

Back in 2004 i had atrophied a neck muscle and ended up in a whiplash brace. The only way i could get up from a laying down position in bed was if i clasped my hands together and threw myself forward with them.
So mom had me to the ER at the hospital where the doctor wanted me to do that dang pain scale numbers thing. Even with pics for the pain scale, i am clueless and have absolutely no idea how to figure the thing out so i circle 3 which is one of my favorite numbers.

The doctor was surprised that i had a pain tolerance i did and was supposed to put note into the computer. I'm not really sure what i did with my neck, however it was days before my mom made me go to the hospital.

I have a pretty high pain tolerance. I tend to like pain actually, but that is a different story BUT I get that. What I have a hard time with is, when I do have pain, it might really bother me, but there is something wrong, even though I can take the pain, like kidney stones. They hurt, but nothing I couldn't handle. My mom who can't deal with pain, and others, looked like they were close to death. So it's hard for me because I can handle it, but like I say pain is a warning that something's wrong, so I have to speak up and tell someone, and then lie that it's worse than it actually is so they fix me up. Plus give me meds lol

I'm not very articulate today sorry Having an "off" day. Can't seem to process words very well today.

I don't think the pain scale is useful at all, as regardless of the answer, the doctor decides whether or not it "should" be painful enough to do anything about. I saw that over & over again with several people close to me, who suffered kidney stones (excruciatingly painful to potential suicidal levels) ; for whom nothing was given, and with myself in the reverse when I was told I'd need pain pills for certain things (said to be painful but weren't to me), so I didn't need any of the pills which were insistently prescribed to me. People lie all the time to get drugs, and sadly, doctors are programmed to assume you're an addict and have trumped up a reason to get pain meds. I'm very grateful that I have a high pain tolerance, and just deal with it by "shutting it off", and take a few Advil if needed.

Charles

I have spent a lot of time in the hospital for leukemia, so would frequently be asked about how much pain I was in. Something I learned is that the pain scale is subjective. I have a high pain tolerance, and would rarely rate anything a 5 or above. Because I had a team of nurses that always stayed the same, they began to notice my ratings. After a while I was informed that they take the number I rate my pain and double it to get an average person's rating. So if I said the pain was a 3 they would act as if it was a 6.

However in an emergency room setting the person asking for your pain scale number wouldn't have knowledge of how well you tolerate pain. I would think this is where misinterpretation would occur. If someone like me would tell them their pain was a 4, they wouldn't know to treat it like an 8. I would think that the person's pain tolerance would make up for the different treatment though. If they perceive the pain as a 4 than pain medication used to treat a 4 should be enough for them, while giving them pain medication for an 8 would probably be overkill. So it may just work itself out.

Going off on a bit of a tangent but, a year or two ago I was having the template for a tattoo transferred onto my wrist. The ink is semi-permanent and the artist just could not get the position correct so we had to keep putting it on and then scrubbing it off with alcohol and a sponge. It was mainly the tattoo guy doing the scrubbing off each time and I was told to stop him if it became 'too painful'. The thing is, at no point during the ten or so attempts did say stop. I registered after the first couple that it was becoming painful but certainly nothing i could not bare. I used to cut myself and, like others here, have a complicated relationship with pain. I never once asked him to stop and just trusted that he must know what he was doing. Turns out he didnt. Most of my skin had been scrubbed off my wrist by the end and for weeks it looked as if I had third degree burns there.

I suspect that most NTs would have known to stop him but to me the pain is often something I can be aware of be decide not to be affected by.

Glad to see I'm not the only one who struggles with this. Thanks for the useful tips, too. I'll try to remember them when I'm in pain.

Thanks, those actually look like useful descriptions (despite the source). I can work with those!



I'm not convinced about that. Of course, different people may experience the same injury or illness differently, but their "pain range" really depends on what they've experienced so far - which the doctor has no way of knowing. So even the same person may rate the same experience of pain differently from one occasion to another, because they have more information. I guess they just ignore that particular problem, since there's no way around it. Well, they could subject every patient to the same kind of pain (eg. electric shock with the exact same current) and get them to compare their other pain to that, but I can't see that happening. Scientific, but not very practical.



That's interesting to know, too. Based on what's been said here I'm not convinced that just giving my most accurate estimate is the best idea. I may have to adjust it (upwards) to get something done. Actually, this nearly got me the one time that I was in emergency for something very serious. The first doctor who saw me nearly made the wrong diagnosis, because I didn't report enough pain for the correct one. Luckily he got a second opinion promptly! Maybe I should have done as Callista advised and told him that I might perceive less pain than most. (I didn't know about ASD at the time.)

The other question this brings up is: how do you determine your pain tolerance? A few people have said theirs is high and I suspect mine is high, too, but I can only really guess at it from indirect evidence, like the incident above and a few others. I'd be interest to know if anyone thinks they have a low pain tolerance and how they worked that out, because otherwise it could just be good old self-serving attributional bias or illusory superiority - you know, 90% of people thinking they have above-average pain tolerance, that sort of thing.

I like the pain scale pictures. I read about a girl who had necrotizing fasciitis, and it hurt so bad that she was begging the doctors to cut off her legs.

I hate the pain scale! Argh! Pain is extremely subjective, and I speak as a person who gets migranes (probably a 5-6 on the pain scale) and has had a kidney stone (definitely a 9-10). Because, you'd think after going through the kidney stone pain, I'd be like "hey, no sweat, just a migrane" but in fact my migranes still are debilitating and make me curl in a ball and cry for mommy when I'm not allowed to take medicine for it. ((we're not on birth-control so for the last 2 weeks of a cycle I don't allow myself to take excedrine migrane which is the only medication that does anything at all for my migranes)

That being said, to me, you know that you are at least over a 5 if you are in fact over a 5. In my opinion. There was absolutely nothing that I wouldn't do within my capabilities to get the kidney pain to stop. Heck, even the residual pain was too high to deal with and I ended up back in the ER for that so I could get more pain meds too. The question for me is what's a 5, what's a 7, what's a 10. I KNOW there's no worse pain than the kidney pain, but anywhere between 5 and that is just... confusing to me.

That being said, it should be noted that if you persistantly have a 3-pain, it can become just as troublesome as 7-9 pain. I won't go as far to say that it's as bad as a 10, but it can be up there if you can't get relief


So yea... it's subjective. I like the two posters above though. Having a kidney stone feels like 1- just kill me right now and 2- someone IS killing me right not by dragging a knife through my insides. No fun at all.

The pain scale is like self-empathy. And it remains a very awkward problem for me. The question brings me to my most Aspie moments. It's the sad side of the "Hi! How are you feeling!?" coin.

I finally learned to find a way to rate my pain high enough to sound as serious as it should be - usually I would say my pain is much milder than it was.

Anyway, I found out that my doctor rated my pain of 7-8 as "mild," apparently because I was not limping.

Even finding ways to give answers, this is a very difficult question for me. Where can I place my pain that is not exaggerating, but not undermining the fact that I am in pain.

I used to have problems with that, but as I've had gallstones, I can compare it with that. Gallstones is a 9.5 (10 would result in passing out). Induced, back to back, labour is a 9. Acute sciatica is a 9. After having gallstones, I'd say most other things I experience are under 5, even things that I might have once said were a 7 or 8.

One of my two worst pain experiences was having an anaesthetic injection put in at the side of my eye (not into the eye, further to the right of it) before they removed several styes from inside my lower eyelid. A stye on my outer eyelid had burst and the infection had gone inside my eye and caused these other styes to grow inside the lower eyelid.

That injection pain was BAD in a 'This is a whole new experience level of pain' type way!

It was 'I don't think I can handle this pain it's so bad BAD!'

When the Dr was cutting out the styes I also felt pain I couldn't deal with and kept saying 'It's hurting a lot!'
It was as if the Dr didn't want to take me seriously at first as he seemed to think he'd given me an adequate dose of anaesthetic
but I persisted in saying how much it was hurting and they may have waited longer for the anaesthetic to take fuller effect or something.

At no point did anyone refer to a pain scale.

Afterwards he said I may have to return to have a remaining smaller stye removed as well and I remember thinking
'You must be f-king joking!'

Last edited by nessa238 on 17 Jan 2013, 7:06 am, edited 1 time in total.