4:03am August 10, 2014

Pain scales really are very individual.

youneedacat:

bittersnurr:

youneedacat:

They always ask you to rate your pain on a scale of zero to ten. Zero is no pain, and ten is the worst pain you can imagine and/or the worst pain you’ve ever had.

When I was in the ER with aseptic meningitis, I rated my pain an eight. And the nurse was like, “Are you sure it’s not a ten?” and I was like “No really it’s an eight.”

Because for me, a nine is when it starts severely impairing your consciousness, and a ten is when you’re either on the point of passing out, have already passed out, or by all rights should have passed out at some point whether you did or not.

And I’ve experiences nine and ten, many times. I know what they feel like. This was a particularly hellacious eight, but it wasn’t a ten. Not on my scale.

I was talking to a friend whose pain scale is very similar to mine. We both rate a migraine in the 6-7 range, and we’re aware a lot of people will rate a migraine at a 10. And that’s fine, if that’s what works for them, but we’ve experienced pain far worse than migraines.

I remember when I first went on Neurontin for pain control, and I had to revise my entire pain scale. What I thought was a “1” was actually a “6”. That happens when you’ve never lived without severe pain.

And neuropathic pain, of all kinds, is far more likely to throw a 10 at you than other kinds of chronic pain. So you’re likely to eventually find out what a 10 is. I found out through untreated trigeminal neuralgia. You can find out through other ways too, though. Diseases that completely fuck up your organs are another good way to learn what a 10 is.

But at any rate, I get the sense that there’s people where 10 is as bad as they can imagine and they can’t imagine very bad pain. And that’s fine, for them. And then there’s people who’ve been through hell and back and will rarely admit to pain over a 6. And then there’s the rest of us somewhere in between.

But it’s extremely subjective. And I do wish nurses understood that sometimes. That when I say something’s a six, I mean it’s something that someone else might call an eight or a ten even. And if I do start giving numbers 7+ it’s really fucking serious.

yeah as far as pain scales go I use this one now

because this is the only one that I think can accurately convey pain at all. I am guessing this is pretty accurate to how you scale it because you mentioned earlier iirc that it was an 8 not a 9 because you weren’t delirious?

Doctors will occasionally ask me something about like “where is a migraine on the chart”

The answer is I can’t really answer that. on average a migraine would probably be a 7, but I have had about 3 migraines that spiked past that and once my pain gets to an 8, it starts a chain reaction that triggers my autonomic dysfunction so I add on more symptoms past that. At that point the combined pain from multiple problems can spike all the way up to a 10 and knock me out.

But then there is problem #2 with painscales, at least as a chronic pain patient. Pain tolerance.

If you are using these charts for chronic pain, which EVERY doctor I have met does, you will likely fail to take into account what happens if your tolerance increases. Every pain related ER trip I have to make my pain drops a level on the scale. Every time I experience a 9 that will never be a 9 again. It now will be an 7-8.

So when I tell the doctor my pain TODAY and every day of my life is currently a level 6, and they look and see 3 years ago my pain was a level 6 they see a static level of pain but it’s not even remotely true. Because the scale is static and 10 is always “the worst pain you can imagine” every time you learn of new pain the numbers all drop.

But this isn’t taken into account at all. So the doctors just sort of ignore you getting worse because as long as they don’t ACTUALLY TREAT YOU for the pain you get “better” because your pain tolerance gets higher.

And they don’t get why this isn’t helpful as a from of measurement outside of emergency rooms.

I most often use the Comparative Pain Scale:

https://lane.stanford.edu/portals/cvicu/HCP_Neuro_Tab_4/0-10_Pain_Scale.pdf

Because it has such detailed descriptions of the way the pain affects you. But you’re right, I must have picked up 9 = delirious from somewhere else.

Some interesting discussion here. I like both of those pain scales better than average.
Though it’s obvious from the examples given that whoever came up with the one on the PDF link has not experienced either a poison ivy reaction or “bad” back pain like I and a number of people I know have experienced them. My jaw dropped open at the poison ivy itch as an example of 1 there. Granted, I get the kind of reactions where I need Prednisone for anything more than a very small patch, or I am in hell for 6 or 7 weeks instead of 2 or 3. But I get burning, shooting nerve pain which combined with the relentless itching that fills up most of the world has sent me into looping suicidal thoughts on more than one occasion. More nitpicking than anything else, but that one really did impress me. It helps illustrate how individual this stuff is, though.

But, overall, I do like the emphasis with both on how it’s affecting your life. Also allowing there for learned tolerance, of course, dealing with chronic pain. If I couldn’t somewhat function once it gets to the nausea and dizziness point, I would get even less done than is the case now. (That is called “evening, where I have been up for a while” most of the time here.)
And yeah, if asked, I would usually say 4 or something. But I have also been at passing out 10 on both scales, while apparently the majority of people have not. And according to both of these, my baseline these days would be 7 or 8, fluctuating above and below that sometimes. Probably nobody would believe me if I did answer accurately by those scales.