• Why Your Pain Rating is More Important Than You Think

    “On a Scale of 1 to 10, where would you rate your pain right now?”

    On a scale of 1 to 10, how much do you hate that question? If you’re like a lot of people your answer to the second question is somewhere around 11. And you’re probably not much fonder of the the pictogram version either.

    pictogram version of the pain scale

    It’s so Subjective…

    The biggest complaint I hear about the scale is that people don’t really know what the numbers are supposed to mean because it’s subjective. That’s a fair complaint. Everyone has a different pain tolerance and different reference for what worst pain feels like. A 7 may make one person cry but someone else may not even reach for the ibuprofen until their pain reaches a level they consider to be a 9. Gah! What’s a body to do??

    As much as you hate it, giving your pain a number is important for at least 2 reasons: 1) That number informs the type of treatment you’ll receive. In massage, a higher number generally means you can’t tolerate deeper pressure or other irritating types of strokes. 2) That number serves as a reference point to judge the efficacy of the treatment you received.

    A Pair of Cautionary Tales

    1) It’s Not That Bad

    I once had a client who rated their current sciatic pain at a 10. That’s the highest number that’s reserved only for the worst pain. This is Emergency Room level pain, yet they came in to get a massage.

    Normally, I’m firmly in the camp of, “When your client/patient tells you how bad their pain is, believe them.” But every rule has an exception, and this was one of them. I believed they were in pain but, I didn’t believe their pain was a 10. Let me explain why:

    • This person had been at work all day, and was going back to work after their appointment – ER level pain usually keeps people out of work.
    • This person’s voice was clear and loud – normally it gets softer and harder to understand as pain increases.
    • This person had a normal gait – higher pain levels in the low back, hip, and leg usually alters the way you walk as the body tries to find ways to move that are less painful.
    • This person could stand to have my elbow jammed into the meatiest part of their backside AND they could stand to have me bend their knee and move their leg around while I did it. This particular technique is usually too painful for anyone who’s pain is above a 7 or 8.
    • They had not taken any medication (over the counter or prescription pain reliever) for their pain. Most people need to take something once the pain goes past 7 or 8.
    • High pain tolerance does not mean that you can walk around at a pain level of 10 as if nothing is wrong. 10 still hurts the same no matter what your tolerance level is. The difference is that it takes a person with a high tolerance longer (i.e. they need more painful stimulus) to rate their pain as debilitating.

    2) What’s the Big Deal?

    I have at least one family member who has routinely had issues with doctors not taking her complaints of pain seriously. It’s only been recently that I found out why. Not only is she female and elderly, 2 populations whose pain is routinely minimized, she answers the pain rating question with what seem like ridiculously low numbers. I used to sympathize (and still do, actually) with doctors not taking her pain seriously. However, I can now explain to her why, at least in part, that this is happening. Here’s what I discovered:

    • When asked to rate her pain when it’s at its worst, she said 5 – I’ve seen her when her pain is the worst and it makes her cry. A level 5 pain should not make you cry.
    • When her pain meds were wearing off after surgery and she was fighting to keep herself together when asking when her next dose of pain meds was due, she rated her pain at a 3. Most people don’t even need an ibuprofen when their pain is a 3.

    A Less Subjective (i.e. More Accurate) Pain Scale

    Years ago, I came across an amazing and objective pain scale at an internal medicine office where I was doing chair massage on the staff. They kindly let me copy it down and use it. I absolutely love it, but it has one flaw. It’s too objective. For instance at a 9, you vomit due to pain and at a 10 you pass out. Realistically, these are the body’s responses to the worst pain possible.

    Fortunately for most of us, we’ve never had pain so intense we either vomited or passed out. Unfortunately for this scale, that leaves 8 as the highest pain level most of us have felt. However, most healthcare providers are looking for something that allows everyone to realistically achieve a score of 9 or 10.

    While it seems like an impossibility to reconcile a subjective and objective pain scale, I think it can be done. To that end, I give you some guidelines to use when rating your pain.

    Guidelines for Rating Your Pain

    Caveat: These are just general guidelines and there’s overlap because there’s more than one way to describe things and because everyone has their own way of feeling and dealing with pain.

    1 = Little to no pain
    3 = Bee? Maybe it’s a bee sting. (Maybe not if you’re allergic to bees, but you get the general idea)
    5 = I kinda want some ibuprofen or other over the counter (OTC) pain reliever
    5 = Annoying headache level of pain
    7 = I really don’t want the pain to get any worse
    8 = OTC pain relievers aren’t cutting it
    8/9 = crying
    9 = Speaking or moving the affected area is very difficult
    10 = Childbirth or kidney stone level pain

    TL;DR

    No one is going to give you prescription pain meds or treat your pain as an emergency if you tell them it’s a 5.

    No one is going to believe your pain is a 10 if you’ve just told a joke or have no obvious signs of distress.

    Rating your pain accurately is, sadly, no guarantee that healthcare providers will take you seriously. It is, however, the best tool you have to get your pain treated in an appropriate manner. It also reinforces the veracity of any other symptoms you tell your healthcare provider about. And… it serves as the baseline when determining if the treatment is at all successful.