“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.
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.
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:
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:
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.
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
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.