One, two: buckle my shoe . . . nine, ten: score your pain!
How do you give an “objective” score to something that is inherently subjective? It has always been incredibly challenging for me to give my pain a score from 1-10. I never quite know how to answer that question, and I feel like I am giving inappropriate information if I try to answer it without some knowledge of how the scale works.
I had a honest talk with my physical therapist about this one day (who asks me this question twice a week) and here’s how she defined it. I thought it was pretty decent and have personalized it for myself below.
0: You are not consciously aware of your body. Basically, it’s doing its job invisibly and not asserting its presence on you.
1-2: You are aware of the part of your body (it is not actively in pain but not invisible neither). For me, this is what I call “a good day.”
3-4: You are aware of some pain but it won’t slow you down and you don’t need to take breaks because of it, don’t need emergency pain medication yet but maybe an extra muscle relaxer won’t hurt. This is my “new normal” under the current pain management regimen.
5-6: Now the pain is bad enough so you need to take breaks because of it but you can still mostly keep up with what you need to do, maybe after a pain pill (and a muscle relaxer), might need a heating pad/blanket. I am frequently at this “sub-normal” that’s not quite a flare.
7-8: This is where your face starts to show how much pain you are in, you need frequent breaks, probably cannot do much of what you need to – just grab a heating blanket, a higher than usual (but not over the recommended max!) dose of painkillers and and get in bed. I would call this “a bad day” – “flare” category.
9-10: Under a heating blanket and crying, probably even after taking all the pain medication you possibly can. For me, this is the stage where I avoid drinking water so I don’t feel the need to pee because I cannot make it to the bathroom. Full-blown flare.
Although this scale doesn’t take into account the different types of pain or the accompanying fatigue, it makes room for you to judge its impact on you. I have described my pain as aching, gnawing, sharp, stinging, shooting and stabbing at various times in various parts of my body. And an objective 1-3 of the neuralgia-type of pain feels way worse (on a practical level) than a similar level of aching pain. Similarly, dealing with a 4-5 aching pain on a high-fatigue day feels worse than usual. The descriptive scale gives you the room to give it a higher score for those instances than what the “objective” measure might suggest because of its impact on you. This can be especially helpful on a computer, to whom you cannot explain the daily fluctuations in the types of pain or fatigue levels.
Having this scale makes me feel like Helen Keller who has just had an “eureka” moment after connecting the coolness of the water, the quenching of her thirst, to the abstract hand gestures made by her teacher spelling out W-A-T-E-R!
It is a curious relief to receive a straight answer to your very personal chronic pain-related questions. Most of the time it is met by a blank face or a shrug of the shoulders that just lets you know that your doctor cannot really comprehend what you are going through. This incident really made me connect with my therapist and trust her more. And trust (and honesty) are, of course, the crucial first-steps to her being able to help me!