The Pain Scale

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!

Love,

Fibronacci

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12 thoughts on “The Pain Scale

    1. WOW, that’s neat! Thank you for sharing that with me!! It’s great to have some independent validation for this scale. πŸ™‚ My physical therapist came up with the general descriptions for it, which I then personalized for myself. It’s a pretty handy sheet to take into an office for the next score-your-pain question, LOL!!

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    1. Yes exactly! I never quite knew how to interpret that scale or what’s a decent measurement. And it frustrated me to no end getting asked this question twice a week and not knowing quite how to answer. But the way my therapist described the scale made so much sense!! So glad you liked it too! πŸ™‚

      Liked by 2 people

  1. Thank you for that! That’s the best description of the pain scale I’ve ever heard. I always had trouble with it too. My thought was, OK I’ve had severe he is severe and acute sports injuries that were incredibly painful – the most pain I’ve ever experienced so I equated those with a 10. Based on your scale, I now see that I’ve been undervaluing my chronic pain because I’m comparing it to a grade 3 sprained ankle , a shredded rotator cuff & labrum in the shoulder after throwing a baseball from deep shortstop (2 surgeries) or a pop in the knee collapsing inward (2 surgeries) during inline hockey game which turned out to be a torn MCL & meniscus cartilage. That traumatic injury pain the worst I’ve experienced so in my mind that had to be a 10 and I went down from there with chronic pain. Compared to traumatic injuries, chronic pain is rarely close to that “10”, but your scale changes everything. I’m now more educated & will be a much better communicator with my medical professionals because of this post. That list should be a chart on every doctors office wall & ER waiting room across the country. Thank your PT for me if you think about it πŸ™‚ and thank you. Great post!

    Liked by 1 person

    1. You are most welcome! So glad you found it usefull!! πŸ™‚
      What you said about equating broken-bone-pain to 10, is exactly what I used to do! But chronic pain is inherently different from that (physiologically and emotionally) and is never quite that severe at any one time, but it wears you out with time. Broken bones/surgeries may be a lot more painful at the time but it eventually heals. Chances are your medical team also has a fairly good idea how to treat your surgical pain but treating chronic pain is a lot trickier. So for all these reasons, putting those two types of pain in one scale is like comparing apples to oranges (both fruits/pain, but inherently different).
      Yes, I will definitely try to remember to thank my PT for you! Feel free to personalize this chart and use it as a handy sheet next time you walk into a doctor’s office so they know what your score means for you. πŸ™‚

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    2. HAHAHHAHHHAAAAA!!!!! That is an AMAZING idea!! It really cracked me up, LOL! πŸ˜‰ The only problem I see to that is me giving it out freely to whoever wants/needs it. I have the same problem getting my painting business off the ground – I am only too happy to give it away for free! Haha!!!

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      1. πŸ˜†πŸ˜‚ Glad you liked it – lol! Giving it away would be the noble thing to do. If your therapist runs with it, tell him you & I will spit just 50% for the idea. Imagine if they sold for even a $1. Wait, what am I thinking? it’s a “medical device” so we should sell it for $50 each πŸ˜‚. We’d all be wealthy. I’m a lawyer so I’ll copyright it for us….
        It’s fun to dream of making money without doing anything. πŸ˜†πŸ˜‚πŸ˜‚
        Glad you enjoyed itπŸ˜„

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  2. thanks for sharing this i too have always been confused by the pain scale reading this was slightly terrifying for me. based on those descriptions i assume i was a child the last day i could describe as 0. I have no concious memory of it. It has been at least 4 years since i can claim 1-2 with any regularity. my normal day is now a 3-4. Id currently describe myself as experiencing 5-6 and its not a bad pain day for me! its a semi normal evening. its a very scary realisation.

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    1. I can totally understand how you feel Francesca, and I am very sorry to have to say that. 😦 I used to underscore my pain all the time. I agree, I haven’t been at a zero for over a year or more. Some parts of my body may be at 1-2, but most of it is at 3-4 at all times with my current medication. I am often at 5-6 as well, and I am hating to think that it might soon become a new “new-normal” given its frequency. I thought about increasing my medicine dosage to combat that (bring it back down to 3-4), but instead figured I’d try physical therapy first to see if I can push off going up on the Lyrica dosage for a while longer yet. I can sometimes use pain-management meditation to reduce the impact of a ~5 to about ~3-4 as well. It is scary indeed, but it’s the hand we’ve been dealt, and we’ve just gotta make the best of it. ❀ Sending lots of love and positive vibes your way!

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