Another Pain Scale

I had discussed before how difficult it is often for me to give my pain a score. So my physical therapist enlightened me with a relatively simple pain scale that is easy to follow.

Since then, I have found another on a pain diary app (that looks great but unfortunately doesn’t work), made by Andrew Brooks for Windows Phone, last updated in 2011. Since the app is free to download, I didn’t see an issue with sharing the attached pain scale here, which is more extensive than the one I described before.

0 = no pain

1 = pain is very mild, barely noticeable; most of the time you don’t think about it

Definitely a good day when I can say I am at an “1” with this scale. Parts of my body may be at “0” but most of it almost never is anymore.

2 = minor pain; annoying and may have occasional stronger twinges

3 = pain is noticeable and distracting, however you can get used to it and adapt

The “2-3” range is probably my new normal on my current medication regime, according to this scale, which is more or less consistent with the last one.

4 = moderate pain; if you are deeply involved in an activity, it can be ignored for a period of time but it is still distracting

5 = moderately strong pain; it can’t be ignored for more than a few minutes, but with effort you can still manage to work or participate in some social activities

Sort of a sub-normal for me when I am at “4-5” on this scale, but not quite flare-level.

6 = moderately strong pain that interferes with normal daily activities; difficulty concentrating

7 = severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships; interferes with sleep

The trigger points in my midsection have been acting up recently, starting to throb ridiculously and shooting nasty pains in all directions. I would say that experience falls under a “6-7” on this scale. I would call this flare-level pain. The cumulative effect of the flare tends to rise the longer it lasts.

8 = intense pain; physical activity is severely limited, conversing requires great effort

I think I only hit “level 8” periodically and in waves, like when the throbbing pain wave has me in its grip. I am lucky to have not experienced this level of pain constantly for extended periods of time – largely thanks to emergency pain medication!

9 = excruciating pain; unable to converse, crying out and/or moaning uncontrollably

10 = unspeakable pain; bedridden and possibly delirious, very few people will ever experience this type of pain.

The last two levels sound like the pain you would feel if you were shot in the trenches or had to have surgery without anesthesia. Thankfully, I have experienced neither. I have been at a point when I am crying or moaning out of pain, but I feel like I could have pulled myself together to save face if I really needed to. And I have never been delirious with pain, thank goodness. Apparently, even the developer of the pain scales seems to acknowledge that few people will ever reach “level 10.”

While I kind of like that this pain scale is more extensive and covers more ground than the last one I posted, I also feel that it is almost too extensive. On a daily basis, I doubt I would remember what each level means as easily as I would with the other, simpler scale. Still, I thought I would put it out there to keep a record of it in case I ever need it in the future, or if it can help someone else!



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!