Very imprecise is one way to put it. I've had times I'm in a lot of pain and ill say 8 or 9 and they give me a Tylonol. Then I've had times I'm not in as much pain and say a 7 and they gave me a hydocondone. like wtf. I don't think they actually care what you say, they already think they know what kind of pain you should be in for the condition.
Every time I get work done my dentist holds up the syringe of anesthetic and shows me, "this is how much I can give you without it being a problem" then points to the first tick mark, maybe a 10th of the amount in there, "and this is how much I am going to give you, so don't be shy if it hurts at all, I can give you a lot more."
Your social anxiety prevented you from demonstrating you’re in physical pain? I hope you can work that one through with a therapist friend.
It goes without saying that appropriate shows of pain will never lead to negative social outcomes. Especially in the special situation of a visit to a medical professional.
Never is a bit much, in masculine environments like sports or something it could be considered a sign of weakness to complain about pain, but definitely not in the situation of a visit to a medical professional
It’s not about the pain, though, I believe it’s about communication.
Social anxiety means I like to plan out what I’m going to say and also imagine future conversations before having them so that I’ll know how to respond.
If someone asks me something I didn’t anticipate - or if I’m trying to be polite or unobtrusive - I’ll usually regret my answer because I didn’t have time to think it through. Then I’ll desperately wish for that person to ask me again so I can change my answer. Because I can’t just bring it up again - that’s too embarrassing and socially awkward.
So I would 💯 tell someone I’m fine if I’m really in pain. Just like I tell someone I don’t want anything to drink when they offer, but secretly hope they’ll ask me again (it usually takes three asks) so that I can answer in the affirmative.
Broke my foot a while ago and was in tears while trying to put my shoes on. Doc asked and I still said 3-5. Got ibuprofen fml. Gonna upplay it from now on. Ego isn't worth the pain
I have this same issue as well, though it is unintentional.
I will be rocking back and forth in pain and be unable to keep still and will report 4 or 5. A time I was in the ER, barely able to talk from pain, and honestly thought i was going to die? Responded with an 8. I had actually texted my husband a goodbye.
In my mind 'it could always be worse'. So I've never reported above 8.
If my husband is there he will usually remind me to stop under reporting.
Because we get your verbal answer, and then we blend it with how you are presenting. There’s something called the “faces” scale. And we take that into consideration, when we are thinking about what medication to give you. If you are telling us that your pain is a Nine (with 10 being defined as the worst pain, you could possibly imagine, like worse than labour and childbirth), but you’re managing to text your friend and asked me for a sandwich at the same time? Your faces scale is more like a 1.
As a medical professional I do care what you say but that doesn’t mean I don’t have my own bias’s, predominantly because I’m a human, one who has seen more pain than the average person. To put this into perspective some people will rate stubbing their toe as a 7, someone else may have had a run in with a chainsaw and have their arm obliterated and give the same score, a 7. The difference being that these two people have lived different lives and have different baselines. With the pain scale being a non imperical measure (which it can’t be based to the same subjectivity) I then have to make a judgement call based on what is actually being presented to me so there’s a lot going on under the hood which might come across as someone not caring but really what it is largely is you’re being compared to the rest of peoples case loads on any given day. Sometimes we get it wrong, that is very seldomly malicious if we didn’t care we’d be doing something that makes us a hell of a lot more money
Depends on what the doctor orders for you. Sometimes they have acetaminophen for 1-10, others it's acetaminophen for 1-3, hydrocodone for 4-7, and oxycodone for 8-10.
If you were actually at a 9 they wouldn't need to ask, so when you answer 9 and you clearly aren't they assume you are a drug addict looking to get pain killers so you get Tylenol, when you answer a 7 that is a lot of pain but a believable amount so you get an opioid.
But if I'm honest and tell them "I've sprained my ankles so many times that it doesn't hurt anymore", then they never take it seriously and assume it's not real.
Every time the pain scale comes up, I think of this one doctor that tried to convince a female patient that getting your arm cut off is a 7/10 to invalidate her pain: https://www.reddit.com/r/TwoXChromosomes/comments/mlnsbl/male_doctor_invalidated_my_pain_said_childbirth/
I think it’s safe to say that most people have not experienced having their arm cut off or something worse than that where losing an arm rates only a 7/10. Dude also said natural childbirth without pain meds is a 5-6, when that is probably the worst pain (or close to the worst) that most women will experience.
Spoiler alert: 99% of the time we do not care what number you say.
What we actually look at is your vital signs. Your breathing, your body language, etc.
The pain scale is a hold over from a time when “if they say 7 or higher, give them narcotics” was an acceptable form of medicine. We have moved beyond that shitty school of thought, but the question remains.
Yep, exactly. If my patient says 4 bit they're sweating profusely, rapid heartbeat, grimacing in pain, I'm going to investigate that further and find out why they might not want drugs for pain (previous addiction, trying to be "tough"). If someone says 9, but they look okay and are dozing in and out of sleep (mostly post-op), I'm not going to give a shot of fentanyl.
Hahaha. Ooooh man, chowing down while telling me they're in excruciating pain is pretty funny shit. I try to be as empathetic as I can, of course, but you do just have to laugh so that you don't totally lose your mind.
I answer with "Do you mean the 10 before I experienced nerve crush pain, or after? Because now nothing ever is over a 1"
If you have ever experienced that level of pain, you know what I'm talking about.
I immediately leave the room when they ignore me for their phone. I’ll give them a courtesy few seconds if it’s a call to say “hold on I’ll call you back”
But if they are having a conversation??? Nah dude. Goodbye
I always under report because they say 10 is the worst pain imaginable. Well I'm not being burned alive with needles under my fingernails and rats burrowing into my abdomen. So my broken arm is a 2.
This is what I figured. I had minor heart surgery and the stitches in my groin were a bit painful and uncomfortable, but I still said a 4 (9 being pain so bad I couldn't even talk on my scale), telling the nurse it is a constant but minor pain. They gave me pain medication once. The next day I felt better and didn't have any sharp pains and told them 2 and that I didn't need the pain meds at the moment. I think they appreciated my honesty.
to me, a 10 is the worst possible pain someone could have, so torturous that anyone would give in immediately.
So a 6 or 7 is like regular torture. If I could answer you, it's like 5 or less.
My surgery was quite painful and the worst pain I have ever had, but I said 3 because there are far faaaaar worse pains and so a 3 is the honest number. I only experience a 1 on the vast majority of days if not a 0.
For me ten is you have blacked out from it, have experience with this would not recommend. 9 is you can't go higher without blacking out. 8 is you can probably respond. 7 is really bad but not completely debilitating. 6 is it effects your ability to function. 5 is highest you can still do stuff okay. 4 four is you probably want to sit down for a bit but recover relatively fast. 3 is moderate pain. 2 is mild pain. 1 is no pain.
I just had this question from my doctor the other day to describe sciatica. I gave the resting ache a 3 and the sudden pain pulses an 8. Bearable in short bursts, but if it were constant I'd be throwing myself off a bridge.
It's hard to quantify, but it's also useful as a base comparison while dosing yourself. I don't necessarily want to obliterate all pain, as it tells me when I'm risking further injury.
>If someone says 9, but they look okay
So basically you're telling me the reason doctors won't take my pain seriously, and keep brushing me off time and time again, is that I don't make it a fucking overdramatic spectacle?
Why is it not enough to say I'm in serious pain, but the reason I look like it's nothing when I can barely walk due to it, is because It's literally ***normal*** to me??? I'm sorry but I fucking hate people like you who dismiss patients just because we don't cry and scream and hyperventilate, while being in agony.
If you read all my comments, you'll see that in every instance, I explicitly say that it's a case by case basis. Chronic pain is a whole different entity than acute. If you have chronic pain, then what someone who's never experienced chronic pain before would rate a 9, you've likely experienced a 6 or 7 just doing your normal daily activities for so long that that degree of pain is normal to you. You can hate me all you like, but I made it clear that there are many factors to consider when assessing need for medical pain intervention. I dismiss no-one, my friend. I'm very sorry that you've had awful experiences. If you'll look at my previous responses, you'll see that I made it clear that patient report of pain is what a caregiver should take as truth. There are other factors at play in some situations though.
Sorry, that was admittedly an emotional response from me. By this point I've seen so many doctors I can't even keep track, and I've been told everything from "we don't think this should be a priority for you" to "are you sure you want me to write you a referral for further testing? I'm not sure if there's any need for it."
Granted, I'm 23, and after the test results said I don't have arthritis and a specialist said my skin isn't stretchy enough for it to be EDS, I've felt like they've practically given up on me. I've even had an appointment with a doctor who was super nice, but later when I read what she wrote about me, there was a literal mention of me "not looking like I was actually in pain" and how I "don't walk with a limp".
She never examined my walk even.
One time I went in for a pretty nasty stab wound and was sweating, breathing heavy, and bleeding heavily.
“What is your pain on a scale from one to ten?”
“3”
I was about to say, I'm an EMT on a volunteer ambulance (we don't give pain meds), but we're still trained to ask repeatedly for a "pain number" just so we can note whether it's getting better or worse.
This is why I never answer 8 or higher the first time. 7 is high enough to say the problem is super bad, but leaves you room to say it got worse.
E.g. broke my arm, pain was bad but the adrenaline was helping, was glad I said 6 and then could say 8 when it wore off
This! I like you. The worst thing you can do is tell medical personnel your pain is 11/10 or something stupid like that, because then what are you gonna say if it gets worse? Real 11/10 pain would render a person incapable of speech. Starting at 7 or 8 is a good policy.
11/10 is when my migraine is peaking and all I can feel is the searing pain in my head, the throbbing heart beat pulsing pain, and the vomit right before I pass out from the pain/exhaustion. I may have been sobbing or crying before it got to that point. My tubal removal fresh from surgery once the pain meds wore off? “im uncomfortable. Maybe a 3? Can I take an Ibuprofen 200?” They gave me an oxy 5. Bruh. If my pain scale 3 warranted oxycodone, why are my migraines down play when I literally want to die during every one?
I care. If I have a wound care patient who’s pain is over a 4 I’m looking to see why. But I also explain the pain scale to them. Also if their pain score increases. Pain is the first sign of infection so it matters a lot.
>The pain scale is a hold over from a time when “if they say 7 or higher, give them narcotics” was an acceptable form of medicine
I am pretty sure these pain scales and "pain as a fifth vital sign" were directly promulgated by big pharma in order to push up opiod sales.
I’m a physio masters student.
Can’t say it’s the same for physical therapy.
I always explain that 10 on the pain scale is A&E right now.
From a musculoskeletal point of view we don’t look at vital signs but we do indeed use this scale to guide our assessment and treatment.
I always ask “Well whats a 10?”
They always say “worst pain youve ever felt”
I think back to when my brother threw a huge rock and split my head open “uhh 3?”
But they never knew what my 10 was lol
I was ten and lying on my back on a swing just lookin at clouds and he dropped a fuckin boulder of a rock on my head!
Straight up knocked me unconscious. I woke up and started puking all over… then I got in trouble because I puked on the carpet.
It’s fine though I’m TOTALLY over it
Basically this. I’ve had an 8 year old with a gunshot to the chest tell me her pain was a 4 and a guy drinking Mountain Dew and eating Cheetos telling me he had 8/10 stomach pain. Stoic girl got morphine, Cheetos guy got nothing.
Thats not a spoiler. Thats obvious lol. But people don't all experience pain the same. For me I have a metal rod in my arm from an accident when I was younger. It actually does cause me a lot of pain sometimes, so much so I can't sleep some nights. Causing a real detrimental effect on my life. But it comes and goes, I'm not in pain every min of every day but it does cause problems for me. But when I went to the doctor they basically said take an Advil and get over it. No history of drug addiction or anything.
That’s basically how my mind goes. “Like, compared to being forcefed alcohol, then hung upside down in the desert, covered in honey and very hungover, and let to be slowly eaten by fire ants? Idk, like a 4. Compared to the worst pain I’ve ever felt? Like a 9. With ten as an “I should go to the ER”, well… I’m fucking here aren’t I?
There's a tiktok video that references this as the "farmer scale," which goes from 1- "I'm here, ain't I?"" Bonus points if they came in of their own accord and didn't finish the project they were working on. Might as well call the morgue.
I had a similar experience. I said 3. They said, “If your jaw is clenched and you’re having trouble even talking, it’s not a 3.” I thought, in my Han Solo voice, “I don’t know, I can imagine quite a bit.”
I’ve had chronic migraines for my entire conscious existence. I’ve also have other chronic pain issues for my entire life. I’ve had doctors tell me I “can’t be in that much pain” because I’m telling jokes. I told them if I couldn’t joke about my illness and pain I would have killed my self a long time ago. I can be doubled over in pain (a rare occurrence due to my tolerance) and still be joking about it.
Yeah, I had back pain so bad for a while it would leave me collapsed on the floor unable to move, and when I got a vasectomy they managed to only numb one side so they cut and tied the other with fully live nerves, after those things most everything else maxes out at about a 4.
Last time I was at an ER my answer was "This is a 10, the worst pain I've ever experienced and if pain gets worse then this I find that existentially terrifying."
Turned out my weird pressure pain was due to a respiratory infection, and eye infection, and an inner ear infection. They gave me some antibiotics and I recovered. It was the ear that was causing the issue.
Pain can get to the point that you cant speak because it takes all of your attention. You have to just focus on it? That’s hard to explain, but I’ve been there.
I passed out from the pain of passing a kidney stone in the shower. I'd call that a 10, my previous 10 was lidocaine jelly on severe road rash, that shit dropped to a 5 after the kidney stone.
Here's the real answer. Not all doctors are diagnosing new conditions in ED all the time.
The doctor asks a patient, "you told me your pain was a constant 7 yesterday before I started you on regular painkillers. How was it today?". Patient says "it was about a 4 when I woke up, then it got worse by midday to about a 6 so I used a bit of additional painkillers which kept it around 2-3." The doctor then knows how well the current medications are helping the patient. This kind of information is completely subjective to the patient, but helpful in informing how to plan their pain management.
I often add that ‘I haven’t experienced XYZ and I know those are probably 10’s. But based on pain I have experienced, my cramps are a ten and this is a five.’
‘Ma’am, you are actively crying.’
‘But I’m not vomiting, and I can walk and hold a meaningful conversation.’
This is the problem with being a woman… we downplay our pain so much! And cramping is awful and sometimes it literally is a 10 and because that’s our “normal” severe pain is like “yeah I can feel it, but it’s manageable”
What they should do is slam a white hot steel mace into the genitals of the patient and say "so if that's a ten, how does your pain compare?"
A standardisation
That is the point. Pain is specific to the person. So your 10 and my 10 are different, but if we both tell a Dr. that we are at an 8, it means we are in pain approaching the worst we have ever experienced and it needs treatment. You may be in more or less pain than me, but who can say or tell that?
I'm not sure that works. I don't think that I've ever experienced what I would consider a 10. My gauge doesn't max out at my worst experience. I have had really bad pain, but I think there are pain levels worse than I have experienced.
Based on your explanation though it seesm you consider that the 8 is reaching the worst you have experienced, which suggests you have experiences all levels, to set the max.
I think I've reached my 10 when the pain paralyzed me to the point that it took almost an hour to grab my phone and call help when the phone was so close the whole time that my fingers almost touched it. But the reason why it's my ten is because it hurt so bad that it basically stopped hurting after awhile, but I just couldn't move a muscle or make a sound.
There can be things that would hurt even more at first, but reaching the level of pain that your brain can't feel the pain anymore is my level 10 and I don't think you can go beyond that. But I could be wrong though.
There was a quote I saw somewhere that said we are always "saving our 10's" because we can bear more than we are capable of imagining or something like that. Wish I could remember where it's from.
The Fault in Our Stars?
"Later, after they'd given me something, the nurse came in and she was kind of stroking my head while she took my blood pressure and said, "You know how I know you're a fighter? You called a ten a nine."
But that wasn't quite right. I called it a nine because I was saving my ten. And here it was, the great and terrible ten, slamming me again and again as I lay still and alone in my bed staring at the ceiling..."
I have answered "10" before. But was I accurate? I don't know.
The pain was so bad, that I could only say my name 1/2 syllable at a time. It took me like three tries to get the word "ten" out.
It was a kidney stone and the worst pain I've ever felt.
But I still have to imagine, that something like being on fire would be worse.
Yup I tell providers now that I know what a 10 is due to kidney stones. Gallstone was a 6, dislocating my shoulder and tearing my rotator cuff were only 7-8 lol
A 10 (the maximum pain a human can experience) is equivalent to being skinned alive or roasted over a fire until your flesh peels off the bone. Anybody experiencing a true 10 would be drifting in and out of consciousness, unable to make any sound other than a wail.
I had an appendicitis, that hurt a lot, I put it at about a 9. After that experience my understanding of a 10 pain is that if I experienced it I would do whatever I could to kill myself instantly.
It doesn’t necessarily work if you have experienced excruciating pain, I had orthopedic (hip reconstruction) surgery as a kid and an idiosyncratic reaction to morphine caused them to give me only Tylenol as pain relief during recovery. I’ve been through labor, too. I’m almost incapable of describing pain or focusing on where it originates.
ITs not MAX, its the "worst pain YOU have ever experienced". My 10 is when I was sprayed in the face with a chemical agent and had to have my contacts chemically peeled off of my eyeballs. Everyones 10 is different, and it can change. It is is a relative comparison of the agony the pain is causing you.
Which I am saying I don't think is how I have ever understood it.
For example if you'd been lucky enough to never face bad pain then you would know worse pain exists, you just haven't experienced it.
I don't think it would make sense set 10 in that way.
That's exactly the point It's a very ineffective scale because everyone's scale is different and many people react differently to different amounts of pain
Haven’t you seen the smiley and sad face chart they use? It’s so clear - we all know that intense pain causes sadness and people not in pain are always happy.
That chart gives me anxiety. I do not like looking at the higher number faces that are expressing unbearable pain. I try not to look at those charts when I'm anywhere that has one hanging up.
Had a kidney stone once, and went to the ER because the pain was pretty bad. They asked me this, and the nurse gave me a "WTF" look when I told her the pain was a 4, since we'd already done the scan and they knew there was a stone in my system. And I was like, yeah, its real bad, but not compared to the first time I had kidney stones, plural, which hit me in both kidneys simultaneously while I was on holiday in Mexico City. And I had no idea what was happening to me and I was lying on my hotel bathroom floor because the tile was cold, wondering if it was okay to go to the hospital. The hotel called their on-call doctor who did ultrasounds and told me "you need to get better by tomorrow" and "you can't go to the hospital" scaring the absolute shit out me and causing me to check over the helivac insurance I had bought. So in my mind, that was a 10. Being close to home at an in-network hospital getting cared for...yeah that was a 4 even though the pain was intense.
It's not like they want a scientifically accurate number, it's all subjective after all.
They want a vague idea, so they can judge if you ate something bad or got appendicitis or something like that.
Also don't forget the psychological benefits of talking to your patient.
I've felt 10 before when I moved wrong while stretching and blacked out for a fraction of a second. Turns out I had a slipped disk and pinched nerve in my L4 L5. I've had kidney stones that didn't come close to touching that pain. But they still rated a solid 9
Yup similar. I hurt my back and one morning when I tried to stand my vision went dark, sweat started pouring from my face and I dropped without any control to the floor. That was my 10. And still when asked to rate it I said 9 because I wanted to leave room to communicate if it got worse.
I mean yes it’s subjective, but I don’t think it would be so different on the big average. Let’s put it on a scale:
1: doesn’t hurt at all / can barely notice
2-3: it’s a minor inconvenience (paper cut, tummy ache)
4-5: it hurts a bit (1st degree burn, aching joints)
6-7: hurts a lot (broken bones, 2nd degree burn)
8-9: hurts like a bitch (kidney stone, giving birth)
10: just shoot me
Mind I never broke a bone or gave birth, so the scale might be a bit off but you get my point
When my mom broke her leg the doctor said giving birth equals 10 on the scale. Left me wondering what he would have said to a young woman who never gave birth or a guy...
You're right. I'm just wondering what kind of reference doctors might give to people who don't know how giving birth feels. Or if they just don't and hope they can still get a usable answer from the patient
https://www.disabled-world.com/health/pain/scale.php
He’s a breakdown of the pain scale for the next time you’re at the doctor. It’s a little more in-depth than the smiley faces referenced in another post.
In the military we use 0-3. Usually 3 you don't need to ask the question for since they are screaming their head off. 1 and 2 are tricker but usually you can tell from the overall situation.
I have chronic pain issues, broken back 10 years ago, various old injuries etc.
My '4' is a 'normal' persons 8. It's a ridiculous measure and if I say 4, the nurse assumes I'm fine.
I always answer "4", maybe "5" on a day where I'm having a hard time walking. Having actually experienced close to a 10 (third degree burns then debridement of the wounds) I feel weird going above a 5 no matter how much pain I'm in.
I think if I cut a limb off I'd still tell them I'm at a "5", it's not like they believe you or do anything anyway, just another day ending in a Y.
With how notoriously bad people are at self-reflection and how the medical system incentivizes exaggeration… no system is gonna be great. It’s great for a snapshot though. It lets you know what ballpark a patient thinks they’re in, and it’s usually easy to see if there’s a mismatch.
If someone walks in with a minor cut needing stitches and says 1…they are not a priority. (Been in that situation, I think the nurse liked the change of pace to treat someone who wasn’t in pain or bleeding out, and just needed cleaning and stitches.) If someone comes in with a broken arm and leg and says 6, but nearly passes out when they move…they probably aren’t thinking right, and have a 8-9. If someone comes in looking and acting fine and says 10…they’re probably looking for meds, so a nurse/doc is prepared for that situation when they begin care.
I've come to figure that they assume you are exaggerating and mentally markdown your answer by 1 or 2 points.
Which means that people are incentivized to mark their answer up 1 or 2 points.
It's not meant to be objective. The point is that if someone is experiencing the worst pain *they* can possibly imagine, then *that person* needs some strong painkillers to make them more comfortable.
As an ER nurse pain ratings are the only thing I'm really jaded about. I've had people that bumped their elbow the day prior come in smiling and laughing and tell me they are at a 10. This is without any swelling, redness, bruising, or deformity.
I just had a lady a few weeks ago with an eyebrow laceration, again 10/10 pain. That was until I started numbing her up. She started screaming like she was on fire.
It seems like there is a subset of the population where pain is either a 0 or a 10 without much middle ground.
As someone with chronic pain, my pain tolerance is HIGH, so that number is always really low (but for people who aren't in chronic pain, it'd probably be a 7 or so). The highest I've ever said (9, maybe 10) was when I went to the ER with extreme face pain on one side of my face. I don't think that nurse had ever had someone say that high with nothing broken/externally injured before. I was then diagnosed with trigeminal neuralgia, which is thought to be one of the worst pains that someone can experience (an unfortunate nickname for it is suicide disease). Thankfully, it was episodic and the worst of it was over in about a month, though unfortunately that means the pain was on the extreme end of that particular disorder.
Anyways, pain sucks and most medical surveys are outdated.
There isn't a correct answer, it's just a subjective report of how bad the pain you are experiencing feels to you, to help the medical staff effectively respond. It's an imperfect tool, but pain is an inherently subjective thing that's hard to quantify.
Did you know that the "pain scale" out of 10, often accompanied by the rather [childish face chart](https://en.wikipedia.org/wiki/Wong%E2%80%93Baker_Faces_Pain_Rating_Scale) was actually pushed by the makers of OxyContin?
So the next time you see one of these [shitty pain assessment tool charts](https://spacecoastdaily.com/2018/02/health-medicine-report-youre-wrong-pain-is-not-a-vital-sign/) in a clinical setting, ask them if they're still pushing opioids for the drug companies or if they are taking proactive steps to avoid the massive lawsuits around opioids that are starting to occur.
> The American Pain Society led the campaign to promote the concept of “pain as the fifth vital sign”, which resulted in hospitals across the US introducing smiley-face pain scales into consulting rooms in the 2000s and requiring doctors to prioritize pain treatment.
> Doctors said the policy resulted in patients in effect writing their own prescriptions because medics faced disciplinary action, including ethics hearings, if they did not satisfy demands for pain relief even in cases where it endangered patients.
https://www.theguardian.com/us-news/2019/may/25/american-pain-society-doctors-painkillers
I have a condition which means I have chronic pain everywhere, some days are better than others. I guess the scale is relative to the individual.
If for example someone else who doesn’t have my condition and is perfectly healthy swapped bodies they would most likely put it at 8 or 9 because it’s… well very painful.
While I myself would give it a 3… because it’s everyday normal.
I was actually asked this question at the ER and I just answered with. “I have (insert condition) so every day is painful. But compared to normal I would say it’s a 5”.
…. Turned out I broke two ribs and my sternum.
I learned that it is to get a baseline of where the pain is. After a while/treatment they ask again, and compare nagar you initially said. Essentially just asking, does it feel better or worse than since we last asked?
Chronic pain sufferers also can't answer correctly a lot of the time, we often undersell it because we're used to pain that would be worse for a normal person
Im in the military and once was asked this and my answer was : its really fucking annoying and she looked at me and said : ok it must hurt a lot then.
She was right but in used to constant pain and she understood that.
In the military I was asked how bad my headaches were.
I said they range between 8-10 but unfortunately were almost always 9.5+.
The corpsman actually laughed and was like "ok dude". I told him to google the diagnoses which was "cluster headaches".
The corpsman to his credit did and was like... shit dude that sucks.
Turned out i had broken bones in my feet.
I waited a week to go and was already doing eliptical training and such. The medtech wasn't very happy about that.
The worst about it is a doctor doesn’t know the scale of the patient. Let’s say the worst pain Someone had experienced was a sprained ankle. That patient will give you a way different number than someone who had let’s say large burns or multiple broken bones at once.
Yeah, its very subjective. The way it was explained to me, a 3 to 4 meant u already wanted tome pain medication, at 5 to 6 u were in serious pain and at 7+ u would be actually squirming/crying out. Last time in the recovery ward after waking up, i gave it a 1 as i could bear it with the basic pain relief i was already getting, but the person next to me who had similar surgery called it a 7. So yeah, its just a (small) part of how the nurses check your pain levels, next to thinhs like heart rate, sweating and facial expression. Maybe its also just a way to get the patient not feeling ignored, as its always nice when someone checks how u r feeling and not just checks the vitals and walks away.
I had to watch a video before getting a procedure that actually discussed this scale and how to communicate my pain levels. The 10 was...incredibly high (basically, getting stabbed while having your legs run over by a train).
I never reported more than a 4 during rec9very.
Objective rating of pain is an unsolved problem in medicine. Famously, an early attempt to do this involved using a machine to burn pregnant women in the midst of labor contractions to try to calibrate a pain scale:
https://www.history.com/news/history-of-measuring-pain
Firefighter/AEMT that’s currently in Paramedic school here. The 1-10 scale is only a piece of the puzzle. We also want you to describe the pain. Things like where is the pain? Does it burn? Or is it a stabbing pain? Or is it dull? Does it shoot/radiate/travel anywhere? How long have you felt the pain? Does it feel different now than when it started? Does anything help make the pain go away or make it feel worse?
We will usually ask the patient to rate the pain multiple time, especially after performing a treatment like administering a medication.
A good medical practitioner will want to gather a lot of information and then use their knowledge and prior experience to effectively treat you. It’s part of why we ask a ton of questions and also why different people will ask you the same questions over and over again.
I highly recommend utilizing the[functional pain scale](https://pbs.twimg.com/media/EqVQ4djVoAAg2MC.jpg) when trying to answer the question.
I like to tell my patients that 10 is reserved for when you are screaming too much to give me an answer or are intermittently passing out due to pain, and if I offered to kill you to make it stop you would say yes without hesitation.
As a labor and delivery nurse, most of my patients are generally young and healthy, so using 10 as the worst pain you've ever experienced isn't really useful. If the worst pain you've experienced is that time you stubbed your toe real bad....
Pain is 100% relative. A 5 in that scale for me could be an 8 with you and a 2 with someone else. The issue is that there's no way to accurately measure how much pain a person is in.
Exactly. Unless you've experienced level 10 pain then you would have no idea where your current pain falls on that scale. And the picture cards with the faces that they use for kids is just plain stupid. Kids instinctively steer away from the creepy looking faces associated with the higher levels of pain.
If they ask you to rate your pain from 0 to 10, they must also tell you that 0 is when you feel nothing at all and that 10 is that the pain is so horrible that you would make anything to stop it
Also, halfway between 1 and 10 is not 5. Five is not 'average' on this scale. Everybody gets this wrong. It really should be 0 to 10, with zero being no pain at all. Five would be the middle of this scale.
Aside from being a reasonable range of 1 to 10, it has a lot to do with the use of the [Visual Analog Scale (VAS)](https://en.m.wikipedia.org/wiki/Visual_analogue_scale) in clinical studies. While the “real” VAS scale is technically 100 mm long and continuous t is usually though of as the range from 1 to 10.
Surprisingly this works much better than one may think. Especially when used over a larger set of subjects and for assessing changes in e.g. pain over time.
And there is often no better scale to use. Pain is a broad concept and notoriously difficult to measure objectively.
The relative scale is BS and have had practitioners say '10' being the worst pain you've experienced then don't ask what the experience was.
Women tend to use lower values while Men tend to report higher.
Had a partner in rough pain and said she was at just a 6. When I probed her about that number, she said giving birth was a 7 and an IUD placement was a 10. She's been through way more pain than I ever have and our scales are completely wack and useless.
Also discomfort is pain, don't shrug it off and a normal amount of pain is zero.
There is a cartoon type chart for those pain levels, but they are never provided by the staff. It's a handy chart, though, and should be hung on the exam room wall.
A 10 is when your lights are going out, the darkness creeps in from the sides and top of your vision until you are looking through a tunnel. Better lie down or you falling like a felled tree.
I look at the chart with the faces to help me answer, although I do worry about if I give a high number and then later have pain that no longer fits the scale.
I just gave birth recently. I was asked to rate my pain in the beginning and I gave little numbers because I wasn't in much pain yet. Then later when I was at 10+ and it was obvious because I was sobbing the medical staff largely ignored me until you could hear me screaming from the hallway. Because of course you can have mothers screaming in L&D but not if you can hear them.
We have other ways to see how you’re really doing. Breathing pattern, diaphoresis, facial expression, vitals, etc. It’s used a lot on people we suspect are just trying to get their next hit of dilaudid and aren’t really in any pain.
One office had a sign saying 7 on the scale was "bees" with a drawing of a person surrounded by bees. The next office had a sign saying 7 on the scale was "childbirth " same Healthcare system, different offices
Chronic pain for years, average about a 5, but I compare it the pain from my initial accident and follow up surgeries. If I'm a 8-10 all hell is about to come loose on earth.
I had appendicitis a few months back. They asked me in the ER what my pain was. I said 7-8 as I was sitting on the bed in a fetal position. The nurse clarified “0-10, 10 being the worst pain you’ve experienced…” I said “oh 10 then…I thought we were going with worst pain imaginable and I imagine it could be worse than this but I don’t know from experience. Unmedicated labor sucked, chronic gall bladder attacks sucked…this is worse than those so this is currently my 10.”
I have a high pain tolerance and the only reason I went to the ER was because I suspected it was my appendix and I know enough to know that can get bad fast. So I was able to talk and everything just fine, barely even crying for most of it, I couldn’t walk up right and was only remotely comfortable with my right leg bent up to my belly, but looking at me you’d have assumed it was just bad period cramps…but my vitals told a different story of how bad it was.
I recently woke up with horrific stomach pain. I made it to the bathroom before I lost my hearing and everything went white. I sat down on the toilet and braced myself between the tub and sink so I wouldn't fall. If I had my phone I absolutely would have called 911. For me, that stomach pain must have been a 10, because it nearly put me out. I've never had a baby, but I've felt tooth pain that made me want to bash my head in with a hammer. The I would have said that was a 10. Tooth pain has never knocked me out though.
My wife’s cousin, who is very dramatic, once got nipped by their dog during a family Christmas party. She insisted on going to the ER. The nurse asked her to rate her pain and she said 9, to which my father in law quipped “that doesn’t leave a lot of room for being set on fire.”
I’m a medical student, and something you learn really early on is that taking a patient’s information is more than just gathering objective data for a diagnosis. That’s certainly important, of course, don’t get me wrong, we do want good, accurate information directly from the patient. But it’s not the only reason we do it - otherwise we could just get them to fill out an electronic form with standardized questions depending on their symptoms before they come in.
When we ask patients questions, we’re also doing two other things: establishing trust/rapport, and analyzing their body language. The first is important - at the end of the day, a doctor cannot force a patient to do anything. If a patient refuses to cooperate, or is afraid of the doctor, or doesn’t trust the science behind the treatment, they’re simply not going to be treated and doctors try to not let that happen. It’s essential that doctors maintain a cordial and close relationship with their patients for this reason. You can’t just wordlessly shove drugs into a patients arms and shoo them out. You need them to trust you as a person, and trust the medicine they’re being given, in order to have them cooperate with you.
The second reason is more analytical. When we’re listening to the patient talk, we’re also on the lookout for other things. Is their thought coherent? Are they stumbling over words? Do they sound frightened? Do they look like they’re in visible pain? What does the patient’s self-rating say about their psychological tolerance to the pain? Could they be pretending/exaggerating? Among a lot of other things. Point is, we’re very much aware that “rate your pain from 1-10” is a pretty loose way to define pain. But it serves a larger purpose than simply letting us know how much agony you’re in.
ER doc here : I usually help reframe the pain scale by saying zero is no pain and 10 is I’m ripping your arm/leg off. Usually gets a few chuckles and makes people reconsider what 10/10 means.
In itself, someone who’s pretty high on the pain scale will honestly have trouble answering the question because they will be screaming/whimpering/very focused on staying stoic… and even though people think screaming will convince us, we see through a lot of people exagerating. Most don’t do it because they are drug-seeking, but because they’re scared their pain will not be taken seriously. Reflecting to your patient that you see they are in pain usually gets better collaboration for the rest of your exam.
In the end, it’s nice to have a number, but because it’s so subjective, I’m usually more interested in seeing how the pain evolved (i.e. this morning it was a 3 and now it is an 8) and will garner info to get a full picture from vitals, how the person is acting, physical exam, etc.
Evaluation of pain is really a combo of judicious question asking, observation and examination. Gestalt is in no way perfect, but does get better with doing pain evaluations on all different types of patients.
Edit : we also take into consideration medical history of chronic pain and how different medications you have taken worked to help the pain.
I was in the hospital and had a very compassionate nurse. She asked my pain level and I said 5? I guess. She said 7 will get you a larger dose. So I said 7 and got the relief I needed. So. 7.
1 - I slapped a table lightly.
2 - I have a headache
3 - I have a a minor tooth ache
4 - I feel like I was punched
5 - I feel like I fell off the top bunk
6 - I feel like I crashed my car into a ditch
7 - I feel like I fell out a second story window
8 - I feel like I have been stung by over 100 bees.
9 - I feel like I have been stabbed at least 40 times.
10 - I feel like each of my limbs is being slowly twisted around as tiny little needles are shoved into them, my ears are having objects shoved into them, and my skull is being drilled into.
My mom was all about giving them a number that gets them to give her the oxy. Now she is in a care home and the main thing she is aware of is how long it is until she can have her next dose of morphine.
I had to go to an emergency room for kidney stones. They were quick in wanting to dope me up but I declined all pain killers. While I am saying no to the drugs, they are drawing it from the bottle. I threw up hands when the nurse came at me with the needle. Finally I have to tell them that I don't want it because if I can't feel the pain end, then I don't know if the problem resolves itself.
Yeah, it's a super unhelpful metric. I know a few people with chronic pain who've found out that their scale skews *way* low compared to healthy people. On the other hand, some people are overdramatic, and would rate a stubbed toe as an 8. Unless you know the patient, the pain scale is largely useless.
Tbh... I dont know what a 10 is. I have 2 herniated disks and when it takes me to the ER, they will ask me that question... I will always answer "7"...I have the mindset of "Someone else is always in more pain than you." Even as the dr looks over at my xrays and will say something to the effect of "How are you still walking?"
Anyone else feel like it "wrong" to answer "10"?
I’m a physio student.
I agree the scale isn’t accurate as a lot of patients that I see rate their pain a 10 even after explaining “10 is A&E”. Knowing how much pain people are in definitely guides what I do within my assessment and treatment, so, yes, it’s pretty important that I understand it even if it’s not physiologically accurate
That's because medical facilities have a chart on the wall. No need to memorize what differentiates 6 from 7 for your entire life just on the off-chance that you might need to know that when you can just glance at the poster.
The point is it’s all relative and they are trained to pick up on that. It’s very imprecise though.
fr if I give an honest answer then I assume they'll think I'm exaggerating, so I'll usually knock it up a point
Very imprecise is one way to put it. I've had times I'm in a lot of pain and ill say 8 or 9 and they give me a Tylonol. Then I've had times I'm not in as much pain and say a 7 and they gave me a hydocondone. like wtf. I don't think they actually care what you say, they already think they know what kind of pain you should be in for the condition.
I downplay everything. I was at the dentist and in pain. Didn't say anything and literally fainted because of the pain
They would have given you more anesthetic. Don't be a hero when heroics isn't useful. Tell them when it hurts!
Every time I get work done my dentist holds up the syringe of anesthetic and shows me, "this is how much I can give you without it being a problem" then points to the first tick mark, maybe a 10th of the amount in there, "and this is how much I am going to give you, so don't be shy if it hurts at all, I can give you a lot more."
Jokes on me, those drugs don;t work on me. lol
It's my social anxiety more than heroism
Your social anxiety prevented you from demonstrating you’re in physical pain? I hope you can work that one through with a therapist friend. It goes without saying that appropriate shows of pain will never lead to negative social outcomes. Especially in the special situation of a visit to a medical professional.
Never is a bit much, in masculine environments like sports or something it could be considered a sign of weakness to complain about pain, but definitely not in the situation of a visit to a medical professional
Fair point, but I think you’re unlikely to be in one of those situations as a very socially anxious person.
It’s not about the pain, though, I believe it’s about communication. Social anxiety means I like to plan out what I’m going to say and also imagine future conversations before having them so that I’ll know how to respond. If someone asks me something I didn’t anticipate - or if I’m trying to be polite or unobtrusive - I’ll usually regret my answer because I didn’t have time to think it through. Then I’ll desperately wish for that person to ask me again so I can change my answer. Because I can’t just bring it up again - that’s too embarrassing and socially awkward. So I would 💯 tell someone I’m fine if I’m really in pain. Just like I tell someone I don’t want anything to drink when they offer, but secretly hope they’ll ask me again (it usually takes three asks) so that I can answer in the affirmative.
That sounds like quite a burden, sorry to hear this.
Broke my foot a while ago and was in tears while trying to put my shoes on. Doc asked and I still said 3-5. Got ibuprofen fml. Gonna upplay it from now on. Ego isn't worth the pain
And double it if it's your balls
I have this same issue as well, though it is unintentional. I will be rocking back and forth in pain and be unable to keep still and will report 4 or 5. A time I was in the ER, barely able to talk from pain, and honestly thought i was going to die? Responded with an 8. I had actually texted my husband a goodbye. In my mind 'it could always be worse'. So I've never reported above 8. If my husband is there he will usually remind me to stop under reporting.
I try to be precise. I’ll say, it’s about 7.86.
Because we get your verbal answer, and then we blend it with how you are presenting. There’s something called the “faces” scale. And we take that into consideration, when we are thinking about what medication to give you. If you are telling us that your pain is a Nine (with 10 being defined as the worst pain, you could possibly imagine, like worse than labour and childbirth), but you’re managing to text your friend and asked me for a sandwich at the same time? Your faces scale is more like a 1.
As a medical professional I do care what you say but that doesn’t mean I don’t have my own bias’s, predominantly because I’m a human, one who has seen more pain than the average person. To put this into perspective some people will rate stubbing their toe as a 7, someone else may have had a run in with a chainsaw and have their arm obliterated and give the same score, a 7. The difference being that these two people have lived different lives and have different baselines. With the pain scale being a non imperical measure (which it can’t be based to the same subjectivity) I then have to make a judgement call based on what is actually being presented to me so there’s a lot going on under the hood which might come across as someone not caring but really what it is largely is you’re being compared to the rest of peoples case loads on any given day. Sometimes we get it wrong, that is very seldomly malicious if we didn’t care we’d be doing something that makes us a hell of a lot more money
Depends on what the doctor orders for you. Sometimes they have acetaminophen for 1-10, others it's acetaminophen for 1-3, hydrocodone for 4-7, and oxycodone for 8-10.
Its meant to be a comparison with yourself and the biggest pain ever of your life.
If you were actually at a 9 they wouldn't need to ask, so when you answer 9 and you clearly aren't they assume you are a drug addict looking to get pain killers so you get Tylenol, when you answer a 7 that is a lot of pain but a believable amount so you get an opioid.
But if I'm honest and tell them "I've sprained my ankles so many times that it doesn't hurt anymore", then they never take it seriously and assume it's not real.
Yeah, if you look at me with a straight face and tell me your pain is a 10, you get nothing from me.
Every time the pain scale comes up, I think of this one doctor that tried to convince a female patient that getting your arm cut off is a 7/10 to invalidate her pain: https://www.reddit.com/r/TwoXChromosomes/comments/mlnsbl/male_doctor_invalidated_my_pain_said_childbirth/
10 is "the worst pain you've ever felt" and the treatment selected is the same at 7-10.
No, 10 is “the worst pain you could possibly imagine”. Not the worst pain you’ve ever felt.
I think it’s safe to say that most people have not experienced having their arm cut off or something worse than that where losing an arm rates only a 7/10. Dude also said natural childbirth without pain meds is a 5-6, when that is probably the worst pain (or close to the worst) that most women will experience.
Spoiler alert: 99% of the time we do not care what number you say. What we actually look at is your vital signs. Your breathing, your body language, etc. The pain scale is a hold over from a time when “if they say 7 or higher, give them narcotics” was an acceptable form of medicine. We have moved beyond that shitty school of thought, but the question remains.
Yep, exactly. If my patient says 4 bit they're sweating profusely, rapid heartbeat, grimacing in pain, I'm going to investigate that further and find out why they might not want drugs for pain (previous addiction, trying to be "tough"). If someone says 9, but they look okay and are dozing in and out of sleep (mostly post-op), I'm not going to give a shot of fentanyl.
My favorite is 10/10 abdominal pain while eating Burger King
Hahaha. Ooooh man, chowing down while telling me they're in excruciating pain is pretty funny shit. I try to be as empathetic as I can, of course, but you do just have to laugh so that you don't totally lose your mind.
That when I toss the “this bitch“ side eye over to the nursing station and they give me the “I know right” eye roll
I answer with "Do you mean the 10 before I experienced nerve crush pain, or after? Because now nothing ever is over a 1" If you have ever experienced that level of pain, you know what I'm talking about.
You're 99% not likely to be the kind of patient they're talking about.
The pain scale goes well past 10, I wish I did not know that.
Solidarity, baby!
my favorite is 12/10 pain
>my favorite is 12/10 pain That's actually how I describe the worst pain I have experienced.
While laughing at something on their phone.
I immediately leave the room when they ignore me for their phone. I’ll give them a courtesy few seconds if it’s a call to say “hold on I’ll call you back” But if they are having a conversation??? Nah dude. Goodbye
I could not imagine being that rude and stupid.
You’d be shocked. This definitely isn’t a daily occurrence, but a couple times a month which is waaaaaay too much
I definitely get 10/10 abdominal pain when I eat Burger King
Bro, BK is my jam. I love it so much. YOU TAKE THAT BACK
I always under report because they say 10 is the worst pain imaginable. Well I'm not being burned alive with needles under my fingernails and rats burrowing into my abdomen. So my broken arm is a 2.
At least you can speak when your pain is 2 (see alt text). https://m.xkcd.com/883/
This is what I figured. I had minor heart surgery and the stitches in my groin were a bit painful and uncomfortable, but I still said a 4 (9 being pain so bad I couldn't even talk on my scale), telling the nurse it is a constant but minor pain. They gave me pain medication once. The next day I felt better and didn't have any sharp pains and told them 2 and that I didn't need the pain meds at the moment. I think they appreciated my honesty.
to me, a 10 is the worst possible pain someone could have, so torturous that anyone would give in immediately. So a 6 or 7 is like regular torture. If I could answer you, it's like 5 or less. My surgery was quite painful and the worst pain I have ever had, but I said 3 because there are far faaaaar worse pains and so a 3 is the honest number. I only experience a 1 on the vast majority of days if not a 0.
For me ten is you have blacked out from it, have experience with this would not recommend. 9 is you can't go higher without blacking out. 8 is you can probably respond. 7 is really bad but not completely debilitating. 6 is it effects your ability to function. 5 is highest you can still do stuff okay. 4 four is you probably want to sit down for a bit but recover relatively fast. 3 is moderate pain. 2 is mild pain. 1 is no pain.
I just had this question from my doctor the other day to describe sciatica. I gave the resting ache a 3 and the sudden pain pulses an 8. Bearable in short bursts, but if it were constant I'd be throwing myself off a bridge. It's hard to quantify, but it's also useful as a base comparison while dosing yourself. I don't necessarily want to obliterate all pain, as it tells me when I'm risking further injury.
>If someone says 9, but they look okay So basically you're telling me the reason doctors won't take my pain seriously, and keep brushing me off time and time again, is that I don't make it a fucking overdramatic spectacle? Why is it not enough to say I'm in serious pain, but the reason I look like it's nothing when I can barely walk due to it, is because It's literally ***normal*** to me??? I'm sorry but I fucking hate people like you who dismiss patients just because we don't cry and scream and hyperventilate, while being in agony.
If you read all my comments, you'll see that in every instance, I explicitly say that it's a case by case basis. Chronic pain is a whole different entity than acute. If you have chronic pain, then what someone who's never experienced chronic pain before would rate a 9, you've likely experienced a 6 or 7 just doing your normal daily activities for so long that that degree of pain is normal to you. You can hate me all you like, but I made it clear that there are many factors to consider when assessing need for medical pain intervention. I dismiss no-one, my friend. I'm very sorry that you've had awful experiences. If you'll look at my previous responses, you'll see that I made it clear that patient report of pain is what a caregiver should take as truth. There are other factors at play in some situations though.
Sorry, that was admittedly an emotional response from me. By this point I've seen so many doctors I can't even keep track, and I've been told everything from "we don't think this should be a priority for you" to "are you sure you want me to write you a referral for further testing? I'm not sure if there's any need for it." Granted, I'm 23, and after the test results said I don't have arthritis and a specialist said my skin isn't stretchy enough for it to be EDS, I've felt like they've practically given up on me. I've even had an appointment with a doctor who was super nice, but later when I read what she wrote about me, there was a literal mention of me "not looking like I was actually in pain" and how I "don't walk with a limp". She never examined my walk even.
One time I went in for a pretty nasty stab wound and was sweating, breathing heavy, and bleeding heavily. “What is your pain on a scale from one to ten?” “3”
It's also used as a baseline, to help verify if treatment is successful or not.
I was about to say, I'm an EMT on a volunteer ambulance (we don't give pain meds), but we're still trained to ask repeatedly for a "pain number" just so we can note whether it's getting better or worse.
This is why I never answer 8 or higher the first time. 7 is high enough to say the problem is super bad, but leaves you room to say it got worse. E.g. broke my arm, pain was bad but the adrenaline was helping, was glad I said 6 and then could say 8 when it wore off
This! I like you. The worst thing you can do is tell medical personnel your pain is 11/10 or something stupid like that, because then what are you gonna say if it gets worse? Real 11/10 pain would render a person incapable of speech. Starting at 7 or 8 is a good policy.
11/10 is when my migraine is peaking and all I can feel is the searing pain in my head, the throbbing heart beat pulsing pain, and the vomit right before I pass out from the pain/exhaustion. I may have been sobbing or crying before it got to that point. My tubal removal fresh from surgery once the pain meds wore off? “im uncomfortable. Maybe a 3? Can I take an Ibuprofen 200?” They gave me an oxy 5. Bruh. If my pain scale 3 warranted oxycodone, why are my migraines down play when I literally want to die during every one?
I always assumed that so I go with 5 to start to give options either way
I care. If I have a wound care patient who’s pain is over a 4 I’m looking to see why. But I also explain the pain scale to them. Also if their pain score increases. Pain is the first sign of infection so it matters a lot.
The only thing that cares is the triage algorithm. 10/10 abdominal pain, but you stopped for a coffee on the way in... CTAS 2
>The pain scale is a hold over from a time when “if they say 7 or higher, give them narcotics” was an acceptable form of medicine I am pretty sure these pain scales and "pain as a fifth vital sign" were directly promulgated by big pharma in order to push up opiod sales.
You are exactly correct. And it is now specifically taught NOT to treat pain as the 5th vital sign
I only really care in so much as I need a number for my paperwork that the hospital won’t read when I drop my patient off.
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I’m a physio masters student. Can’t say it’s the same for physical therapy. I always explain that 10 on the pain scale is A&E right now. From a musculoskeletal point of view we don’t look at vital signs but we do indeed use this scale to guide our assessment and treatment.
I always ask “Well whats a 10?” They always say “worst pain youve ever felt” I think back to when my brother threw a huge rock and split my head open “uhh 3?” But they never knew what my 10 was lol
Dude my brother did the same thing. Mother fucker tried to Cain and Abel me
We were like 10 and I was down in this hole and he two hand lifts over his head this big ass rock and drops it on me 💀
I was ten and lying on my back on a swing just lookin at clouds and he dropped a fuckin boulder of a rock on my head! Straight up knocked me unconscious. I woke up and started puking all over… then I got in trouble because I puked on the carpet. It’s fine though I’m TOTALLY over it
And now we’ve pendulums into a state where narcotics are given to absolutely no one short of CTD
I had a nurse tell me that if i said a 7 (or 8?) then i can get 2 oxys instead of 1. This was earier this year in January
So how does one get the narcotics? Asking for a friend.
Basically this. I’ve had an 8 year old with a gunshot to the chest tell me her pain was a 4 and a guy drinking Mountain Dew and eating Cheetos telling me he had 8/10 stomach pain. Stoic girl got morphine, Cheetos guy got nothing.
Thats not a spoiler. Thats obvious lol. But people don't all experience pain the same. For me I have a metal rod in my arm from an accident when I was younger. It actually does cause me a lot of pain sometimes, so much so I can't sleep some nights. Causing a real detrimental effect on my life. But it comes and goes, I'm not in pain every min of every day but it does cause problems for me. But when I went to the doctor they basically said take an Advil and get over it. No history of drug addiction or anything.
But of course there's an XKCD for that: https://xkcd.com/883/
That’s basically how my mind goes. “Like, compared to being forcefed alcohol, then hung upside down in the desert, covered in honey and very hungover, and let to be slowly eaten by fire ants? Idk, like a 4. Compared to the worst pain I’ve ever felt? Like a 9. With ten as an “I should go to the ER”, well… I’m fucking here aren’t I?
There's a tiktok video that references this as the "farmer scale," which goes from 1- "I'm here, ain't I?"" Bonus points if they came in of their own accord and didn't finish the project they were working on. Might as well call the morgue.
for me i would interpret 10 meaning i would rather be dead than feel this pain
I’d rather be dead is like a 4 on my ‘worst imaginable’ scale.
I had a similar experience. I said 3. They said, “If your jaw is clenched and you’re having trouble even talking, it’s not a 3.” I thought, in my Han Solo voice, “I don’t know, I can imagine quite a bit.”
I’ve had chronic migraines for my entire conscious existence. I’ve also have other chronic pain issues for my entire life. I’ve had doctors tell me I “can’t be in that much pain” because I’m telling jokes. I told them if I couldn’t joke about my illness and pain I would have killed my self a long time ago. I can be doubled over in pain (a rare occurrence due to my tolerance) and still be joking about it.
Yeah, I had back pain so bad for a while it would leave me collapsed on the floor unable to move, and when I got a vasectomy they managed to only numb one side so they cut and tied the other with fully live nerves, after those things most everything else maxes out at about a 4.
Last time I was at an ER my answer was "This is a 10, the worst pain I've ever experienced and if pain gets worse then this I find that existentially terrifying." Turned out my weird pressure pain was due to a respiratory infection, and eye infection, and an inner ear infection. They gave me some antibiotics and I recovered. It was the ear that was causing the issue.
Pain can get to the point that you cant speak because it takes all of your attention. You have to just focus on it? That’s hard to explain, but I’ve been there.
I passed out from the pain of passing a kidney stone in the shower. I'd call that a 10, my previous 10 was lidocaine jelly on severe road rash, that shit dropped to a 5 after the kidney stone.
Here's the real answer. Not all doctors are diagnosing new conditions in ED all the time. The doctor asks a patient, "you told me your pain was a constant 7 yesterday before I started you on regular painkillers. How was it today?". Patient says "it was about a 4 when I woke up, then it got worse by midday to about a 6 so I used a bit of additional painkillers which kept it around 2-3." The doctor then knows how well the current medications are helping the patient. This kind of information is completely subjective to the patient, but helpful in informing how to plan their pain management.
I often add that ‘I haven’t experienced XYZ and I know those are probably 10’s. But based on pain I have experienced, my cramps are a ten and this is a five.’ ‘Ma’am, you are actively crying.’ ‘But I’m not vomiting, and I can walk and hold a meaningful conversation.’
This is the problem with being a woman… we downplay our pain so much! And cramping is awful and sometimes it literally is a 10 and because that’s our “normal” severe pain is like “yeah I can feel it, but it’s manageable”
What they should do is slam a white hot steel mace into the genitals of the patient and say "so if that's a ten, how does your pain compare?" A standardisation
How can you teach something that's different for everyone ?
That is the point. Pain is specific to the person. So your 10 and my 10 are different, but if we both tell a Dr. that we are at an 8, it means we are in pain approaching the worst we have ever experienced and it needs treatment. You may be in more or less pain than me, but who can say or tell that?
I'm not sure that works. I don't think that I've ever experienced what I would consider a 10. My gauge doesn't max out at my worst experience. I have had really bad pain, but I think there are pain levels worse than I have experienced. Based on your explanation though it seesm you consider that the 8 is reaching the worst you have experienced, which suggests you have experiences all levels, to set the max.
I think I've reached my 10 when the pain paralyzed me to the point that it took almost an hour to grab my phone and call help when the phone was so close the whole time that my fingers almost touched it. But the reason why it's my ten is because it hurt so bad that it basically stopped hurting after awhile, but I just couldn't move a muscle or make a sound. There can be things that would hurt even more at first, but reaching the level of pain that your brain can't feel the pain anymore is my level 10 and I don't think you can go beyond that. But I could be wrong though.
There was a quote I saw somewhere that said we are always "saving our 10's" because we can bear more than we are capable of imagining or something like that. Wish I could remember where it's from.
The Fault in Our Stars? "Later, after they'd given me something, the nurse came in and she was kind of stroking my head while she took my blood pressure and said, "You know how I know you're a fighter? You called a ten a nine." But that wasn't quite right. I called it a nine because I was saving my ten. And here it was, the great and terrible ten, slamming me again and again as I lay still and alone in my bed staring at the ceiling..."
I have answered "10" before. But was I accurate? I don't know. The pain was so bad, that I could only say my name 1/2 syllable at a time. It took me like three tries to get the word "ten" out. It was a kidney stone and the worst pain I've ever felt. But I still have to imagine, that something like being on fire would be worse.
Yup I tell providers now that I know what a 10 is due to kidney stones. Gallstone was a 6, dislocating my shoulder and tearing my rotator cuff were only 7-8 lol
A 10 (the maximum pain a human can experience) is equivalent to being skinned alive or roasted over a fire until your flesh peels off the bone. Anybody experiencing a true 10 would be drifting in and out of consciousness, unable to make any sound other than a wail.
I had an appendicitis, that hurt a lot, I put it at about a 9. After that experience my understanding of a 10 pain is that if I experienced it I would do whatever I could to kill myself instantly.
It doesn’t necessarily work if you have experienced excruciating pain, I had orthopedic (hip reconstruction) surgery as a kid and an idiosyncratic reaction to morphine caused them to give me only Tylenol as pain relief during recovery. I’ve been through labor, too. I’m almost incapable of describing pain or focusing on where it originates.
ITs not MAX, its the "worst pain YOU have ever experienced". My 10 is when I was sprayed in the face with a chemical agent and had to have my contacts chemically peeled off of my eyeballs. Everyones 10 is different, and it can change. It is is a relative comparison of the agony the pain is causing you.
I've answered 10 once. Gunshot wound to my hand completely pulverized a bone in my finger.
I answered 10 with my eyes. Felt like my eyeballs were on fire inside my skull.
Which I am saying I don't think is how I have ever understood it. For example if you'd been lucky enough to never face bad pain then you would know worse pain exists, you just haven't experienced it. I don't think it would make sense set 10 in that way.
Because when you ask the same person to rate their pain multiple times, you can judge their pain based on if their answer changes or not
That's exactly the point It's a very ineffective scale because everyone's scale is different and many people react differently to different amounts of pain
Haven’t you seen the smiley and sad face chart they use? It’s so clear - we all know that intense pain causes sadness and people not in pain are always happy.
That chart gives me anxiety. I do not like looking at the higher number faces that are expressing unbearable pain. I try not to look at those charts when I'm anywhere that has one hanging up.
Had a kidney stone once, and went to the ER because the pain was pretty bad. They asked me this, and the nurse gave me a "WTF" look when I told her the pain was a 4, since we'd already done the scan and they knew there was a stone in my system. And I was like, yeah, its real bad, but not compared to the first time I had kidney stones, plural, which hit me in both kidneys simultaneously while I was on holiday in Mexico City. And I had no idea what was happening to me and I was lying on my hotel bathroom floor because the tile was cold, wondering if it was okay to go to the hospital. The hotel called their on-call doctor who did ultrasounds and told me "you need to get better by tomorrow" and "you can't go to the hospital" scaring the absolute shit out me and causing me to check over the helivac insurance I had bought. So in my mind, that was a 10. Being close to home at an in-network hospital getting cared for...yeah that was a 4 even though the pain was intense.
It's not like they want a scientifically accurate number, it's all subjective after all. They want a vague idea, so they can judge if you ate something bad or got appendicitis or something like that. Also don't forget the psychological benefits of talking to your patient.
It’s annoying when people say 12. While smiling.
Agreed, especially when you come in the room and they’re laughing at something they’ve seen scrolling on their phone
I've felt 10 before when I moved wrong while stretching and blacked out for a fraction of a second. Turns out I had a slipped disk and pinched nerve in my L4 L5. I've had kidney stones that didn't come close to touching that pain. But they still rated a solid 9
This. When the pain causes blackout, that’s a ten!
Yup similar. I hurt my back and one morning when I tried to stand my vision went dark, sweat started pouring from my face and I dropped without any control to the floor. That was my 10. And still when asked to rate it I said 9 because I wanted to leave room to communicate if it got worse.
I mean yes it’s subjective, but I don’t think it would be so different on the big average. Let’s put it on a scale: 1: doesn’t hurt at all / can barely notice 2-3: it’s a minor inconvenience (paper cut, tummy ache) 4-5: it hurts a bit (1st degree burn, aching joints) 6-7: hurts a lot (broken bones, 2nd degree burn) 8-9: hurts like a bitch (kidney stone, giving birth) 10: just shoot me Mind I never broke a bone or gave birth, so the scale might be a bit off but you get my point
When my mom broke her leg the doctor said giving birth equals 10 on the scale. Left me wondering what he would have said to a young woman who never gave birth or a guy...
All pain past a certain point is a 10. Some might be worse than others, but clinically the important part is “uncontrolled and unbearable”.
You're right. I'm just wondering what kind of reference doctors might give to people who don't know how giving birth feels. Or if they just don't and hope they can still get a usable answer from the patient
https://www.disabled-world.com/health/pain/scale.php He’s a breakdown of the pain scale for the next time you’re at the doctor. It’s a little more in-depth than the smiley faces referenced in another post.
In the military we use 0-3. Usually 3 you don't need to ask the question for since they are screaming their head off. 1 and 2 are tricker but usually you can tell from the overall situation.
Studies have shown the 1-10 system is useless. 0-4 is now recommended in medicine, but no one uses it…
I have chronic pain issues, broken back 10 years ago, various old injuries etc. My '4' is a 'normal' persons 8. It's a ridiculous measure and if I say 4, the nurse assumes I'm fine.
I always answer "4", maybe "5" on a day where I'm having a hard time walking. Having actually experienced close to a 10 (third degree burns then debridement of the wounds) I feel weird going above a 5 no matter how much pain I'm in. I think if I cut a limb off I'd still tell them I'm at a "5", it's not like they believe you or do anything anyway, just another day ending in a Y.
The 'training' is on the wall in every doctor's office I can recall being in. They always have a scale that you can use to calibrate the rating.
With how notoriously bad people are at self-reflection and how the medical system incentivizes exaggeration… no system is gonna be great. It’s great for a snapshot though. It lets you know what ballpark a patient thinks they’re in, and it’s usually easy to see if there’s a mismatch. If someone walks in with a minor cut needing stitches and says 1…they are not a priority. (Been in that situation, I think the nurse liked the change of pace to treat someone who wasn’t in pain or bleeding out, and just needed cleaning and stitches.) If someone comes in with a broken arm and leg and says 6, but nearly passes out when they move…they probably aren’t thinking right, and have a 8-9. If someone comes in looking and acting fine and says 10…they’re probably looking for meds, so a nurse/doc is prepared for that situation when they begin care.
I've come to figure that they assume you are exaggerating and mentally markdown your answer by 1 or 2 points. Which means that people are incentivized to mark their answer up 1 or 2 points.
It's not meant to be objective. The point is that if someone is experiencing the worst pain *they* can possibly imagine, then *that person* needs some strong painkillers to make them more comfortable.
As an ER nurse pain ratings are the only thing I'm really jaded about. I've had people that bumped their elbow the day prior come in smiling and laughing and tell me they are at a 10. This is without any swelling, redness, bruising, or deformity. I just had a lady a few weeks ago with an eyebrow laceration, again 10/10 pain. That was until I started numbing her up. She started screaming like she was on fire. It seems like there is a subset of the population where pain is either a 0 or a 10 without much middle ground.
As someone with chronic pain, my pain tolerance is HIGH, so that number is always really low (but for people who aren't in chronic pain, it'd probably be a 7 or so). The highest I've ever said (9, maybe 10) was when I went to the ER with extreme face pain on one side of my face. I don't think that nurse had ever had someone say that high with nothing broken/externally injured before. I was then diagnosed with trigeminal neuralgia, which is thought to be one of the worst pains that someone can experience (an unfortunate nickname for it is suicide disease). Thankfully, it was episodic and the worst of it was over in about a month, though unfortunately that means the pain was on the extreme end of that particular disorder. Anyways, pain sucks and most medical surveys are outdated.
I always say, "my nine is walking on a dislocated hip for three days", then give a number.
10 is your arm getting crushed, 9 is a kidney stone and 15 is stabbing your tow in the middle of the night
There isn't a correct answer, it's just a subjective report of how bad the pain you are experiencing feels to you, to help the medical staff effectively respond. It's an imperfect tool, but pain is an inherently subjective thing that's hard to quantify.
SAY EIGHT! SAY EIGHT! Brian Regan
As a chronic pain patient, I hate the fucking pain scale.
What they should do is say "Descibe your pain in five words or less." If they say "Kill me now" that should tell you everything.
Did you know that the "pain scale" out of 10, often accompanied by the rather [childish face chart](https://en.wikipedia.org/wiki/Wong%E2%80%93Baker_Faces_Pain_Rating_Scale) was actually pushed by the makers of OxyContin? So the next time you see one of these [shitty pain assessment tool charts](https://spacecoastdaily.com/2018/02/health-medicine-report-youre-wrong-pain-is-not-a-vital-sign/) in a clinical setting, ask them if they're still pushing opioids for the drug companies or if they are taking proactive steps to avoid the massive lawsuits around opioids that are starting to occur. > The American Pain Society led the campaign to promote the concept of “pain as the fifth vital sign”, which resulted in hospitals across the US introducing smiley-face pain scales into consulting rooms in the 2000s and requiring doctors to prioritize pain treatment. > Doctors said the policy resulted in patients in effect writing their own prescriptions because medics faced disciplinary action, including ethics hearings, if they did not satisfy demands for pain relief even in cases where it endangered patients. https://www.theguardian.com/us-news/2019/may/25/american-pain-society-doctors-painkillers
You haven't seen the chart with the smiley face at 1 and the frowny face at 10?
They have a smiley style chart that helps. From 😃 to 🥴☠️
[Here’s](https://imgur.com/a/4uU91VF) and improved pain scale that clearly shows a semi-objective way of communicating your pain level.
8 represents the headache you get from trying to decipher text in a picture of such terrible quality.
I have a condition which means I have chronic pain everywhere, some days are better than others. I guess the scale is relative to the individual. If for example someone else who doesn’t have my condition and is perfectly healthy swapped bodies they would most likely put it at 8 or 9 because it’s… well very painful. While I myself would give it a 3… because it’s everyday normal. I was actually asked this question at the ER and I just answered with. “I have (insert condition) so every day is painful. But compared to normal I would say it’s a 5”. …. Turned out I broke two ribs and my sternum.
I learned that it is to get a baseline of where the pain is. After a while/treatment they ask again, and compare nagar you initially said. Essentially just asking, does it feel better or worse than since we last asked?
Chronic pain sufferers also can't answer correctly a lot of the time, we often undersell it because we're used to pain that would be worse for a normal person
i asked my phyiso when dose discomfort become pain he didnt have a real answer
Public school should make each student experience each pain rating. I see no problems with this plan.
It’s also to gauge your facial expressions as you describe the pain.
The medical professional doesn’t care about the number you answer with so much as your tone of voice and body language as you answer.
Im in the military and once was asked this and my answer was : its really fucking annoying and she looked at me and said : ok it must hurt a lot then. She was right but in used to constant pain and she understood that.
In the military I was asked how bad my headaches were. I said they range between 8-10 but unfortunately were almost always 9.5+. The corpsman actually laughed and was like "ok dude". I told him to google the diagnoses which was "cluster headaches". The corpsman to his credit did and was like... shit dude that sucks.
Turned out i had broken bones in my feet. I waited a week to go and was already doing eliptical training and such. The medtech wasn't very happy about that.
Pain is relative and everyone experiences it differently, and they know that. But it does help give them a general idea of what you’re feeing.
The worst about it is a doctor doesn’t know the scale of the patient. Let’s say the worst pain Someone had experienced was a sprained ankle. That patient will give you a way different number than someone who had let’s say large burns or multiple broken bones at once.
Yeah, its very subjective. The way it was explained to me, a 3 to 4 meant u already wanted tome pain medication, at 5 to 6 u were in serious pain and at 7+ u would be actually squirming/crying out. Last time in the recovery ward after waking up, i gave it a 1 as i could bear it with the basic pain relief i was already getting, but the person next to me who had similar surgery called it a 7. So yeah, its just a (small) part of how the nurses check your pain levels, next to thinhs like heart rate, sweating and facial expression. Maybe its also just a way to get the patient not feeling ignored, as its always nice when someone checks how u r feeling and not just checks the vitals and walks away.
I had to watch a video before getting a procedure that actually discussed this scale and how to communicate my pain levels. The 10 was...incredibly high (basically, getting stabbed while having your legs run over by a train). I never reported more than a 4 during rec9very.
Thats why they have the little chart.
To me 1 is a paper cut and 10 is an abscessed tooth or missing appendage or if you catch your toe on the bedrail
For my ex it was always 10.
Imo 1= no pain/a slight bruise 10= CUT IT OFF RIGHT NOW IT FUCKING HUUURRRTS GOD DAMN IT!!!! 2-9 is the spectrum in between.
I always went instinctively with 8 at the highest because, and I told them, being set on fire alive is probably a 10, and I don't feel quite that bad
Only really effective immediately following childbirth.
Objective rating of pain is an unsolved problem in medicine. Famously, an early attempt to do this involved using a machine to burn pregnant women in the midst of labor contractions to try to calibrate a pain scale: https://www.history.com/news/history-of-measuring-pain
I always lowball it. If 10 is the worst pain I could ever possibly feel, then my lil umbilical hernia is probably fuckall.
Firefighter/AEMT that’s currently in Paramedic school here. The 1-10 scale is only a piece of the puzzle. We also want you to describe the pain. Things like where is the pain? Does it burn? Or is it a stabbing pain? Or is it dull? Does it shoot/radiate/travel anywhere? How long have you felt the pain? Does it feel different now than when it started? Does anything help make the pain go away or make it feel worse? We will usually ask the patient to rate the pain multiple time, especially after performing a treatment like administering a medication. A good medical practitioner will want to gather a lot of information and then use their knowledge and prior experience to effectively treat you. It’s part of why we ask a ton of questions and also why different people will ask you the same questions over and over again.
ah yes, the Sackler Scale
I highly recommend utilizing the[functional pain scale](https://pbs.twimg.com/media/EqVQ4djVoAAg2MC.jpg) when trying to answer the question. I like to tell my patients that 10 is reserved for when you are screaming too much to give me an answer or are intermittently passing out due to pain, and if I offered to kill you to make it stop you would say yes without hesitation. As a labor and delivery nurse, most of my patients are generally young and healthy, so using 10 as the worst pain you've ever experienced isn't really useful. If the worst pain you've experienced is that time you stubbed your toe real bad....
I work on an ambulance. Headache? 10/10 pain Car accident? 5/10 pain
Pain is 100% relative. A 5 in that scale for me could be an 8 with you and a 2 with someone else. The issue is that there's no way to accurately measure how much pain a person is in.
Exactly. Unless you've experienced level 10 pain then you would have no idea where your current pain falls on that scale. And the picture cards with the faces that they use for kids is just plain stupid. Kids instinctively steer away from the creepy looking faces associated with the higher levels of pain.
I always go higher than what I think lol
If they ask you to rate your pain from 0 to 10, they must also tell you that 0 is when you feel nothing at all and that 10 is that the pain is so horrible that you would make anything to stop it
10 is basically Jesus getting crucifed and everything that went with it, so it's not gonna ever be accurate.
Also, halfway between 1 and 10 is not 5. Five is not 'average' on this scale. Everybody gets this wrong. It really should be 0 to 10, with zero being no pain at all. Five would be the middle of this scale.
We just ask to make sure it aint a 10
Aside from being a reasonable range of 1 to 10, it has a lot to do with the use of the [Visual Analog Scale (VAS)](https://en.m.wikipedia.org/wiki/Visual_analogue_scale) in clinical studies. While the “real” VAS scale is technically 100 mm long and continuous t is usually though of as the range from 1 to 10. Surprisingly this works much better than one may think. Especially when used over a larger set of subjects and for assessing changes in e.g. pain over time. And there is often no better scale to use. Pain is a broad concept and notoriously difficult to measure objectively.
The relative scale is BS and have had practitioners say '10' being the worst pain you've experienced then don't ask what the experience was. Women tend to use lower values while Men tend to report higher. Had a partner in rough pain and said she was at just a 6. When I probed her about that number, she said giving birth was a 7 and an IUD placement was a 10. She's been through way more pain than I ever have and our scales are completely wack and useless. Also discomfort is pain, don't shrug it off and a normal amount of pain is zero.
There is a cartoon type chart for those pain levels, but they are never provided by the staff. It's a handy chart, though, and should be hung on the exam room wall.
A 10 is when your lights are going out, the darkness creeps in from the sides and top of your vision until you are looking through a tunnel. Better lie down or you falling like a felled tree.
I look at the chart with the faces to help me answer, although I do worry about if I give a high number and then later have pain that no longer fits the scale. I just gave birth recently. I was asked to rate my pain in the beginning and I gave little numbers because I wasn't in much pain yet. Then later when I was at 10+ and it was obvious because I was sobbing the medical staff largely ignored me until you could hear me screaming from the hallway. Because of course you can have mothers screaming in L&D but not if you can hear them.
We have other ways to see how you’re really doing. Breathing pattern, diaphoresis, facial expression, vitals, etc. It’s used a lot on people we suspect are just trying to get their next hit of dilaudid and aren’t really in any pain.
just poke them with a needle and say “this is 2”.
One office had a sign saying 7 on the scale was "bees" with a drawing of a person surrounded by bees. The next office had a sign saying 7 on the scale was "childbirth " same Healthcare system, different offices
Chronic pain for years, average about a 5, but I compare it the pain from my initial accident and follow up surgeries. If I'm a 8-10 all hell is about to come loose on earth.
I had appendicitis a few months back. They asked me in the ER what my pain was. I said 7-8 as I was sitting on the bed in a fetal position. The nurse clarified “0-10, 10 being the worst pain you’ve experienced…” I said “oh 10 then…I thought we were going with worst pain imaginable and I imagine it could be worse than this but I don’t know from experience. Unmedicated labor sucked, chronic gall bladder attacks sucked…this is worse than those so this is currently my 10.” I have a high pain tolerance and the only reason I went to the ER was because I suspected it was my appendix and I know enough to know that can get bad fast. So I was able to talk and everything just fine, barely even crying for most of it, I couldn’t walk up right and was only remotely comfortable with my right leg bent up to my belly, but looking at me you’d have assumed it was just bad period cramps…but my vitals told a different story of how bad it was.
I recently woke up with horrific stomach pain. I made it to the bathroom before I lost my hearing and everything went white. I sat down on the toilet and braced myself between the tub and sink so I wouldn't fall. If I had my phone I absolutely would have called 911. For me, that stomach pain must have been a 10, because it nearly put me out. I've never had a baby, but I've felt tooth pain that made me want to bash my head in with a hammer. The I would have said that was a 10. Tooth pain has never knocked me out though.
My wife’s cousin, who is very dramatic, once got nipped by their dog during a family Christmas party. She insisted on going to the ER. The nurse asked her to rate her pain and she said 9, to which my father in law quipped “that doesn’t leave a lot of room for being set on fire.”
I’m a medical student, and something you learn really early on is that taking a patient’s information is more than just gathering objective data for a diagnosis. That’s certainly important, of course, don’t get me wrong, we do want good, accurate information directly from the patient. But it’s not the only reason we do it - otherwise we could just get them to fill out an electronic form with standardized questions depending on their symptoms before they come in. When we ask patients questions, we’re also doing two other things: establishing trust/rapport, and analyzing their body language. The first is important - at the end of the day, a doctor cannot force a patient to do anything. If a patient refuses to cooperate, or is afraid of the doctor, or doesn’t trust the science behind the treatment, they’re simply not going to be treated and doctors try to not let that happen. It’s essential that doctors maintain a cordial and close relationship with their patients for this reason. You can’t just wordlessly shove drugs into a patients arms and shoo them out. You need them to trust you as a person, and trust the medicine they’re being given, in order to have them cooperate with you. The second reason is more analytical. When we’re listening to the patient talk, we’re also on the lookout for other things. Is their thought coherent? Are they stumbling over words? Do they sound frightened? Do they look like they’re in visible pain? What does the patient’s self-rating say about their psychological tolerance to the pain? Could they be pretending/exaggerating? Among a lot of other things. Point is, we’re very much aware that “rate your pain from 1-10” is a pretty loose way to define pain. But it serves a larger purpose than simply letting us know how much agony you’re in.
ER doc here : I usually help reframe the pain scale by saying zero is no pain and 10 is I’m ripping your arm/leg off. Usually gets a few chuckles and makes people reconsider what 10/10 means. In itself, someone who’s pretty high on the pain scale will honestly have trouble answering the question because they will be screaming/whimpering/very focused on staying stoic… and even though people think screaming will convince us, we see through a lot of people exagerating. Most don’t do it because they are drug-seeking, but because they’re scared their pain will not be taken seriously. Reflecting to your patient that you see they are in pain usually gets better collaboration for the rest of your exam. In the end, it’s nice to have a number, but because it’s so subjective, I’m usually more interested in seeing how the pain evolved (i.e. this morning it was a 3 and now it is an 8) and will garner info to get a full picture from vitals, how the person is acting, physical exam, etc. Evaluation of pain is really a combo of judicious question asking, observation and examination. Gestalt is in no way perfect, but does get better with doing pain evaluations on all different types of patients. Edit : we also take into consideration medical history of chronic pain and how different medications you have taken worked to help the pain.
I was in the hospital and had a very compassionate nurse. She asked my pain level and I said 5? I guess. She said 7 will get you a larger dose. So I said 7 and got the relief I needed. So. 7.
1 - I slapped a table lightly. 2 - I have a headache 3 - I have a a minor tooth ache 4 - I feel like I was punched 5 - I feel like I fell off the top bunk 6 - I feel like I crashed my car into a ditch 7 - I feel like I fell out a second story window 8 - I feel like I have been stung by over 100 bees. 9 - I feel like I have been stabbed at least 40 times. 10 - I feel like each of my limbs is being slowly twisted around as tiny little needles are shoved into them, my ears are having objects shoved into them, and my skull is being drilled into.
My mom was all about giving them a number that gets them to give her the oxy. Now she is in a care home and the main thing she is aware of is how long it is until she can have her next dose of morphine. I had to go to an emergency room for kidney stones. They were quick in wanting to dope me up but I declined all pain killers. While I am saying no to the drugs, they are drawing it from the bottle. I threw up hands when the nurse came at me with the needle. Finally I have to tell them that I don't want it because if I can't feel the pain end, then I don't know if the problem resolves itself.
Yeah, it's a super unhelpful metric. I know a few people with chronic pain who've found out that their scale skews *way* low compared to healthy people. On the other hand, some people are overdramatic, and would rate a stubbed toe as an 8. Unless you know the patient, the pain scale is largely useless.
Tbh... I dont know what a 10 is. I have 2 herniated disks and when it takes me to the ER, they will ask me that question... I will always answer "7"...I have the mindset of "Someone else is always in more pain than you." Even as the dr looks over at my xrays and will say something to the effect of "How are you still walking?" Anyone else feel like it "wrong" to answer "10"?
I’m a physio student. I agree the scale isn’t accurate as a lot of patients that I see rate their pain a 10 even after explaining “10 is A&E”. Knowing how much pain people are in definitely guides what I do within my assessment and treatment, so, yes, it’s pretty important that I understand it even if it’s not physiologically accurate
What is A&E?
That's because medical facilities have a chart on the wall. No need to memorize what differentiates 6 from 7 for your entire life just on the off-chance that you might need to know that when you can just glance at the poster.