Can I share something with you all? I don’t hate many things; hate is a very strong emotion and most times it latches on to you and its negativity destroys you more than the thing that you hate. So it is not to be taken lightly when I say that I despise, I hate, I loathe the pain scale.
I understand why it’s there, I do – in the emergency room setting you have a doctor who doesn’t know you at all and they have to make quick decisions so a pain scale makes sense in theory. The doctor is supposed to use that scale as unique to each person, knowing that each person’s pain is different.
Unfortunately, in my experience, it has not worked out that way. For me and for people I have heard from like me – those with chronic pain who have a high pain tolerance – the pain scale backfires. We can be at a normal person’s seven, where they might be writhing, and yet we are still sitting up, maybe reclining on the hospital bed, a grimace here or there. If you are like me, then humor is a coping mechanism, so you crack jokes with the nurse. They ask your pain level and you freeze because you don’t know what number to give. To you there is pain you can handle and pain you can’t, and your pain is getting to the point you can’t – that’s why you are there. So you throw out a number. You don’t want to sound dramatic so you low-ball it and the doctor isn’t seeing a patient in that much pain, so what happens? Nothing, another wasted trip. So what are we supposed to do, lie there moaning and acting?
Please, stop telling me to give you a number. I can’t give you a number, my life is not a number. How about asking me about my life. What is the pain stopping me from doing? What does my normal day look like? What about my day has changed because of the pain? Do I feel like I am a danger to myself because of the pain? What do I hope to get out of the visit? Those questions would open up such a huge dialogue between patient and provider and hopefully lead to some kind of treatment. I find with the pain scale, once the doctor sees me and hears my pain scale number it’s like vault doors closing on his mind and he is already thinking about the next patient.
The pain scale and its very odd illustrations are great for kids but I am a 40-year-old woman. I don’t want to point to a face or throw out a number. I want a doctor to sit down as my partner in my health care and have a conversation with me about my health.
I am lucky enough to have found a wonderful primary care doctor who understands how much I hate the pain scale. His health network still requires that it is used but he didn’t complain when I wrote out my own definitions to each of the numbers on the pain scale, unique to me, and asked that he keep it in my file so we will both know exactly what I mean when say “four.”
I actually had to take a break from writing this in order to go to a doctor appointment. A med student did my initial appointment today and I was so impressed because there was no talk of the pain scale from her. She asked me things like, what kinds of things is the pain preventing me from doing in my home life? How about recreationally, with my hobbies, etc.? (Ha, yeah right – but she doesn’t know that.) That is how you assess pain in an efficient yet personal way.