How to Measure Pain

If only pain were as easy to measure as, say, volume. As height, or weight, or speed. Medical professionals try to quantify it. How bad is your pain on a 1 to 10 scale, with 10 being the worst pain you can imagine?

Most health professionals I have come across also add ‘childbirth counts as 10.’ This always puzzles me, as using childbirth as a standard excludes probably 70% of patients. It even manages to exclude women who have experienced childbirth, but had relatively painless ones. For me, at my most exaggerated estimate, I would only put childbirth at 6 on the scale. 4 is more accurate. Menstrual cramps were far worse than labour.

I always struggle with the ‘how bad…’ question. If I have sliced a centimetre deep gash into my finger with the bread knife, and someone says compare this to the worse pain you can imagine, I can easily imagine something much more painful; say, a starving wolf sinking its yellow, rotting fangs into the flesh of my finger and gnawing it to the bone before ripping it off at the knuckle. That would hurt way more.

measuring pain pin (5)Some medical professionals ask ‘How bad is your pain on a 1 to 10 scale, with 10 being the worst pain you have ever experienced?’ It’s easier to answer. A decade ago, I had gallstones, and the pain was the worst I’d ever experienced. It left me curled up in a ball, unable to function at times. So, yeh, that was a 10. But since then, I have experienced pain that rendered me virtually catatonic. If the current pain is more painful than the last pain recorded as a 10, it makes the pain scale useless. 10 is already the worst. Saying 11, or 12, or off the scale just sounds like exaggeration, and is more likely to make medical people think the patient is just a drug-seeker, or the pain is only psycho-somatic.

For those of us with a chronic pain condition, where pain is a constant companion ghosting your every footstep, these questions are particularly arbitrary and clunky. I have trigeminal neuralgia, a condition very often described by doctors and patients as the worst pain known to humankind. The trigeminal nerve, which is responsible for sensation and movement in the face, is so damaged it misreads signals and reacts with episodes of extreme pain. A soft spring breeze, for example, feels like my face is being sliced by knives.

I also have cluster headaches, a condition also often described as the worst pain known to humankind. The pain is a jack hammer drill, thumping and grinding a shaft down through my forehead, my eye and to my jaw. It is a flaying, acid flame blanket clinging to my cheek. It is a fiery, burning tennis ball trying to burst out of my eye.

Judging by the worst pain known qualifier, I guess most people would think both conditions count as a 10 on the pain scale.

But the truth is, sometimes they don’t. Just because something is described as the worst pain known, it doesn’t mean every attack, every flare up of pain is automatically at the top of the pain scale. Sometimes, my cluster headache just makes my eye hot and dry, and my cheek sting. Sometimes my TN is a dull ache, or an annoying sensation of pins and needles.

Conversely, just because a pain condition does not have worst pain known as a descriptive tag, does not mean it can’t cause episodes of pain at the top of any pain scale. I have other conditions. Sjogren’s Syndrome, which has phases of causing my joints to become stiff, inflamed and painful. Ehler’s Danlos Syndrome, which means most of my joints dislocate as often as most people do up buttons on clothes. And as easily. These two conditions don’t even feature on top ten lists of the most painful medical conditions. Yet with both these conditions, I have had episodes where I was fainting or unconscious.

The label of worst pain known is spectacularly unhelpful. It gives no useful information about the actual pain experience. And a number on a pain scale is spectacularly unhelpful, as it doesn’t convey useful information unless the scale is calibrated in a meaningful way. Description and experience of pain needs to be conveyed clearly so patients and medical staff can give the right, most effective help and treatment.

Through a Facebook support group, I often see other people also experience difficulties explaining their pain. So I decided to have a crack at creating a pain scale, with visual, colour-coded cards I’d find easy to use, and that makes sense whatever the type of pain. 

Now I feel much more confident about giving medical people a useful answer.

painscales triptych

 

 

  27 comments for “How to Measure Pain

  1. 12/07/2020 at 9:35 pm

    Like!! Really appreciate you sharing this blog post.Really thank you! Keep writing.

    Liked by 1 person

    • Trish
      13/07/2020 at 12:03 pm

      thank you

      Like

  2. Alma K
    14/10/2019 at 8:11 am

    My Neurologist described it best one time, he said it felt like a severe tooth pain in all your teeth… then multiply the pain times 300. My last experience with pain was exactly as he described. Thankfully I’m in remission 🙏🏻 Praising God everyday

    Liked by 1 person

  3. 14/02/2019 at 1:49 pm

    Absolutely brilliant! Assigning pain a number is meaningless — each of us have a different experience of pain, which means that the medical professional and you are definitely not on the same page. But adding a description about the pain’s impact means that you’re talking about the same thing. I love these cards. Thanks so much for creating them — have shared this all over.

    Liked by 1 person

  4. 14/02/2019 at 9:26 am

    I agree with everything you’ve said here. It is so so difficult to pin pain down to a number. It’s possibly easier for acute pain. If you get sudden, incredible pain from an accident, you probably have knowledge of what zero pain is, therefore, you have a comparison. But when you live with chronic pain, especially from several conditions, it is difficult to gauge by giving a number. We all deal with pain differently, and we can often deal with it differently every day. We do need to explain how the pain is making us feel, and your cards are a great way of doing that.

    Like

  5. Rachel Bob
    02/01/2019 at 7:01 am

    I found your post on chronic illness bloggers facebook group and glad I did! This is a great post! I know I have very similar experiences with my health conditions of chronic migraines, interstitial cystitis, Hashimoto’s, pelvic floor dysfunction… I think I’m forgetting one or two lol. Either way, my point is, I always hate when doctor’s ask me the pain scale, I always feel like I’m answering wrong if the number is too high or too low. It’s too subjective..how can they possibly quantify my pain with a number line? Oy!
    Great post! Happy new year!
    Stay well,
    Rachel
    http://www.alifelessinvisible.com

    Liked by 1 person

    • trish veltman
      02/01/2019 at 3:22 pm

      Thank you Rachel. Oh, that’s a nasty handful of conditions you have there. Yeh, a numberline on its own is a waste of time, but this should help patients and doctors with some useful information.

      Like

  6. 02/01/2019 at 5:55 am

    What a great way to redefine the scale. It is so difficult answering the question. It is so subjective. This helps. Thanks

    Liked by 1 person

    • trish veltman
      02/01/2019 at 3:19 pm

      Yes, makes it so much easier to explain to doctors when it can be made meaningful.

      Like

  7. 17/11/2018 at 1:13 am

    That’s fabulous thank you so much, hate that question, and it’s worse when your being asked when the pain is that bad you can’t even answer them but the tears in my eyes said it all..great graph xx

    Liked by 1 person

    • trish veltman
      17/11/2018 at 5:18 pm

      You’re welcome – I keep a copy of the charts on my phone, and point! It does make communication with medical staff a lot less fraught.

      Like

  8. 27/09/2018 at 7:25 pm

    I like how you explain the gradation of pain because it does become difficult to quantify it. What is painful for me might be less painful for somebody, Thresholds make a difference too. I hope you dont have to go through too much pain though

    Liked by 1 person

  9. Jyoti Kiran
    27/09/2018 at 1:06 pm

    Such a beautiful post.
    Thank you so much for sharing

    Liked by 1 person

  10. krish
    27/09/2018 at 6:01 am

    Everyone has a different threshold for pain..pain cannot be actually related to a number…
    Regards

    Like

  11. tennismom miami
    27/09/2018 at 4:49 am

    Love, love, love this!! My experience with pain has changed as i age. I too am one of those people that didn’t consider childbirth super painful. It’s hard to explain, but my brain is not traumatized from it. However, i’m still traumatized from the pain of a biopsy, even though i had local anesthesia while with childbirth i was completely drug free. I’m still traumatized from the pain of a miscarriage and a d&c procedure.
    I love your graphics!! I always had a hard time giving an answer on the 1-10 pain scale!!!

    Liked by 1 person

  12. 27/09/2018 at 3:13 am

    measuring pain is so complicated, especially when you have to switch doctors. People often use different words to describe it and sometimes it leads to confusing. chronic pain is horrible to deal with, I am so happy and thankful to God I no longer need to measure pain everyday

    Liked by 1 person

  13. Zai Photography
    26/09/2018 at 11:40 pm

    Wow I’m so sorry about the pain, I shared this with a friend who has the same condition

    Liked by 1 person

    • veltman1
      27/09/2018 at 12:25 am

      Hope your friend finds it helpful, and is managing ok with it. Thanks for sharing.

      Like

  14. milestonetravelsllc
    26/09/2018 at 10:07 pm

    Wow, this is great! I really hate answering that question at the doctors. My 5 is my husbands 8 it has always amazed me how differently we handle pain. Thanks for sharing!

    Liked by 1 person

    • veltman1
      27/09/2018 at 12:24 am

      Glad it’s helpful. Yeh, it’s amazing how differently people handle pain.

      Like

  15. 26/09/2018 at 8:03 pm

    Aaaawwwww….am sorry to hear what you go through, Trish. It’s terrible, really.

    I’m very glad you’re getting some help on that.

    Thanks for sharing.

    Liked by 1 person

    • veltman1
      26/09/2018 at 9:59 pm

      Thank you. Pleased to say that for the most part meds and lots of pain management strategies like meditation etc have it all under better control than at the beginning, but I can’t ever claim a zero on the scale!

      Liked by 1 person

    • 27/09/2018 at 5:07 pm

      Oooohhhh….that’s alright, Trish. 😊🤗❤️✊🏼

      Like

  16. 23/09/2018 at 11:37 pm

    I love this Trish. So so difficult to gauge pain with a number. And one person’s number doesn’t mean the same as another person’s. We are individuals. So your pain scale idea works really well.

    Like

    • veltman1
      24/09/2018 at 12:23 am

      Thank you. I hope it’ll be helpful to more people. My daughter has snaffled the pictures to show her nursing tutors!

      Like

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