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Old 01-28-2010, 12:36 AM   #1
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Post Pain Scale

IMHO, proper understanding of the pain scale is critical. Unfortunately, it's misunderstood by many patients and thus, may be responsible for incorrect treatment. Good congruency between one's pain and the pain scale is very important. One of the biggest mistakes CPers make, is not correctly communicating their pain. PMs use a common scale of 1-10 to diagnosis a patients pain level, and will put a lot of emphasis on this rating as to decisions they make re: possible treatment plans.

The pain scale, working backwards:
  • A "10" is the worse pain imaginable. Most people have never experienced a 10, so Docs wouldn't take someone serious if they report a lot of 10s.
  • "9" is very serious pain...Something like post surgical, or very debilitating type pain that cause one to be bed ridden.
  • "8" is very serious pain that causes one to miss work or school and requires serious medication. Physical activity is often significantly limited as a result. Even reading can be difficult.
  • A "7" is bad pain, but some may try to go to work or school, but may not accomplish much. Discomfort level is high. 7's cause mood fluctuations and the pain is very bothersome.
  • When working up from the bottom of the scale, "6"s are where the pain starts to get serious IMHO. 6's can often cause disruptions in people's lives. Pain at 6 and above can cause mood swings, absenteeism, and is a general nuisance.
  • "5" is where many professionals will define pain as starting to be "distracting." For those with very serious conditions, most PMs will set an expectation that severe chronic pain can be acceptable around a "4" or "5"....Many will say that one should be able to live with pain around this area, especially if they were once at a much higher level.
  • Most PMs will consider pain below 5 as minor in nature, and may not require a pain mgt specialist. A lot of pain below 5 can either be handled by a GP, or even OTC meds, depending on the type of pain, and the needs of the patient.

The above is by no means the gospel. However, I would say it does a pretty good job of describing pain in general. Again, one of the biggest mistakes a CPer makes, is not correctly assessing their pain. Most patients underestimate their pain, thus causing under treatment. If you don't communicate your pain correctly, the PM won't be able to help you as much as he/she would otherwise.

However, it's equally important that one doesn't overstate their pain either, or you may not be taken seriously. For example, if you're joking around with the Doc about something that was on the news, or last nights American Idol show, chances are you don't have an "8" or "9."

A general rule of thumb in PM is for treatment to reduce one's pain by at least 30%. Applying this to the pain scale, if one starts at fairly regular level of 7 or 8 (before PM intervention), then a level around 5 would be a reasonable target goal. It's very possible, however, that pain responds much better to treatment, and one's pain is lowered by a very large amount.

Some pain on the other hand, is so great, that only a modest reduction is possible. These cases are usually very challenging for PMs and often result in high levels of narcotic therapy.

Lastly, some PMs will use a 1-10 scale, with pictures of faces corresponding to each #. This scale should be considered nearly identical to what I outlined above.

Regards,

Ex

Last edited by Administrator; 02-22-2010 at 08:16 PM.

 
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Old 02-07-2010, 03:14 AM   #2
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Arrow Re: Pain Scale

10 - for me is where you "literally pass out" from the pain in my book... Never been there myself but if known burn patients to experience it...

9 - is what I call blinding pain.... beyond the tears I actually get flashes of white when it peaks and I know I am bordering 10... only time I get there usually is during Trigger Point or some other injection procedure when I have to say "lets take a break or the the next injection will knock me out".

8- for me is when my back starts spasms and I am forced to lay down or I actually collapse.

7- is where most my bad days are... when 5-10 minutes of standing, bending, walking will put me in an 8...

6- I can function for an hour or two before it escalates...

5 - I can function about 4 hours before needing a break...

4 - I can put in an 8 hour day of sitting up right at a desk working... then I need to go home and pass out...this is often where my meds leave me

3- I can get by on my LR meds with no breakthrough pain meds that day...

2 This is the best I get with my meds The pain is still there but I can push through it without it showing on my face that I'm in pain...

1- Basic "aches and pains" where an OTC will suffice.

This is my personal scale but it covers the full range of pain and so it works for my pain management docs too..

Mine is a bit more exponential than Ex's but being able to have 28 trigger points injections in one session (with 2-4 breaks), my doctor says I have a high tolerance for pain..

So most days I start at 7-5 and with my meds get down to a 4-2.... So I average a 6 w/o meds.. and will go down to a 4 with them and back up to a 6 before I take my final meds to get to sleep if I have an active day...

Last edited by Administrator; 02-22-2010 at 08:13 PM.

 
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Old 02-07-2010, 08:52 AM   #3
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Re: Pain Scale

Yes, I think your scale is very specific to you, but really, it's almost identical to what I posted....You just say it a bit differently. The key is that whatever scale you're using, that the patient and Dr are on the same page. The biggest mistake is when there isn't congruency. For example, the patient may think a "5" is bad pain, while a Doc does not....That type of thing.

Last edited by Administrator; 02-22-2010 at 08:14 PM.

 
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