Thursday, February 12, 2009

Revised Pain Scale

After reading medical blogs, I realized how much some patients exaggerate and recognized that when I say my pain is at a 5, doctors may not be taking my pain seriously. The problem with the pain scale is that people quantify pain in completely different ways. After coming across the "Objective Pain Scale" at Scalpel or Sword, in December I developed the following chart to more accurately discuss what I mean by pain with one of the spine doctors. I'd actually rate my pain lower than Scalpel's scale would, though I tend to be quieter and there's a lot of grunting and low moaning to cope with slow movement at an 7.5 or 8. When I try to avoid passing out, I get really quiet, though that takes effort. I don't complain a lot and can thus surprise nurses that may pain really is that high when I try to move. I'm one of those people who gives birth in near silence too (yeah, without pain meds).

4 and below – can live with it, though can get fatiguing
5 = pain intrudes on consciousness continually but able to do physical tasks for a while, can ignore for a while if distracted, push self more but may regret it later
6 = diminished concentration, unable to do complex intellectual work, unable to do most physical tasks for long, seeking to escape pain
7 = autonomic dysfunction (tachycardia, low bp, presyncope), unable to work or sleep; restless
8 = focused only on coping with pain, vomiting; movement avoided (protest or shriek); have passed out at this point
8.5 = symptoms above + shaking from pain
9 = not sure
10 = imagined equivalent of accidental amputation, severe burns

I have only rated something as a 10 once, briefly, and have never rated something as a 9. With 10 pain, I cannot speak, my body is rigid.

The goal I am working on is getting my pain level at 5 or below for about 6-8 waking hours a day without overmedicating so I can really work more and get my life back in order. And I mean my goal is a pain level of 5 while having a semblance of a life, which is difficult since activity and being out increase the pain and quickly move me toward 7. My pain is often at a 6 much of the time, and I am genuinely not up to the kind of complex, challenging work I used to do at that point. I'm at a 7 for many several evenings a week, and if I'm unlucky during the day as well; I'm occasionally at an 8 for a while, which will cause hair loss later. Blogging and light reading I can do even while at the lower end of 7, though I can't concentrate on anything very technical. These pain levels are with pain medication.

I should note that there is some variation here--I may mostly be at a 6 and gasp sharply if I try to move. I may be able to get myself to a 4 by positioning myself carefully and thus will report a 4, not that the 4 is contingent on remaining still.

I think conversation went better with my own individual pain scale brought in.


yanub said...

Creating your own pain scale with clear meaning is a great idea! I never know what to say either when confronted with the standard pain scale.

FridaWrites said...

Yeah, unless I have some physical characteristics to attach those numbers to, it's pretty vague. This also helps with consistency--a 6 is always a 6.