Rating Your Pain - Issues With The Traditional Pain Scale
A pain scale is a tool used to allow the patient to assess and quantify the intensity of their pain. Typically, you are asked to rate your pain on a scale from 0-10, with 0 being no pain and 10 being the worst pain imaginable.
Healthcare professionals ask you to rate your pain so they can gain an understanding of your pain levels, to help provide an accurate diagnosis, and develop treatment plans. Your pain rating is meant to help the medical professional gauge how serious your pain is and how to treat you. As a chronic pain patient, I have often viewed the scaled rating as a way to determine if the medical professional should take me seriously. When I say my pain is a 10, I am often dismissed and it is assumed I am exaggerating or inflating my pain level. I can assure you, I am not.
On the traditional numeric pain scale, pain is subjectively broken down into the following scores:
0: No pain
1-3: Mild pain that may be noticeable but doesn’t typically interfere with your daily activities.
4-6: Moderate pain that may be interfering with your daily activities.
7-10: Severe pain that significantly impacts your daily activities and may require medical intervention to manage.
Pain scale from Healthline
The key here is the scale is meant to be subjective and pain is different to everyone. When asked what your pain level is on a scale from 0-10, the answers will be skewed based on your own experiences.
The problem becomes when a patient has chronic pain, like Trigeminal Neuralgia (TN). For chronic pain patients the scale is different. When asked to rate my pain and I say it is a 9 or 10, I tend to not be believed even when that is the correct answer. To help with understanding, I’ve added different qualifiers over the years:
“My pain is a 9. I’ve had two children naturally and this is worse than labor pain.“
”My pain is an 8 or 9. It’s unbearable and I’ll start passing out soon. I’m on the verge of not being able to handle this level of pain”
”My pain is a 10. That means the pain is so bad I’m passing out or throwing up. I cannot handle this level of pain.“
I tend to break my Trigeminal Neuralgia pain down in the following way:
0: Does this pain level really exist? (How can I live here‽)
1-3: This is not pain. If I had this level I wouldn’t need medical intervention and I’d be living my best life.
4-5: Pain is starting to get annoying. I can sometimes function but I’m more worried about the pain spiking. I can handle this level on most days as long as I do not have a flare or attack.
6: My pain is annoying and starting to hinder my activities and talking. Again, I’m worried about the pain spiking.
7: The pain is getting higher and I’m unable to fully function. I may not be able to talk well. I’ll be resting more and withdrawing from activities. I’m becoming very concerned about the pain spiking.
8: Oh man, here we go again. The pain is high. I can’t function and I’m resting to try to manage my pain. I’m highly concerned about a pain spike. I’m restless and starting to shake.
9: Please, not again. Pain is too high. I can’t function at all. All I can do is lay down and try to manage the pain. I’m shaking and highly restless. I fight the tears leaking from my closed eyes, which hurt to have rolling down my face.
10: I’m done. I can’t handle the pain at all. I’m a mess. I am throwing up or passing out. The pain is horrific. Please help me manage the pain to a more functionable level. I am fairly silent and can’t talk, please don’t ask me to explain anything. Please listen to my caretakers when they explain my problem and believe them.
Perceptions of pain and care
I’ve experienced different perceptions of pain throughout my life. Each I would rate as the worst I’ve ever experienced. From scrapes, bruises, and broken bones when I was little, to surgeries, labor and delivery, migraines, and Trigeminal Neuralgia as an adult. As I’ve grown, my perception of pain has also changed. Each is valid and I’m happy for my younger self that she didn’t experience the horrific pain that Trigeminal Neuralgia would bring to her future.
If I were to ask my kids what their worst pain has been, I’d get a mixed answers from diaper rash, teething, shots, scrapes, bruises, a sibling touching or looking at them, being told no, falling from your bike, twisting an ankle, or something else similar to their experiences. As I live in constant high pain, I have to remind myself that their pain is real. In each of those moments, that is the worst pain they have ever felt. I have to treat their pain as valid and put on my best “Nurse Mom” hat to help them to feel better.
Pain is different for everyone and we all have different experiences. When someone with chronic pain has to go to the Emergency Department at their local hospital for help, they aren’t always treated with kindness and respect. They are asked to rate their pain from 0-10 and when you say a high number, you often get skeptical looks.
Chronic pain patients are often treated as seeking pain medication. Unfortunately, that may be true for some, but for myself I am most definitely not seeking pain medication. First and most importantly, narcotics do not help nerve pain. Secondly, narcotics make me sick. If I take them, I’ll still be in pain and I’ll be throwing and passing out for a different reason. I’ve had a few Emergency Department doctors and nurses tell me my pain isn’t valid. When I was in college, I had a cyst on my ovary that had burst and caused high pain. I was told by my nurse that I couldn’t be in pain if I was refusing to take the narcotics being offered and was dismissed. I’ve found I can tolerate high pain for a certain amount of time, but what I cannot tolerate is high pain, throwing up, and passing out from narcotics at the same time. I also will not tolerate being treated poorly by those I’ve come to for help.
One of the problems with seeking help for chronic pain is that our diagnoses can be unknown to the medical professional trying to treat us. Rather than take a few moments to listen or educate themselves on how to properly care for a Trigeminal Neuralgia patient, we are dismissed as “narcotic seeking” and quickly pushed to leave to open up the bed for a patient they can help or want to help.
Do other pain scales exist?
Other pain scales do exist that help to better define chronic pain and go beyond the traditional 0-10 numerical ratings.
You could be asked to rate your pain according to smiley and frown faces.
Pain scale from PainScale
Some pain scales combine the numeric scale with faces to help with better understanding.
Pain scale from Disabled World
Or you could find a pain scale that has explanations to accompany the numeric rating. This scale does a better job at explaining what each level means and may add more value to your discussion with medical professionals.
Pain scale seen in a Pain Management doctors office.
As a Trigeminal Neuralgia patient, I appreciate the McGill pain scale as it specifically mentions my diagnosis. More importantly, the scale calls out other diagnoses and events to help put the pain in perspective. The McGill pain scale accompanied with a numeric rating may help medical professionals better understand the pain you are dealing with and be able to better treat you.
McGill Pain Scale
There is a need for patients with chronic pain to be fairly treated and understood. I do not know what the answer is and I will continue to find ways to best communicate my pain to those trying to help. What I do know is that more education needs to be done to treat patients outside of their specialists office and for their levels of pain to be believed and treated.
