Oh that’s a good one!
Nurse once asked me pain level, I said 8. She lectured me that’s ER level of pain, not to use it anymore, I must be a pill seeker.
It was an 8.
Nurse once asked me pain level, I said 8. She lectured me that’s ER level of pain, not to use it anymore, I must be a pill seeker.
It was an 8.
The last time I went to the ER (a few years ago now) for something unrelated, I was in extreme pain. I'm used to pain. I can tolerate constant pain pretty well. This pain was way above what I could tolerate.
Instead of help from the nurse I got a lecture about lying about drug use and lying about pain. Eventually I got the help I needed but the whole experience was just so degrading at a time I would have preferred to die rather than continue the pain I felt.
[Edit: I really meant to ask, how do you know it's an 8 rather than a 7 or a 9? Isn't this very highly subjective? What does the number even tell us? Have you read https://xkcd.com/883/?]
I much prefer the "Hyperbole and a Half" author's pain scale. http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-does...
I absolutely refuse to give a numerical answer unless they first give me an objective calibration for the numbers. I recently got into a minor argument with a nurse before a minor surgery. "If you won't tell me a number, how will I know if I need to give you a painkiller?" "If I'm in enough pain to need a painkiller, I will tell you."
The number scale attempts to turn a subjective interpretation into an "objective" value. Instead of having to actually listen to people and apply training and experience to judge which treatments are needed, the number system de facto pushes that decision onto the patient so the doctor/nurse/etc only needs to follow a simple set of treatment rules. Similar to black box "AI" used in e.g. criminal sentencing and employee evaluations, the numeric pain scale is yet another example of a fundamentally subjective situation being laundered into a supposedly "objective" value.
It really sucks that we have no objective measure of pain; a tricorder that you could aim at someone and get a number back would be infinitely better than what we have now.
They're the same because they don't quantify how much it hurts, but instead how the pain affects you.
A 10 would be pain so severe you are unable to perceive anything besides your pain or do anything except writhe.
An 8 on such a scale would be pain that makes it difficult to focus on anything else, let alone listen calmly to a person and give a coherent answer.
A 5, while being distracting, would still allow you to function on some level.
A 3 would be pain that is somewhat easy to ignore.
You see how this is a scale that can actually be measured by an outside observer and is much more useful in figuring out what medication to give. Because while two people may have the same injury, one of them may be able to completely ignore the pain even without medication - so giving medication would only do harm - while the second person may need medication in order to function.
Assuming such a scale was used, it would make sense for the nurse to say "it isn't an 8" - because if it was an eight you wouldn't have been able to listen calmly and explain that to her, by definition.
Well, it won't only do harm though, right? It will still get rid of that person's pain.
If I fracture my ankle, but I learn to compensate by constantly shifting my weight onto my good leg as I limp so that I can still do my job -- in that scenario, I still want my ankle fixed. I don't want a doctor saying, "ah, but you have the special limp, so a cast and crutches would only do you harm." I want the cast, because the cast is probably easier, more comfortable, and in the long term less dangerous than what I'm currently doing.
Why would pain be different? Should someone not be able to get relief from suffering just because they've gotten good at mentally focusing through it?
It seems like the result of approaching pain from the perspective you're advocating for would just be to discourage people from trying to take any practical and/or psychological steps to manage their own pain, because every minor success they have will make it harder for them to get any additional help.
It is completely different. Your analogy isn't great.
A fractured ankle is a bad thing. A cast certainly won't do harm. Pain is a response of your body to a bad thing. Suppressing it can do harm in itself.
Some pain can often be desirable because it prevents a patient from further injuring themselves by, for instance, putting weight on an injured ankle. Pain is a warning system.
Add to that all the possible side-effects of painkillers.
On top of that there's context for everything. You should probably give a patient that experiences pain which can't be avoided painkillers earlier than a patient who experiences pain when they put weight on something they shouldn't.
You're describing someone with chronic pain. So... we should prioritize giving painkillers to someone with chronic pain over someone someone with temporary pain that will quickly go away if they don't do something dangerous? I agree with that.
If someone has chronic pain, that pain isn't helping them avoid doing something bad to their body. It's just pointless pain with no benefit. And even if I can force myself to function with chronic pain, I can still have long-term damage from stress, lack of sleep, damage to relationships, even just damage in terms of pure suffering. It's dangerous for a doctor to say, "you can hold a conversation with me, so medication would only do you harm." I don't think that's an objective scale, and I don't think it actually captures the risks of long-term damage and suffering.
If you want something with more downside than a cast, sub out something like surgery in my analogy instead. Either way, the point is that just being able to function in society is not an adequate measure by itself of whether or not someone needs medical help.
Talk to a chronic pain patient and they'll likely tell you they have to suppress reactions to the pain in order to not be dismissed as "playing it up" and thus drug seeking. That they are used to dealing with pain does not mean the pain is not there.
Add in myths like "black people can handle more pain", too. https://www.aamc.org/news-insights/how-we-fail-black-patient...
People who are regularly in great pain would read this comment as saying "you are being mauled by a bear, but if you have ripped your own vocal cords out so that you're not constantly screaming, we judge that preventing the bear from mauling you won't affect the environment much (since the screaming level will not change), so we will not prevent the bear from mauling you".
But if it goes on more than a few hours I will jump off a cliff to end suffering.
I stayed away from the really strong pain killers. But man it was hard. I did not want end up with an addiction on top of everything else.
I have small fibre neuropathy (nerve damage) in my arms and legs, and when it first started I thought I was going to go crazy - I just couldn't stand that amount of pain, constantly. I cried a lot, I begged doctors to make it go away, I went to the ER.
The fact is you can't stay like that forever - you either kill yourself, or you somehow learn to live with it.
You don't get used to chronic pain, but you adjust to a new "normal" level of pain. You develop coping mechanisms and learn to "bury it", get on with it as best you can. If you're lucky, you find some medication that actually helps somewhat. You research your condition and possible remedies, a lot. All of this isn't to say it gets easy, believe me it fecking well does not.
A lot of people (doctors included) don't seem to believe that you can be in severe pain, while sitting and conversing with them - "he seems fine to me!".
I'll add as well that I'm one of the "lucky" ones for whom a diagnostic test (skin biopsy) has shown concrete evidence that doctors believe in - without that, you'll get nothing but platitudes and shown the door. You'll probably also get told you have fibromyalgia, even if you don't remotely fit the criteria. I know this firsthand, because I have had to research and guide clueless doctors and insist on tests, and insist on re-tests when they've messed up.
That's very familiar. "I feel like I'm being stabbed in the eye" "But you seen fine" "It's been doing that for the last two years; at some point I just stopped reacting to it"
> I'll add as well that I'm one of the "lucky" ones for whom a diagnostic test (skin biopsy) has shown concrete evidence that doctors believe in
Having visible evidence definitely seems to help - my dermatologist seemed to be sceptical that my dermatographic urticaria[1] was as bad as I was saying given the dose of antihistamines I was on. She did a challenge test, and her first comment was words to the effect of "Huh, that _is_ severe". She ended up doubling the does of antihistamines. The "hidden" symptoms are much more of an uphill battle.
This number will be used to determine if a more in depth tool is needed (like if you say 7-10). What type of treatment is needed (pain tolerance is different from person to person, so even if two people have the same injury or disease, one might say 8 and need pain killers and the other might say 3 and not). It will be used to gauge if a treatment is working (when you first came in you were at a baseline of 6, but after taking this treatment, you're at a 2), and so on.
Thus, a personal scale makes sense.
Wikipedia isn't much help[1]. It lists 30+ "pain measurement scales", but clicking a few of them doesn't tell me any specifics about how they work.
Looks like someone has in fact tried strategy 1. https://www.hindawi.com/journals/js/2018/6205896/ mentions: "Recently, a quantitative pain-assessing method using electrical stimulation was introduced [12–15]. PainVision™ devices measure perception threshold and pain produced by an electrical current. This system quantifies pain intensity by comparing the experienced pain with the intensity of electrical perceptions. The perception threshold indicates the minimal electric current sensed by the individual, and the pain produced is defined as the maximal electric current sensed by the individual. However, the skin resistance of an individual may affect the electrical measurement result [16–20]."
Their refinement continues: "our system measures from the patient’s skin resistance before measuring the pain." "In this work, we developed a pain measurement device that has two analysis methods, electrical stimulation and applying pressure, for more accurate cross-validation assessment. During electrical stimulation, electrical stress is applied on a nonpain site and then the observed stress can be compared to pain. ... During the pressure evaluation, pain was assessed by applying pressure on the pain site. Inflammation was induced on the rat’s hind paw by carrageenan, and then the inflamed hind paw was stimulated by a hand-type pressure stimulator. The pressure site was then compared with the inflammation levels." Seems like it might be workable.
Talk about the things you used to do that you are not able to do now because of the pain.
For short term pain number 8 is supposed to be able to read or converse but only with effort; dizzy and / or nauseous; limited physical activity; difficulty in functioning; and strong painkillers are not so effective.
Number 9 is unable to speak; crying out or moaning uncontrollably.
Number 7 is interference with sleep, difficulty concentrating.
Chronic pain sucks...but people fail to understand that some people suffer from high level of pain and that doctors often fail to manage it. I have tried many things to manage my pain, it is at a point where I for the most part get on with my life with some "take it easy" days. Unfortunately, the only thing that helps is opiates, and currently nobody wants to prescribe those. My primary does and 30 pills of low dose last me months. Still when I switched doctors they refused giving me opiates, even though all the other meds lyrica, cymbalata, gabapentin did nothing. A pain doctor offered ketamine treatments at $500....like that is reasonable on monthly basis.