I much prefer the "Hyperbole and a Half" author's pain scale. http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-does...
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".
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.