C.S. Lewis and the Pain Scale | Hacker News Reader

C.S. Lewis and the Pain Scale

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15 pointschrisdroukas7 comments

Yes, the pain scale is subjective, because, well, any attempt to communicate internal feelings and experiences is subjective (by definition). But subjective metrics are still useful as a way to try to achieve a shared understanding. "It hurts, but it doesn't hurt as much as other things I've felt before" is still informative, even if it's imperfect.

And the pain scale is useful when you are talking to someone who is not used to talking about their internal feelings -- some people aren't as expressive as others. And some people have less of a grasp on the language you are communicating in. I would expect if I were a doctor or nurse, I wouldn't want to base my standard of care on how capable my patient is of finding an appropriate adjective to describe how they feel.

> By Jack’s peculiar reckoning, 10 was nuclear annihilation. Free though he was to think that way, he had twisted a subjective tool into something that made sense to him and to nobody else on the planet, rendering it unfit for its sole purpose: evaluating pain.

But then, what is a 10? If you have no other instruction, mapping 10 to an extreme seems reasonable. Every time someone asks me this question I think of the time I broke a bone and the pain is never anywhere close to that and I know there must be something even more painful... so what am I to do?

I feel like a 10 has to be some kind of torture such as carving skin off or running a blow torch across your body.

This is interesting to me. I had severe spinal degeneration in my late 30s, to the extent that I had an incident wherein trying to put underwear on while standing led to a series of spasms that totally immobilized me for three days, to the point I couldn't even go to the hospital because I couldn't move, and the feeling was roughly analagous to having some kind of electrode in my spinal cord that shocked and paralyzed every 30 seconds, and would also do the same if I moved. The level of pain was so beyond anything else I've ever experienced that it totally redefined the shifted the entire scale.

But even that was not a 10! When I was taken off of anesthesia before painkillers were adminstered, following a multilevel lumbar interbody fusion that lasted 7 hours, I achieved an entirely new level yet again that I thankfully only vaguely rememeber because of the general haziness of memory formation post-surgery. I know I screamed at the top of my lungs begging a nurse to kill me, and I had no other working senses except pain, but I don't really remember what it was like qualitatively.

Conversely, I broke my hand about a month ago, fourth metacarpal into four pieces with a 7mm displacement, and I didn't even seek treatment for a week and a half because I thought it couldn't be broken because I had never before broken a bone and expected it to be obvious from pain, but the sensation didn't even register to me as pain.

All of which is a long-winded way of saying yes, there are levels of pain you cannot even conceive of if you never experience it and it does make me question the usefulness of the scales, in that when I first enrolled in pain management before things got truly bad, I was typically rating a 6 what today I'm not sure I would even rate a 1, but as far as I know, providers are aware of this and only use your numerical rating to assess how much your level of pain changes over short enough spans of time that your Pain Overton Window hasn't totally shifted in the meantime.

Clearly, we are going to have to do this in a scale (I keep wanting to say logarithmic but I know that isn't right) where 10 essentially maps to infinity, and you can only get asymptotically close to that; what we then really need is a good calibration pain for 5... something everyone probably experiences roughly the same due to physical constraints on the cause of the pain, such as "ice cream headache" (...which, come to think of it, is actually a pretty brutal pain level; if I had to live the rest of my life with that level of pain, I might consider giving up? it probably helps that the sources of most structural body pain aren't constant--you usually can massively lower how much pain you are experiencing by removing all forces and movement--and so I am failing to truly model what those pains would be like if they were constantly at their worst for the rest of my life).

When the doctor asks you to rate your pain and tells you a 10 is "the worst pain you've ever felt", that's effectively meaningless. An objective scale is needed. I've never broken a bone so I don't know if diverticulitis is more painful or less, but I would imagine that being doused in kerosene and set on fire would be a lot worse.

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