Friday, September 2, 2011

On a Scale of 1 to 10

We’ve all heard it. How bad is the pain, on a scale of 1 to 10?

But how exactly do you answer the question when you’ve had more than your fair share of pain? How can anyone know what my 10 is compared to someone else’s?

It seems to me that the more exposure one has to severe pain, the more severe that person’s 10 will be. For instance, if the worst pain Johnny ever felt was a sprained ankle, then Johnny may say that his sprained ankle is a 10. With all the pain I have experienced, a sprained ankle may feel like a 5 to me.

If I say my pain is a 5 to someone who is unfamiliar with the amount of pain I have experienced, I wonder if it may be taken less seriously. It seems like a double-edged sword because saying a very high number may give the impression that one is exaggerating, especially when pain is chronic.

To make it worse, sometimes “with 10 being the worst pain you’ve ever felt” is added; other times it is “with 10 being the worst pain you could imagine” that is added. That could lead to two very different answers for the same person. On the second scale, with all the pain I’ve been through and my imagination, I wince at the thought of what a 10 could be.

In order to clarify my answer, I often follow with a comparison to something most can relate to. For instance, I may add that the pain hurts as much as a sprained ankle.

Being in pain all the time also makes it difficult to tell how much something really hurts. I couldn’t even feel a second degree burn I got last week.

My husband had put dinner in the oven and I was sitting in the kitchen when the timer went off. I figured the least I could do was pull dinner out of the oven, since I was sitting right next to it. Knowing how clumsy I’ve been lately and my tendency to burn myself, I put an oven mitt on each hand and proceeded to take the food out of the oven. Well leave it to me to manage to burn myself even with two oven mitts on!

Luckily, I did feel the pain while my skin was being burned and pulled my arm out.

I could tell by looking at it that it was going to leave a scar (I have extensive experience accidentally burning myself, although this is the first time I managed to do it with two oven mitts on), but within seconds, I no longer noticed any pain, even touching it. It is only a second degree burn, so it should have hurt. It blistered up and looks awful, which is the only reason I even remember it happened.

Maybe it did hurt, but because I am so used to constant pain, I haven’t noticed it.

I get bruises all the time because I am constantly bumping into stuff, and like the burn, I notice a little pain the moment it happens, but it subsides immediately. I usually forget what caused the bruise by the time it shows up because I don’t notice the pain. It seems bruises hurt less than the aches and pains I experience daily. Sometimes they will feel tender when I apply pressure to the bruises, but not as much as my fibro tender points.

Another problem with the pain scale is that 10 is such a small number. It hardly seems large enough to represent the spectrum of pain I have experienced. There is a large gap between numbers for me.

I am currently keeping track of the level of pain I experience daily, among other symptoms, to see if new medications are helping and to keep track of what affects my symptoms. I often find myself using numbers such as 4.5 because I will have a day that is clearly much worse than what I would consider a 4, but not nearly as bad as what I would consider a 5.

It also seems to me that our own pain scales may change as time goes on and we experience and get used to more pain. I remember when I was a kid, I hated paper cuts; I thought they were the worst. Now I would take a paper cut any day over my usual pain. I am sure I would have rated a paper cut much higher on the pain scale when I was a kid than I would today.

How do you feel about the pain scale?


  1. I found this on the web, and think it is a useful pain scale:

    0 Pain free.

    1 Very minor annoyance - mild aches to some parts of the body. No pain medication needed.

    2 Minor annoyance- dull aches to some parts of the body. No pain medication needed.

    3 Annoying enough to be distracting. Over-the-counter pain relievers (such as Naproxen or topical treatments such as Arthritis Pain relieving rubs) take care of it.

    4 Can be ignored if you are really involved in your work, but still distracting. Over-the-counter pain relievers remove pain for 3-4 hours.

    5 Can’t be ignored for more than 30 minutes. Over-the-counter pain relievers help somewhat (bring pain level from 5 to a 3 or 4) with pain for 3-4 hours.

    6 Can’t be ignored for any length of time but you can still go to work and participate in social activities. Stronger painkillers (such as Ultram) relieve pain for 3-4 hours.

    7 Makes it difficult to concentrate, interferes with sleep. You can still function with effort. Stronger painkillers (such as Ultram) are only partially effective. (Stronger pain killers bring pain from a 7 to a 4-6 level.)

    8 Physical activity severely limited. You can read and converse with effort. Stronger painkillers (such as Ultram) are not effective. (Narcotic painkillers do bring this pain down to a level 3 or lower level.)

    9 Non functional for all practical purposes. Cannot concentrate. Physical activity halted. Panic sets in. (Narcotic painkillers bring the pain level down from 9 to the 4-6 level.)

    10 Totally non-functional. Unable to speak. Crying out or moaning uncontrollably - near delirium.

  2. I hate the pain scale. How is it possible to squash the complex experience of pain that we have into a simple formula of 1 to 10? On top of that by the time I get to the doctor I can't even remember the details of my last 30 days. I always give the same answer-4 to 7 or 8. I know it seemed like 10 to me, but I figure I'll hold out on 10 just in case I need it later. But the whole formula is dumb and in my opinion doesn't even apply to Fibromyalgia pain. It's like the tender point test-I just go along with it to satisfy my doctors, because I know they just can't understand, and they need something to fit in their little medical box of explanations!!!

  3. I hate being asked the "where is your pain on a scale of 1- 10?" Clearly so objective it is useless. The scale posted above is very helpful. I had seen one other that had other descriptors like childbirth, broken leg, etc. but i prefer this one.

  4. I use two numbers for pain, one for chronic pain and one for acute. They feel very different to me. A day that has an 8 chronic and 2 acute (bad FM day, small random pains) hurts differently than a 3 chronic and 7 acute (a decent day with a serious injury)and neither one adds up to a 10 for me. My doctor finds this system useful to figure out what exactly is going on. Saying just the acute number doesn't tell him how bad the fibro is today, and saying just the chronic doesn't tell him how bad it hurts right now.

  5. A little late to the game, as I just came across this, but I *hate* the pain scale. It's so subjective, how can the doctor get anything from it? I love the way the writer points out that one person's experience of pain may be much wider than someone else's.

    I sprained an ankle five years ago and never knew it happened until the next day, when my ankle was swollen and my foot was purple. Not sure it ever healed correctly, and I'm having pain there now I never had to begin with. How do I factor that in?