“On a scale of 0 to 10, what is your pain?”
For quite a long time, I would have answered the pain felt when asking that question was somewhere in the neighborhood of 8 or 9. More recently, I’ve challenged myself to take another look.
At the start, it needs to be acknowledged that there is nothing purely objective about the pain scale. The subject is asked the question and, as a subject does, subjectively replies. Is there any redeeming quality to the question? Is anything being accomplished besides checking off a box on the evaluation form? This question, even when the answer is “15,” gives us a peak behind the curtain.
Too often, the emotional component of pain is neglected in favor of the much cleaner tissue damage aspect. The pain experience, at least in the patient’s mind, is framed by the emotional circumstance of the episode. Sure, the sensation isn’t great, but it’s often the inability to do something important to that person’s life that serves as the driving force in seeking treatment and ultimately relief.
And so we’re back to our friend, the analog scale. Often, when we’re asking the question, we’re looking for an objective measure of the pain. However, if we’re listening to the patient’s voice, we’ll hear a measure of the impact the pain is having on their lives: 3-4 – “It’s pretty annoying, can you make it stop?” 9-12 – “This sucks! I can’t deal with it anymore.”
It may be a subtle difference but it’s an important one to make. It’s the difference between wasting some ink checking off another box on your form and hearing the voice of your patient.