Pain Scales... Why We Love to Hate Them

I am honored, excited and humbled to announce that this post was included in the 5th blog carnival at rawarrior.com. Find Kelly Young's take on the "Pain Scale Language Barrier" and check out the 15 other amazing bloggers who were also included here Crossing the Language Barrier of Pain Scales: #Rheum Blog Carnival.

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       "How are you feeling?"  Wow, that's a loaded question.  It is most often asked by well-meaning co-workers and friends, the people who genuinely care but won't know what to do with the answer if it's honest.  I appreciate the concern for my health and well-being, but it's not often that I feel I can answer this question with complete honesty.  Do they truly want to know how my hips are aching, my fingers don't work and my brain is not computing simple things like it should?  Do they even need to know the details?  If I say I am "okay", "alright" or "hanging in there" that usually works to their satisfaction... they can give me a sympathetic look and be done.  If I were to give even one detail (especially lately, as I've been in a particularly angry flare) I fear they would think one of two things: 1) That I am complaining/whiny/wanting attention 2) They would feel so bad for bringing it up that they would never ask again, thereby making me feel rude and inconsiderate.

       This brings me to the subject of pain scales.  This method of patients physically showing care providers how their pain rates on a scale can be useful... though it usually seems futile and too relative to each individual to matter.  Why do doctors feel the need to see where our pain is at before treating us?  It could be because pain is the body's indicator that something is wrong, damage is happening or an injury has occurred.  The trouble with chronic pan is just that, it's chronic.  It doesn't just happen when we hurt a joint or cause damage... the disease itself is causing damage and wreaking havoc inside.

Sometimes it feels like doctors just don't get it.  They don't understand how any of this feels, physically or emotionally.  They need a visual indicator of the way our bodies are feeling in order to assess the progression of the disease.  Pain scales can be useful to show care providers how we are feeling.

Problems arise when the scales we use are expected to relate to each patient the same way.  Like in the above comic, what happens when my perception of 5 is another person's 8?  What if you have been in severe pain for so long that your body doesn't process it the same anymore... you may say you're only at a 2 when anyone else would say the same amount of pain is a 7!
I think the most effective scale of pain will be if we can keep our own scale, daily, weekly, and at each physician check-up.  If we are only rating the pain we experience in comparison to our own pain it should be more effective in helping to identify disease progression and treatment response.  So long as our physicians understand the differences in our individual cases, scales to rate the pain can be useful.

This could also help me at home.  Maybe I need to put a "pain scale" on the fridge and mark where I'm at each day.  Hmm... this could be the start of some better communication.