The Pain Scale

Hi it's Kathy Turner and a little bit more about chronic pain and the pain scale. This is something that many find very very difficult and everybody labels their pain in a different way. If you've not ever had a lot of pain and you become a chronic pain patient, then you may tend to label your pain higher than someone who has been in pain for 20 years because they've gotten used to some of it. This does not discount your pain at all. So when you're filling out that sheet, 1 to 10, where are you on the pain scale? Most of us find that extremely frustrating, especially if that doctor hasn't given us what is one and what is ten. Your overall treatment is not based solely on your pain scale. It will be discussed with your doctor where you can talk more freely about your pain and you can tell them, you know, I don't know what to put on this pain scale. I put a three or I put a ten, but I really don't know. any doctor or medical professional tells you, because this was kind of common in the older days, a tin is like childbirth. Thankfully, that was rare. But if that ever comes up, there's two things. Number one, to my recollection, a man has never had a baby, and they may think that tin is so out of this world world that they could never put down a 10. On the other hand, some women would consider a lot of things a 10 because they didn't have an easy childbirth. If you tell me to use childbirth as 10, then I had it easy. So you see where you have to be really careful on what level of the scale you're using when you're describing your pain. It gets confusing. It may say like the worst pain ever. Well, maybe you have been fortunate to have not had a bad, bad pain incident and this is your first time. How do do you compare it? So there's so many factors that come into that. So I want to show you a couple of things that you could think about, but also remember you can put beside the sheet, may we discuss this. I find that many are intimidated when they go to the doctor's office and they feel they can't say anything or whatever, it's okay because if you don't understand something, your doctor wants to know. I sat by an older man and he was new, a new patient, into this pain specialty office and I kind of glanced over, you know, and what struck me was, glaringly, all ones on this pain scale. Now, if you come into a pain specialist office and you put all ones, do you belong in a pain specialist office? Possibly, but not probably. And how much is that pain specialist going to listen to you, believe you, whatever, if you have got a lot of ones? So I sat there thinking, oh, what am I going to do? I'm an advocate, but I'm butting in. And it was the precious, precious two old couple, just a couple, just darling. And finally, I thought, you know, so I don't know what I thought actually, but anyway, I kind of bent over and said, these forms are kind of hard to fill out, aren't they? And he said, yes, I'm having a lot of trouble. And thankfully, he said, would you help me? And I said, Oh, sure. What are you having trouble with? And so he said, well, from the, this part right here is this pain scale stuff I'm having trouble with. And I said, oh, that, that is hard. So we kind of went through a few things and I said, now this is just an average me, you know, giving you directions. You know, a one means you're, you're fine, basically you've got a life and you know, You don't need medicine and things are going along really well. Attend means you need a lot of medicine, you need a lot of help, you can't get out of bed, you don't have a life, and he goes, really? And I said, yes. So we have to be knowledgeable, but also on the other end, as a pain professional, be knowledgeable in knowing people really don't understand the pain skill. And I still struggle with it, 20 years, and I still struggle with the pain skill. But different pain is hard to rate, and so it's good if there is some direction. You can go on Google and find a million pain skills, but at least it helps you see how you can use the pain skill to your benefit. So let me show you a couple and maybe it will kind of clarify a little bit because it is important to a certain degree. Okay, so here we have one pain scale and it's not very, it doesn't tell the doctor much and it's very hard for you to fill out. got very mild pain, distressing and excruciating. Well, you have, if this is what is before you, you have to go on your feelings. I don't think you would be sitting in a pain specialist office if your pain was very mild, unless you were it for another reason. If it's tolerable, maybe. If it becomes distressing, that's when you belong, definitely, in a pain specialist office. And you can talk to some of the pain specialists here, you can ask them questions, and it may help us understand more of what they're looking for, but this is a common one. I find it difficult, but in a way I don't. I am looking at it through my eyes, and they know I'm looking at it through my eyes. If someone had my paint on, like a dress, then they may rate it at a different rate because they're feeling it differently. So that's why, one reason, I do not like comparing pain. And something that happens, and maybe it's happened to you, invariably, you talk about your pain because someone asked you, and they come back with, oh, I've had a headache before. And that has nothing to do with chronic pain. acute pain, hopefully the headache goes away. If it doesn't, then it does become chronic and they will see a pain specialist. But people tend sometimes to try to comfort and say the wrong things so we forgive them or they're just they're not well-versed. So don't let things like that upset you, okay? That's kind of a tip. Okay, if I'm distressed, I think I would know I was distressed. I'm upset. I might be crying. I might be grumpy. That's signs of distress. If you don't know, ask whoever lives with you the most. Am I grumpy? Am I distressed? And let them tell you. So this is going more off of almost an emotional part, which isn't bad, actually, because your emotions actually travel the same pathway as pain. So, and pain can be emotional. It's okay. You are not crazy. You're in pain. Pain is is what makes us crazy. So, you know, if it is excruciating, you need to say it's excruciating. In my view, this pain is excruciating. I have had pain and I have had a team for 16 to 18 years and that is the only way to go and another video we'll get into that. But when I walk in and I, say, I am not feeling well, they tell me they panic because they know that actually means real bad. So it's kind of, they get to know your personality and and they know when you're not telling the truth, which we really need doctors like that because I have a tendency to lie, but I have a tendency to lie on the mild side. And I think a lot of pain patients do that because they're afraid of unbelief. So when I say I'm uncomfortable, what I really mean is there's a a huge nail going in my chest and out the other end. So the pain scale can be very helpful. Use it correctly and to your knowledge, not to the you know you don't want someone sitting here even if it's your significant other saying you know what I don't think it's that bad they can be helpful but if you believe your pain is extremely bad you need to say it it needs to come from you now my part my husband has to remind me no your pain is not very distressing it It is excruciating. And then I have to, oh, I go back and go, oh yeah, you're right. You know, we forget because do you really wanna remember? That's what one of my doctors said. I said, I can't remember. He says, well, do you really want to? So, you know, just use your discretion on yourself, what others tell you, because it's really you that's in pain. Now let's look at another one. Actually, this is my favorite, and they took it away from me, because I have a lot of other issues, including brain injury. And I can tell you better if it's drawn than if I have to explain. But you look at these and you can see these are used for a lot of children or in other settings. But you see how easy this is? A zero you're happy, one to three you're happy, sort of. You start getting up there and your smile goes flat and then you start frowning and you're really frowning and then you're red. So this is another tool that you can use. Here is my suggestion. If you have trouble with the pain scale, print your own and bring it so that you can say, you know, I like this pain scale because I understand it better. Maybe you can help me kind of transfer it over to yours. It's okay because they'll help you. need to get that across to them is that you're you don't know or you don't understand the pain scale in front of you. Let's keep going. I will have to say that this is a lot of our favorites because it's a little humorous. I don't think doctors use these in their offices, but I like the wording at the bottom. There's no pain. It can be ignored. It interferes with task. It interferes with concentration. So that means it interferes with task and concentration and it interferes with basic needs. So you are having a hard time taking a shower. You're having a hard time getting dressed. You don't eat. You don't want to do nothing. You just don't want to do. And then bed rest required. That's a 10. I would possibly say that probably starts a lot earlier. But I like this because, besides the faces, it tells you what it interferes with. You can also write that down. I can't I can't go to the mailbox. I can't walk to the mailbox, which is you know, I Mean if it's a mile away, that's a different story, but I can't clean my house. I can't do the dishes I don't feel like eating I I Don't get out of bed Tell them what you can't do because that helps a lot. And if you don't know where you're at on the pain scale, if you've got another pain scale you're looking at, and you've put a six, but you're telling them, I can't concentrate, I cannot do one thing but lay in bed, and I don't want to eat, I can't do anything. So that tells them that it's really that six is really higher and they document that. So, you know, these are really, you know, if we could compile them all it would be perfect, but the pain scale is something I think that a lot of pain patients struggle with and I think a lot of these mixtures would be wonderful. I think it would help a lot. Now, let me just give you a couple of tips. One is you're not going to walk into the office and tell your doctor you are a 20. It's just stay within your realm. sound credible it's better. I will tell you that the last year I told my doctor I cannot rate my pain between 1 and 10 right now so I'm telling you that I am going to rate it between 1 and 20 because the pain is so awful that I need that extra 10 so that we see more progress and he understood because I wasn't walking and say I'm a 20 I'm a 20 I explained to him why we had to do 1 to 20. Do you know, not too long ago I told him, we're scrapping that one and we're going back to 1 to 10. I am an 8. Now that is pretty high, yes, but we're back in the realms of what he's used to and it's told him that there's been a a lot of improvement, but I am still bad. At this very moment, what is my pain skill? If you'd like to comment, I'd love for you to guess because we are the best actors and that's what gets people is you're telling them you're really in pain and then they come see you and you quickly try to wash your hair and do whatever and you're smiling so you're not in pain we have learned the art of being in pain and that fools people and there's another video on that and maybe it can be linked to this one so the pain scale may look difficult it may look frustrating but hopefully these little tips will help you and discuss with your doctor how he views the pain skill too. But I would keep in mind what activities you're not able to do along with the activities you are able to do and I think that will be helpful. Thank you for listening.