An alternative to pain scales
On a scale of 1 - 10 where would you say your pain is today?
Does anyone else hate this question? I’ve never found it particularly helpful in either assessing or describing chronic pain. Why? Because pain is still pain. Take for instance my poor confused person below, let’s pretend they’ve had back pain 10 years. Their back hurts every single day to varying degrees. How on earth are they going to know if the pain is a 10 vs an 8?
Even if they could determine exactly what constitutes a 10 vs an 8 (or even 6), that scale is a moving target. Because humans habituate to pain. This adaptive process makes functioning with pain possible. However, the flip side is it makes accurately describing the degree of pain very difficult.
Compounding this is a thing I’ve noticed where as people get better they associate their current pain as level 10 pain, when previously they would have rated it as a 6. I’ll explain this with a scenario that commonly happens in my clinic.
Let’s take the back pain person we talked about above. During their initial visit they tell me their pain is at a level 10 for most of the day. I notice that while we’re chatting they can’t seem to get comfortable in the chair, and they need assistance removing their shoes and socks. They’re concerned because they can no longer take their daily walks that they previously enjoyed.
After several acupuncture treatments they continue to rate their pain with the same levels. However they can sit comfortably during our session, they remove shoes & socks with ease and they report they’re able to walk farther.
This happens all the time at the clinic. As a person’s pain diminishes they now associate their current level of pain as the worst possible pain (i.e. level 10 on the pain scale). Because it is the worst possible pain for them, at that moment. The bar has now shifted. This is why I hate the pain scale. It rarely gives either of us any measure of progress to see if things are getting better.
Instead I encourage people to write down a list of things that currently relate to their pain. This includes things they can’t do, as well as the frequency (and intensity) of something. We then use this list to see if there is improvement over time. What people use depends on the location of the pain but some common ones most people use are:
How many aisles can they walk in the grocery store without needing to rest?
How long can they drive without getting uncomfortable? Do they need to pull over and stretch?
How far can they walk?
Can they walk up or down stairs without pain? If so, how many stairs?
Can they put on their coat or dry their hair (frozen shoulder benchmark)?
Did they have a headache that day? How long did it last? If so, did they need medication? How much? Did the medication help?
Keeping a list of these at the start of trying something new can enable you to determine if whatever you’re doing is helping. I encourage everyone to do this, even if the practitioner you’re seeing uses the pain scale.
It will help you figure out if what you’re doing is making an improvement to what matters, your ability to do the things you want to do in life.
Chronic pain is complicated. Figuring out if you’re getting better shouldn’t be.
One last thing, if you want relief from the pain come see me. I can help.