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Pain Levels

dilaurodilauro ConnecticutPosts: 9,859
edited 06/11/2012 - 8:39 AM in Spine-Health Announcements
Many of us have been long time Spine-Health members and also have been long time chronic pain patients.
We have seen and dealt with just about almost any item you can think about.
One item that we all feel is very serious is Pain Levels.
There are a lot of arguments regarding the validity of the current pain scale, but for what its worth, its the only official scale in place today.
What has been good, is that the pain scale is always visible in doctors offices, hospitals, ERs, etc. It has been very important to post this scales so that the patient can identify their pain level.
One definite observation is that many people tend to over state their pain level. We never question that a person is in pain, but when you read about a person have a 9 out of 10, or a 15 out of 10 or 20 out of 10, you have to stop think what is being said.
In reality when a patient reaches the 8,9 pain levels they basically can not take care of themselves and need to be seen by a medical professional, and perhaps the ER.
I've talked with some ER personnel, and they have told me story after story about patients coming in stating their pain level is a constant 9. One of the major reaons for saying that is they believe they can get pain medication. If they said their pain level was a 4, then they would probably not get any medication.
The time period of having pain also makes a difference. Many times you will hear about a persons who just started having back problems and they already are a 9 out of 10.
Then you talk with many long time chronic pain sufferers and they will tell you about the pain levels of 4, 5 or 6
The purpose of this post is to just let everyone know how the medical field views patients description of their pain levels.
A patient with a constant 5 pain level is many times taken more serious than when a person comes in stating they are a 15 out of 10

Ron DiLauro Spine-Health System Administrator
I am not a medical professional. I comment on personal experiences
You can email me at: rdilauro@veritashealth.com


  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    Recently, I had a discogram. With inadequate conscious sedation. On a disk that was no longer there. So he could not get the needle in. And with me screaming, he tried 4 times. I thought that I had incurred the maximum pain level a human could endure during the course of my years of pain and procedures. But I found out that there was a pain during this procedure that I had not ever experienced before. So for that one and only that one. I experienced a pain that was truly off the charts.
    But that is not what this thread is about. When I was in recovery the nurse asked 2 of us what our pain levels were. I said a 9 which was accurate. The lady next to me said a 25. And as bad as I hurt we all had a laugh. Because she slurred the words with her eyes crossed. So forget the first part. I get your drift.
    Good luck, Jim =))
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • dilaurodilauro ConnecticutPosts: 9,859
    There are situations, diagnostic tests, certain movements, etc that can generate a quick pain level that soars into the sky!
    I can think of several different tests or procedures that I have had over the years and boy if there was a 15 on the scale, for a couple of seconds, I was over that level.
    Good thing, is that those incidents are very short lived (we all hope)
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I remember when they started the pain scale. It was a tool to document that medical professionals were taking a patient's pain seriously, actually asking a patient about their pain. Hospitals for accreditation and reimbursement purposes had to incorporate it on patient's charts. It was made simply to help patients communicate easily to staff the degree of their pain.

    Now as a chronic pain patient, I find it hard to rate my pain. I'm in constant pain and am growing accustomed to it. Those grimacing faces on the scale are unrealistic in my situation I feel. I'd be grimacing all day lol. There are flare ups of my pain and then I could rate it compared to my usual day-to-day pain.

    Best to all,

  • every time you go in for an appointment. There are 3 sheets they give you. One is your present list of problems and meds to verify. The other 2 are the pain scale thing that is listed as "for research only".

    I can just imagine if someone circles anything in the 8-10 range when they come in. Honestly, if you aren't a true chronic patient, you aren't walking into a doctors office with pain level at 9. I would consider that debilitating. I've had the 8-9 hits from the surgery. That must send up a a big bright red flag if your answer to pain is always 9...

    However, you shouldn't discount the opposite. It is not just people yelling a pain of 9 for drugs. When they took my wife in. She doesn't like to be a bother. So she under-rated things. My mom does the same thing. Except when she had a heart attack.
  • I wonder how they rate the pain of childbirth?

    Having had both, at least there's an end in sight to childbirth, whereas, although back pain may be at a lower level, there's never an end in sight.

    Actually, I think that's what you're saying. To wake up with it and go to sleep with it, is just soul-destroying.
  • Dilauro is correct in saying that our perception and rating of the pain we endure to ourselves may diminish over time, than those consistently higher numbers, that is not to say the pain itself is any less, just our coping mechanism to deal with it has improved. No pain clinics rate pain on this scale alone, it is an amalgam of assessment that gives a clearer and overall picture.

    Many arrive here with high rating of pain and we are all encouraged to support them, pain is very personal and perhaps relates to our ongoing well being, the sadder we are the numbers may be proportionately higher as you would expect. Our individual personality makes our chronic pain equally unique; we do have similarities in the condition that we share, although we are all individuals

    It is sometime the words people use and Val is correct in saying that continuance of pain even at a lower scale so difficult to cope with, we uniquely know our short term future is pain and we do well in enduring a condition that we at times have little control.

    The red flag thing is key and the Mc Gill pain scale looks at the words we use as an indicator of how we perceive the pain we endure, where that crossover is from the perception of the pain we have and the actual reality cannot be simply clarified, and one person’s high rating is another person’s lower number. We should be encouraged to express the pain in the terms that we feel comfortable and seek help and relevant support, keeping all that anguish inside is not good and we all need the opportunity to vent our frustrations.

    Experience and time helps us cope more effectively and those with considerable experience do try to enable everyone to get to that optimum strategy more quickly and efficiently, I have 20 years of skills and tools to deal with my pain and those future flare-ups, I know they will come again and am as ready as I can be to survive the storm once again.

    Knowing what our pain level is to us is one things, attempting to manage or even reduce it a completely alternative scenario, in surviving pain every day we already have that internal capacity to exceed what we need to improve and for the sake of some encouragement and tweaking we can learn to cope.

    We are mandated to jump through many hoops and should express the pain level we feel is relevant to us and then deal with it, whatever that number is, and we own it and it has some relevance and emotional development.

    Take care and work on those numbers.

  • Has recently posted the smiley/frowning face charts in all the rooms. Last time I was in the nurse asked me what my pain level was and I honestly said right now with the SCS on it is a 2-3. No big deal.
    After the nurse left I looked at that chart and realized I would have been more honest to say 4.

    Now, I have to wonder, 100 years from now, will it make any difference?

    I honestly think the S/F chart is about as close as you can get to a chart that everyone can somehow relate to. You have young, old, infirm, depressed, dementia, etc, etc; seeking help for thier pain. Some of these people are not going to be able to express their feelings much better than that chart can!

    There is also the fact that just as our sense of time changes as we age, so does our sense of pain. you think you can't stand this pain, until you have to. It gets worse and your old 6 is now a 4. I was as guilty as any other newbie to pain when I would say 9 or 10 or 14. Now, I just don't bother. There is a lot more to pain then a number.
  • Pain is clearly subjective. Hence the need for a pain scale to make it understandable to all those involved. While I was completing a test for work comp I was asked to read and sign the pain scale. It clearly said at a 9-10 you need urgent medical care. If I remember correctly even a 8 meant you were seeking medical advise for your pain. Little did I know when I rated that pain at a 6 when i left there with in a hour i was on the phone with my surgeon and pm doc looking for options to get it under control, with my meds not helping. So pain is clearly subjective.
  • The closest I have ever been to a 10 was when I woke up from surgery and truly thought I'd gone to hell. I wanted someone to put me out my misery. In retrospect child birth pain was no where near the post spine surgery pain (3 babies - no pain meds). I'm not one to admit how much pain I am in and for whatever reason abhor the idea that I might be perceived as being a weenie. For whatever reason, I have to be tough - ie. natural childbirth - which I think at times is detrimental to my physical and mental health and wonder if I have done a disservice to myself at times. I probably am guilty of under-rating my pain.

    I often hear other patients at PT tell the therapist that their pain level is 8-9. I think to myself that they couldn't possibly be there functioning, driving, doing the exercises if they were! Is it a lack of a reference point, the chronic issue, or justification? I've heard the PT say to these patients gently, "If you are at an 8-9, you really should go to the hospital." Those patients generally change their self-rating at that point. I know that sounds judgmental. I guess that goes back to the subjectivity of the scale.

    Should I even "complain" if I generally rate my pain at a 2-3? Ask myself that alot. Seems minimal compared to others. On the other hand, am I being honest about my pain levels to my medical team and myself especially on my bad days? Putting a number to it is difficult.

    BTW, those child birth (Lamaze?) breathing techniques have helped me get through toe stubs, cuts, broken bones, and even my fusion surgery.
  • My PM has recently tossed the smiley scale and switched over to using the Mankoski pain scale. At my appointment about 3 months ago, I had to sign off on the change as an addendum to my pain contract.

    This is a link to a printable version of that scale:

    0 Pain Free
    No medication needed.

    1 Very minor annoyance - occasional minor twinges.
    No medication needed.

    2 Minor annoyance - occasional strong twinges.
    No medication needed.

    3 Annoying enough to be distracting.
    Mild painkillers are effective. (Aspirin, Ibuprofen.)

    4 Can be ignored if you are really involved in your work, but still distracting.
    Mild painkillers relieve pain for 3-4 hours.

    5 Can't be ignored for more than 30 minutes.
    Mild painkillers reduce 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 (Codeine, Vicodin) reduce pain for 3-4 hours.

    7 Makes it difficult to concentrate, interferes with sleep You can still function with effort.
    Stronger painkillers are only partially effective.
    Strongest painkillers relieve pain (Oxycontin, Morphine)

    8 Physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain.
    Stronger painkillers are minimally effective.
    Strongest painkillers reduce pain for 3-4 hours.

    9 Unable to speak. Crying out or moaning uncontrollably - near delirium.
    Strongest painkillers are only partially effective.

    10 Unconscious. Pain makes you pass out.
    Strongest painkillers are only partially effective.
    When I asked what prompted the change, my PM said he was tired of people telling him their pain was a 10, when it was clear to him that it was not even close. He said the Mankoski scale defines pain in a more functional way and makes it clear to patients that if their pain levels really are 9/10, they wouldn't be able to walk into his office visit, sit down in a chair, and have a lucid conversation with him about it.

    Seemed pretty rational to me and as a patient, I think it's a better scale too.

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