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Almost the #1 Topic - Pain Levels and Medication Doses

dilaurodilauro ConnecticutPosts: 9,859
edited 06/11/2012 - 8:39 AM in Chronic Pain
There are a number of topics that get repeated many times here on Spine-Health. We try our best to answer all that come up. There are two topics that we see over and over and over again... My Pain Level and my Pain meds dont help me

Describing one's pain level is a very subjective thing. I believe I have enough experience with members here to make the following statements:

- If I tell a doctor or therapist that my pain level is high, they will be more likely to prescribe additional medications
- If I tell a person in the ER that my pain level is 9 they will see me right away False
- I have a pain level 8 or 9 and work 15 hours a day False
- If I had more pain medications I would have no pain False
- I can take my pain medications more often, no one would mind
- Why wont the drugist refill my pain medications? They are not due for 2 more weeks, but I am in a lot of pain ... They should fill my prescription False

The point that I am getting out is that so many people tend to use the pain scale as a means to make themselves seem in bad condition. In reality almost any good doctor can spot if a patient is in real pain or saying they are having high pain levels to get medications.

When ever a pain level goes over 8, you should be under a doctor's care and not by yourself. Yet, I read about members who have pain levels of 8 and 9 and are working 14 hours a day at hard work. It just doesnt work that way.

The more you have been around pain, the better you understand what its all about. Trained professionals can spot someone in pain and can see someone who just wants pain relief. I discuss this with some of the therapists I know and they tell me that they HAVE to ask the patient and that they do realize that manytimes what they hear is not valid. I dont think anything disturbs an educated medical professional more than when someone tells them that their pain level is 8.... They know that is not true. That is NOT to say that the person is not having a lot of pain.
Thats why I am not a big fan of pain scales. Pain Scales are nothing more than report cards. You want to look good.
On report cards you want the best grades on pain scales you want to see to have the worst pain.

Medications alone will NEVER eliminate pain. People think that if they take more and more pain medications that they will have no pain. That has never been the objective of pain medications. At best what they can do is try to manage and control your pain levels.

This entire subject can be very touchy and personal. Coming to understanding all of this is hard. There is no question, that no one wants to be in pain all the time and likewise, there are no medical professionals that want to see their patients in pain.

There has to be and there is a happy medium. Its working together with your doctor/medical professional and being upfront and honest with them. I believe only then can a patient receive what they really need to control their pain.
And many times it is NOT just pain medication.
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


  • Very well stated. My PM doc and NS both ask me "at what level can I manage". That is the level we strive for. If somehow we get below that, well that's a great benefit. If we don't quite make it, well we strive for getting as close as possible.

    Management is the key word in my world.

    Pain free is a pipe dream.

    Manageable is the prize.

  • Everything you said is very true.Recently I posted that my pain level is a 8 or 9,which I know isn't true,but sometimes it seems that I really couldn't hurt much more,but I'm sure it could really be much worse.I guess sometimes we make statements before we really realize what we are saying.My PM doc really does a good job of helping me control my pain.It really is a pipedream to think I will ever be painfree.I want to apologize if it looked as though I was trying to overstate my pain.I really enjoy reading everyones posts here,you all have helped me deal with everything a lot better and given great advice.Thank you all and I look forward to understanding this struggle we all go through a little better and I'm sure I will as time goes by.Best wishes to you all and be nice to yourselves!!Peace and Love. Mark
  • dilaurodilauro ConnecticutPosts: 9,859
    the more and more we deal with chronic pain and the longer we have to deal with it, the more we can understand the different pain levels.
    I know my brother-in-law. He had some muscle spasms in his back.. He went running to the ER with what he said was pain level 15 or more!
    We know that aint so, but at the time the person experienceing it feels that way.
    So perhaps at times I come across at being cold.. Only because I have been there so many times, have seen so many patients there and understand where things are.
    Bottom line, if you hurt you hurt, no need to even mention a pain level.
    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
  • Thanks Paparon,I never even considered you coming across as being cold,just truthful and knowledgable.Thanks for all the good info and help you provide here. Mark
  • with everything you gentleman have said. Attitude is everything!!!!!
  • A friend of mine who has Cancer was explaining the art of prescribing pain medication. Take what I say with a grain of salt cause the information is second hand from his Doctor. Basically, if you double the amount of pain medication you are taking, you will not receive double the pain relief. The relief is closer to 10-20% more relief.

    You should strive to manage your pain rather than hoping you can eliminate it.

  • Today, Thursday December 17, 2009, I am so sick and tired of hurting. I want it to stop. Now. Today.


    Ok, I'm done - said my piece and am moving on to the next topic/post....

    Have a great day everyone!
  • ron
    as usual, you da man
    you hit the nail on the head
    being a special ed teacher i test kids all of the time. parents freak out because a score has gone down instead of up. tests or scales or whatever are a momentary judgement. one day you feel better because you got a good night's sleep or you ate a big meal. next day you do worse because you argued with your parents. scales or tests are just a way to see where you are at a moment in time. doctors realize this and i believe they take patients numbers with a grain of salt. they realize that inflated numbers may mean a way to get attention or more meds or what patient feels is reality. patients should also take pain scales with a grain of salt. what is a 10 to you might be a 7 to me or a 1 to someone else
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • To Jeaux I say ditto! I am tired of hearing myself say how bad the day is. Move on, go outside for a walk, call a friend or chase the dog. Whatever it takes to get me outside of myself and this stinkin' pain.

    Good day to all,

  • If my pain level got up to a seven, I could not get out of bed. Putting in a full day's work on an 8 or 9 is impossible to me. It's all about common sense. Right now we're stuck using this pain scale so I think it's best to be as accurate and honest when reporting our pain levels.

    Many of us have suffered chronic pain for a long time and we know that no amount of medication will bring the pain level down to 0. It simply does not happen because our pain persists despite whatever treatment method is used. However, "new" chronic pain sufferers don't understand this and they have that misconception that they will need the strongest meds and the highest dose.

    I had a lot to learn when I started my back pain journey a few years ago and this is why I think it's so awesome why we have this site where you can find out how things really are. I remember how frightened, overwhelmed, and devastated I felt when I first experienced this type of pain. You don't know what to do, what's going to happen to you, and you hope that your doctor takes care of your pain adequetly.

    BTW, we've come a long way baby and we gotta keep going :)

  • I tell my doctor that I have dilated from 2 cm to 10 cm in 20 minutes without pain meds, and spent 2 hours on a backboard with 6 broken bones without pain meds (by the way, I reported that as a 9, because it wasn't quite as bad as labor, but close!). There is no way she is going to get more than a 6 from me unless I'm writhing on the floor.

    I don't think it's true, though, that the squeaky wheel won't get the grease. If you are stoic and try not to complain or show your pain, your doctor won't necessarily be able to see through that. I am the type to laugh at everything, how is she to know that? If I look truly unhappy, or don't smile, it usually means I'm in pretty bad shape.

    I agree, pain levels are so subjective. I am betting that ratings change as pain becomes chronic as well.
  • Ok this thread has been bothering me all day. Pain is subjective and for some reason the conclusions above bother me. I worked and rated pain 6-8 most days. I didn't rate childbirth that bad or gallstones (by the way I worked during gallbladder attacks too). I think if anything I was more stoic than I should have been.

    0-1 No pain
    2-3 Mild pain
    4-5 Discomforting - moderate pain
    6-7 Distressing - severe pain
    8-9 Intense - very severe pain
    10 Unbearable pain

    Is the scale my doctor uses. I think every doctor uses a different scale. Not trying to argue just sayin we are all very different and the type of pain is all different.

  • I have wondered more than a few times how some spineys can be in unbearable pain and still posting here on the board. When my cervical disc herniated I was never free from pain, the meds just helped to make it tolerable. I couldn't take anything for pain the morning of my surgery and I would rate the pain then at an 8. I was pacing the floor, holding my arm. There's no way I could have been sitting at a computer, posting a note to say how much I hurt, lol.

    Not belittling anybody or saying anyone is being untruthful, just saying that what Papa Ron has stated really rang a bell with me. I think the subjective nature of the pain scale is at work here. We all look at the scale with individual eyes. I've had my share of severe pain in my lifetime and believe me, when I hurt that bad, I'm doing anything I can to just tolerate it. Typing on the computer is NOT one of those things and going to work is not even an option! ;)

    2009 Foraminotomy C6-72010 PLIF L4-S1Multi RFA's, cervical inj, lumbar injLaminectomy L3-4 and fusion w/internal fixation T10-L4 July 17Fusion C2-C5 yet to be scheduled
  • dilaurodilauro ConnecticutPosts: 9,859
    You covered so much in your post.
    I think everyone can understand or argue or agree with pain levels and the scales.
    But what you said is so true.
    We do need a support system. That is so very valuable. Without that, the chronic pain can start to really take over our lives.
    Spine-Health provides a good support system because people listen. We all share a common bond and understand what goes on with pain.
    The other piece you mentioned that is so true is how stress plays a part with our pain. Its almost like a catch-22 situation. We are in pain, then we get stressed, we get stressed and the pain increases.
    How do we stop that???

    Tammy, thanks again for your post. I hope that your son is doing better. And I am hoping that you and Mike can have as much as a pain free and happy holiday season
    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 agree with the subjectivity of pain scales, but the doctor uses them so I am forced to as well. I use the Mankowski pain scale and it defines pain in terms of how you are affected by the pain. See below.

    I typically have to normalize my pain marks and subtract 1 just to keep myself honest to the chart. When you are in pain things always seem worse than they are. Depending upon the individual, sometimes it is even appropriate to take 2 off.

    I have found that my day starts with a 5 normalized (-1) and ends in a 7. I read alot so the 8 throws me off as frequently my pain get to a point where I can't read.

    Hope this pain scale helps.

    Mankoski Pain Scale
    Copyright © 1995, 1996, 1997 Andrea Mankoski. All rights reserved.
    Right to copy with attribution freely granted.

    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.
  • This is the best scale I've ever seen. Based by this one I ranged 6-7 most of the time, 8 sometimes and 9 only once. It is much more descriptive than any other I've ever seen. Something like that one is what doctors should use.
  • Sorry if anyone has said this, I haven't read them all. I have always thought the idea of pain scales is very unreliable.

    People in pain aren't going to read up on what the proper definition of a 1-2-3-4-5-6-7-8-9-10 is.

    Pain is relative, I had :''( pancreatitis, therefore that is my 10.

    If the worst pain someone has ever had is a sprained ankle then that's their 10.

    :? A thought occurred to me - it is not possible to imagine what pain is like or how bad it can get, you can fear that it will get to more than you can bear but you can't imagine what that would feel like. You can't even remember what pain felt like, you can remember where it was and the nature of the pain and that it hurt like .... but not how it felt.

    The mercy of God, I believe. :)

  • Ron,
    In acknowledgement of describing pain in unrealistic terms, perhaps it is intended to express the norms and expectations here; we are all working diligently in assessing and communicating the pain levels that we have, in term that will help us progress. Once any scale is used, it is only natural that those with the perception of being more visible will be in the higher numbers.

    Where that transition for how we all describe our pain level and the reality is, will always be difficult to evaluate, we are understanding ourselves more, that some pain description and physical reality are not reflective of each other, so something is going on. In expressing an opinion to what the pain level is for any individual, is an insight in how they themselves perceive the pain, which may or may not be reflective of the actual pain, it is very subjective. Managing it more effectively takes time and appropriate support and for us to see that things could be better for the sake of managed tweaking and change of attitude that impacts on our behaviour.

    For me, the more an individual expresses pain in the higher order scale I understand that they have need of additional support, until the pain reduces or the mood lifts, I have with help from the pain clinic developed an improved strategy for coping and have been fortunate to have that half full persona from the start.

    Left in isolation and without adequate encouragement many can develop a negative outlook, early intervention is one key to improvement, many here understand why individuals express the pain they have in emotive terms and a loudness of the message; we are all in pain across the spectrum of duration and severity. The 15 element is more about what is not being said and that internal thought process that brought any individual to the perception that this expression of pain level, even in this SH arena might proved beneficial in the long term.

    It is reasonable that the concept of our pain can be illuminated in ourselves, I have some constraint of how I wish to describe the pain to myself and try not to let my own thought process overtake reality, we are devising best practice and looking to those with experience to glean some shortcuts to managing it more effectively, once all previous intervention has been fully utilised.

    We reduce stress, by seeing where that initial change takes place and initiate what has been well described as an “alternative flight plan ” change the previous strategy, that for many may have been a recipe for continual failure. For me my 20 years pain is no more needy than any newbie pain, the movement from no pain to newbie pain is dramatic and something we never forget. I have two decades of experience, tools and flight plans to help me cope.

    Pain is what it means to us as individuals, continual high numbers are a vocal measure of internal illumination, my objective to make that light dimmer if possible, with support encouragement and the hope of managing it more effectively.

    We are helping and best practice is continuing to develop here.

  • every day i tell people i am at a 7. every time i see my pain dr, i am at a 7. everytime is see my ortho dr i am at a 7. it is easier this way. it seems like a good number, not too high and not too low. just a good old 7. this way the dr has a number and i have one. also not to be too flippant but 7 was mickey mantle's number and has always been my favorite number. i don't know why pain scales are used. i guess doctors need some sort of evaluation to use in their diagnosis. pain scales are so subjective that imho they are useless. what is weird is that there are different kinds of pain scales with different numbers.
    well good luck my fellow pain patients. have a great christmas and don't let the pain get you down or spoil your vacation. i refuse to let pain control my life. i won't let it
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Dear Ron,

    Thanks so much for starting this thread!

    It's interesting to read how others interpret their pain levels, according to the number charts. I really don't care to use numbers to evaluate my pain, as there are so many variables to take into consideration. Because the medical field uses these charts, I've adapted to using these numbers to monitor my monthly pain cycles and will share this information with my doctors.

    Whenever I reach a pain level of "8", I am nearing the point of heading to the ER and calling my doctor. My pain levels of "9" or "10", mean I am at the ER or have been admitted into the hospital. Everything below an "8", is rather easy to determine and make comments on. I can honestly say, there were times I went to work when I was feeling like an "8". I never lasted more than an hour at work and my supervisor had to drive me back home.

    Keeping a pain log has been useful, as it helps the doctor make proper adjustments to my medication and it also shows me... the best schedule to keep, time wise. It took me a while to find the best "cocktail" for sleep, particularly when a new medication was introduced. When I was experiencing a lot of stabbing pains... the very sharp and jolting kind of pain... my doctor prescribed a nerve medication for me to take. I was absolutely amazed at how well the nerve medication worked. I have a lot of short term memory loss from taking Oxycontin and Percocet, so whenever I experience something out of the norm... I log it.

    Over the past year, I have found that there are two other components which play a big part in controlling our pain.

    The first one is having emotional support. We need to vent and Spine-Health is THE best place for us to do this. We are among fellow sufferers who understand our feelings and these members want to help us through any of our turmoils. If we don't vent (or at least write down our inner feelings which need to be expressed), we won't be able to move forward. Each of us will be faced with some sort of emotional pain... it's a given. If you are uncomfortable voicing your troubles in public, please read through the posts on Spine-Health. Use the "search forum" and type in whatever emotional term or physical term that is troubling you. You will find posts from others to read and it always helps to know that you aren't alone. Stress can cause additional physical pain. When the tension grows, we need to bring it down a few notches. Sometimes we can do this on our own, but there are times we need help from others... Spine-Health and a professional counselor are ready to help us get back on track.

    The second part is monitoring our diet according to our activity levels. Those of us who take high doses of narcotics, generally have the lousy side effect of constipation. With decreased activity levels, constipation can also occur. If I am having a bad weather day, I know I will not be doing much walking and my activity level will be very low. On these days, I will drink extra water... will need an extra stool softener... and will keep my caloric intake low. It's easy to dive into the comfort foods (sweets) on days like these, but when we can't work-off the comfort food calories by walking or exercise... we need to grab the grapes, celery sticks, salad and soups. We can have a "bite" of this or that (ice cream, chocolate, pastries, etc.)... but keeping it to a spoonful or two, will help keep the extra pounds from piling up. When I was confined to the hardshell turtle brace for 3 1/2 months, I didn't gain any weight. Over time, with the brace being off, my abdominal muscles formed their own protective brace surrounding my ribs and spine. When this happened, I needed to evaluate my activity level and daily calories... as I started gaining weight rather quickly and I looked like I was 6 months pregnant. At least I was carrying the fictional character high, so it wasn't pressing on my bladder. Ha, ha, ha. Oh! I also found out that I lost 1/2 an inch of my height from my surgery! Is that not wild? Sorry... I digressed a bit there, but that blew me away. I am now an even 5' 7".

    Before I digress even more.... I shall stop for now.

    Excellent thread, Ron. Hope you are having a nice December.

    Happy Holidays to all...

    Tammy :)
  • Pain scales mean nothing if you're trying to compare yourself to another person. It's an important tool for your Doctor if they are tracking your responses over multiple visits. Based on your response they can determine if your treatment is working or not. Of course that last statement is totally dependent on whether your Doctor is tracking your pain.

  • Yep, it's hard to compare when we're not all working with the same definitions! I like the scales that relate the pain to physical results- having experienced the 9 and 9+ I have a lot of difficulty putting an 8 to anything that doesn't have me crying.

    But I have a high pain tolerance. Does that mean my pain isn't as high or that I just tolerate more before I complain? I push myself through a lot of pain because things need to get done.

    My scale basically goes
    4- the pain is there but isn't really making things too hard.
    5- I can manage and smile but the pain is definitely there.
    6- The pain is making it hard to manage. I'm probably laying down and resting a lot.
    7- my heating pad is my best friend.
    8- I'm crying.
    9- I'm delirious
    10- I'm yelling and asking people to kill me (that was labor).

    But my pain is episodic. I am not sure how you rate that differently from constant pain? I mean, I was just very uncomfortable while wrapping presents, but when I sat down it went away. Or I might be very uncomfortable sitting in a certain chair, but when I can lay down for a while it's better.
  • I have my infrared platinum heating pad on and I need a break through percocet which I can't stand taking those as they seem to make me irritable but it seems just the day. I think it's the windchill making the pain worse for me. I had to cancel 2 Doctor appointments when it was so cold. Anyway I wish everyone less pain days ahead. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • It's interesting how we approach pain, especially when people start inventing their own pain scales. It would be impossible for me to be a 6 on HappyHBMom's scale, because the bulk of my personal pain scale falls between the 2 statements she uses to define that single level.
    "6- The pain is making it hard to manage. I'm probably laying down and resting a lot"
  • I like some in here don't use the 1-10 scale (10 sure in the ER and I am a gnats butt from passing out - sure! ) with my doctors. My last visit, when he heard I had issues with getting a good nights sleep, and some of the strong pain I had during the day... He got the true read when I told him that a "good night's sleep" was 5 1 hour naps, and when the pain really gets going, I "york" my din-din. He decided from there aside from some of my reactions to his exam in his office. He is not a "meds" type doctor, but right out of the box, high starting level of Lyrica, and Lyrica has become my god send!!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • can't really recall the specifics of the pain scale when we're at the doctor's office and they ask us what our pain level is. I generally tell the doc my level is two - three, when it is terribly annoying but manageable with an oxycodone. I also have been guilty, pre-surgery, of telling my physical therapist that my pain levels were about a 6-7, with jolts of 15 thrown in. I would have those horrible electrifying jolts that would make me freeze in place, tears run down my face, and I'd lose my breath. Fortunately, they wouldn't last for more than a minute or so. Also fortunately, I haven't had one of those since surgery. My pain is, these days, mostly manageable with with very little medication. For that, I am very grateful.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • I like the pain scale you've presented. according to this, at work before I hit the couch, I reach 8. if i ignore this then the spasm from my thoracic area kicks in and partys over. the "growling" you know the uuuhhhnnnngghh, type noise, and stuff, doesnt scare the co-workers too much and the boss doesnt ask as often if Im ok. thanks for the info!
    William Garza
    Spine-Health Mod

    Welcome to Spine-Health

  • Had my check out appointment with the Doctor who did my SCS implant. Got a smile when the nurse asked me about my pain.

    On a scale of 1 to 10, 1 being no pain and 10 having surgery without anesthesia, what is your current pain level. Surgery without anesthesia made me smile.

  • I am like Jeaux. Today, right now i am in savage pain and i want it to go away, to STOP right now!!
    I can't think streight and can't say anything that would even make sence!!
    Patsy W
  • Aaaah, the curse of opiates. They can work great for pain but then if you need to take them on a regular basis you need more to get the same pain relief. Then the doctor thinks you are a druggie or he's scared of the DEA so no more for you.

    My problem is that nothing else has ever worked to relieve the pain. I have tried dozens of prescriptions, over the counter meds, exercises, devices, herbs, creams, patches, blah blah blah and no help.

    Last month I reminded my doctor that I had not had an increase in my hydrocodone scrip in over a year. I get it compounded so there is no tylenol (that stuff will kill you) He decided instead of increasing the hydro he would add dextromethorpan (cough medicine) to the capsules and try that. Got higher than I ever did on opiates, dizzy, groggy, cornfused, bad stomach, diarhea and couldn't sleep. Yeehaw. $200 down the drain. My rant for the day, sorry.
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