Wednesday, May 27, 2009

A Note About Pain Scales

Here's a little education, free of charge.  You're welcome. If a healthcare provider asks you to rate your pain on a 0-10 scale DO NOT say "12".  I used to tell people to rate their pain 0-10, if zero means no pain at all, and 10 is the "worst pain you can imagine."  Turns out that people have no imagination whatsoever.  I got lots of 10's, and more 12's and 15's than you could shake a stick at.

Given that they can't imagine even the pain that they have, I have started asking it differently.  I now tell them that 10 means "you need to go to the emergency room right now."  Since most people are nowhere near needing the emergency room, this slows them down and I get more realistic answers most of the time.  Yet, some people insist on telling me that their current pain is 10.  I have a very hard time believing them when they are sitting fairly comfortably in the chair in front of me.

And there are some people that still think that they need to impress on me the immediacy and magnitude of their pain, and they insist on telling me that their pain is "12/10".  So far, I have managed to resist the urge to slam down my chart, roll my eyes, and sarcastically excuse myself to go call the ambulance for them.  All they end up impressing on me is their fantastically low pain tolerance. 

 If you want me to take you seriously, give me a 6-7/10 and I might believe you.  Especially if I can start to see it in your eyes.  That's a lot of pain.  In order to be a credible 8-9/10, you probably are not able to sit comfortably in your chair or walk in normally.  And some people legitimately are a 10/10, and I have sent a person or two from my clinic to the hospital, though we don't typically have to call the ambulance.  So if you really need to go to the hospital I want to hear it.

By the way, I hope you never have to see the inside of an ambulance.  But if you do, you need to remember the pain scale changes.  Then 10 is the worst pain that you can imagine, and you better kick the imagination into gear.  If you complain of 7/10 pain and you are not writhing and pale, they will roll their eyes while they strap you down and take you in.  Luckily, I don't have first hand experience of this. But an EMT and I did get into a discussion on this once, and he didn't have any more tolerance for it than I do.


  1. HA HA! I love it. I'm sure I would be really annoyed by that too. Best of luck with those low pain tolerance people. :)

  2. guilty. oh well. I read on someone elses blog somewhere that you should say 10 no matter what. :-) *shrug*
    I like your thinking better. It is hard to use the imagination. I think your phrasing of "go to the ER" is much easier to understand. :-)

  3. Not that i haven't already read this (and already commented), but I miss you and I like to avoid all of my other life obligations at all costs. Because I'm good like that.

    Anyway, I wanted to tell you this story before I forget:

    I went to my 2 week postpartum appointment today (even though it's been 3 weeks. Again, I'm really on top of those life obligations.) and my midwife told me that she is always amazed at the vast difference between each woman and their birth experience. She said it's so crazy to see some women at 10 cm that are so in control and don't say more than "ow" and some women who get off the elevator screaming bloody 2 cm. I asked her if she gets frustrated. She said no because the pain really isn't that different but everyone's pain tolerance is. But she said "When I see those women come off the elevator screaming, I just say 'You're really going to need that epidural'". :)

    Love you.