Wednesday, March 19, 2008

Rate your pain on a scale of....

New-school doctors and nurses sometimes call pain "the fifth vital sign" but the only way to measure it is by asking. And the question they usually ask, at least around here, is something like, "Please rate your pain on a scale of 1 to 10, with one being no pain at all and 10 being the worst pain you can imagine."

L. finds the question ridiculous. It launches her on a series of digressions that, paradoxically, might serve to distract a little bit from the pain. You can see how it goes: Hmmmm…. The worst pain you can imagine, not the worst you've experienced… What is a drill slowly turning through the top of your foot? Having your fingernails pulled out one by one? Childbirth? A limb being hacked off with a dull spade?

Somehow that 10 end of the scale is an invitation to weird speculation, and the little faces that sometimes accompany the scale aren't much help for clarifying matters. The face is smiling at stage 1 — but also stage 2. If he's hurting, why is he smiling?

But the scale, even the little cartoons, has meaning – there are big norms around that little scale and, more relevant to the hospital patient, your self-rating plays a role whether you will get pain medicine and what kind you will get. (To some extent. A nurse isn't going to take a nine seriously if you're lolling back on your pillows riveted to Top Chef.) So it makes sense to try and understand the norms underlying the faces so that you can rate your pain in terms that don't over- or understate reality ("For me a 10 is being doused with gasoline and lit on fire, and I feel much better than that even though I can't move from the fetal position, so my pain is a 4." Nice logic, but for the less hardy souls the nurse sees every day, this is more like a 6 or 7, so you haven't helped yourself out.)

This mashed up, multilingual scale from UCLA can help calibrate your internal pain benchmarks, even as it robs one of the perverse sport of speculating on the worst pain you can imagine. In this scheme, pain of five or above is pain you can't get off your mind; the clinical goal would probably be to medicate it down to 3-4 territory, where the pain is annoying and might stop you from, say, getting up but isn't on your mind constantly. The scale also offers a less apocalyptic view of 10: there's crying or moaning, but no crackle of gasoline flames or thunk of a dull spade. This is preferable, I think

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