“How would you rank your pain on a scale from 1 to 10?”
“Ummm…. It definitely hurts… But it has been worse, so not a 10. I feel better than I have lately, so maybe a 4? Then again 4 sounds so unassuming and it REALLY does hurt….”
For the longest time I hated filling out the forms at my doctor’s office asking, on a scale from 1 to 10, just how bad my pain was. For starters, I did not want to be overdramatic, but I did not want to undersell my pain either. I could understand the basic principle of 0 being no pain and 10 being terrible pain, but I didn’t know how to differentiate between the middle numbers. I would base my score in reference to how I had been feeling in general, not on trackable symptoms. This means that if I was consistently at level 6-7 pain, over time I would start recording it as 3-4. As pain became more normal to me I had a harder time ‘rating’ it accurately.
I’ve seen other people post online about this problem. Basically they feel that pain has only two possible scores: Acceptable and unacceptable. Bearable or unbearable. Manageable or unmanageable.
That is a much simpler way to approaching pain documentation. Unfortunately, bearable vs unbearable do not provide us with many useful details for optimizing our care. At the same time, randomly marking numbers because they seem ‘right’ is not helpful either. It is best for you, and your healthcare provider, when you have a consistent system and reference point when filling out pain scale charts. Consistency with documentation is the only way that you and your doctor can accurately track your pain over the long term.
For this reason, I came up with a few simple points of reference. I no longer have an internal debate over which number is the most appropriate. If I want to look back at past entries I can easily interpret the numbers to see how I was feeling.
If you have already got a good system for filling out a pain scale and it is different than what I am about to share, that is not a problem. The key here is making sure that each individual person fills in the chart the same way every time. As long as you stick to one system, you should be fine!
The 0 to 10 Pain Scale Demystified:
0 PAIN FREE: This is what healthy feels like! If you have a 0 pain day, congratulations! We’re all cheering you on here in the ADL community!
1-3 MILD: In this range you are almost completely functional in your day to day routine. Lower numbers on the pain scale are more preliminary than painful. In terms of joint or muscular pain these numbers describe stiffness and any impairments to your range of motion. From a headache standpoint this range is the ‘calm before the storm.’ You know what I am talking about, the feeling of a headache that is coming but hasn’t taken hold yet. 1-3 pain is characterized by it’s ignobility. When your pain is at this level you can forget about it when you get busy.
4-6 MODERATE: You’ve reached a point where pain is undeniably present. You can still function with pain in this range, but it is no longer easy or ignorable. This pain may cause you to involuntarily flinch. You can still hide it, but hiding it takes some work. A 4 is not that bad, but by the time it gets to a 6 you’re probably using up your energy faster than is maintainable. You’re going to get pretty worn out by the end of a workday in the 4-6 range.
7-9 SEVERE: This is nearing unbearable pain. You may still be able to accomplish a few things, but it requires significantly more effort than is normal. This pain keeps you from being able to focus. If it is musculoskeletal you may not be able to get around on your own, and if it is manifesting in headaches you are definitely in the migraine zone. With an autoimmune disease you might find yourself in this range more often than you have sick days to cover, but if you can manage it you should really stay home and rest.
10 Worst Case: You cannot function at this level. It is no longer about pushing past the pain because YOU CAN’T. This does not usually spring up from 0, so do everything you can to avoid getting to this point when you are in the earlier stages of pain.
How do you approach a 0 to 10 pain scale? Have you ever struggled to define where your pain lands on that scale?