Pain Scales
I was just reading a nursing thread discussing the shortcomings of pain scales. For those unfamiliar with them, pain scales are self-evaluations (on a 1-5 or 1-10 scale) of how much you hurt. Up to a point, they're useful clinical tool.
Trouble is, first, pain is subjective. The same person who will present at the ED with half their humerus hanging out, able to discuss what happened and why until they go under, may be reduced to uncontrollable tears and tremors by a root canal. Second, people are wimps. For example, on a ten point pain scale, 10 out of 10 is reserved for people who are unable to speak and possibly unconscious from excruciating pain. It is not for use for someone who presents with a twisted ankle, laughing and joking with friends, with a cell phone glued to their ear. Third (and someone in the thread brought this up) those of us who deal with chronic pain function on an entirely different scale of pain than those gigglers with the cell phones.
On one scale, I observed that the scale's designer equated two of the intermediate levels to "average" migraine, and the next to "severe" migraine. The little club of people with neurophysiological disorders, myself included, hit those levels regularly. It can be a relief when an episode tops off at, say, a level 6 (the average migraine level) because you have enough reason left to know that your heavy-duty painkillers are going to get a handle on it before it gets worse. On the other hand, you can become completely useless when trying to explain a lesser pain experience to a clinician, or when getting some procedure that is supposed to hurt. It doesn't: really. It doesn't because one casualty of one's condition is anything approaching a normal set of pain responses.
People who say their twisted ankle or whatever is a 9/10 or a 10/10 simply haven't been there. They don't want to. Even if they are wimps, I don't wish it on them.
For the scorekeepers, yesterday was about an 8.8. It makes me imagine a little row of neurological judges holding up their scorecards at the end of the performance.
Trouble is, first, pain is subjective. The same person who will present at the ED with half their humerus hanging out, able to discuss what happened and why until they go under, may be reduced to uncontrollable tears and tremors by a root canal. Second, people are wimps. For example, on a ten point pain scale, 10 out of 10 is reserved for people who are unable to speak and possibly unconscious from excruciating pain. It is not for use for someone who presents with a twisted ankle, laughing and joking with friends, with a cell phone glued to their ear. Third (and someone in the thread brought this up) those of us who deal with chronic pain function on an entirely different scale of pain than those gigglers with the cell phones.
On one scale, I observed that the scale's designer equated two of the intermediate levels to "average" migraine, and the next to "severe" migraine. The little club of people with neurophysiological disorders, myself included, hit those levels regularly. It can be a relief when an episode tops off at, say, a level 6 (the average migraine level) because you have enough reason left to know that your heavy-duty painkillers are going to get a handle on it before it gets worse. On the other hand, you can become completely useless when trying to explain a lesser pain experience to a clinician, or when getting some procedure that is supposed to hurt. It doesn't: really. It doesn't because one casualty of one's condition is anything approaching a normal set of pain responses.
People who say their twisted ankle or whatever is a 9/10 or a 10/10 simply haven't been there. They don't want to. Even if they are wimps, I don't wish it on them.
For the scorekeepers, yesterday was about an 8.8. It makes me imagine a little row of neurological judges holding up their scorecards at the end of the performance.
posted by Uncle | 17:48
2 Comments:
Well, I think you may still ahead with your head orc, but I have a bit of background like recurrent full dislocations of a shoulder, the tib/fib fracture and so forth. While I read books on pain from an adolescent fascination, it was sports and then a summer job that focused some lessons.
I'm convinced as you seem to be that it's the emotional involvement with particular pain that makes the difference, not as so many wimps and simps would have it, that the tough are "insensitive" to pain. In wrestling and swimming, intense pain was frequent, but we were on task. Likewise, my fingers, knees and hips could be pounding during and after 10 hours of hammering, climbing, lugging and such while building houses.
Wasn't that Gordon Liddy who allegedly popularized the notion about pain was that the trick is not to mind it?
The same thread talks about ways to make it clear that pain scales talk about pain, not inconvenience. One nurse told a cell phone wielder than 1/10 meant the pain didn't even break her concentration, whilst 10/10 meant both of her arms were ripped out. That made an impression...possibly because she wouldn't then be texting?
For the record, comminuted fractures usually rate in the upper triad of those scales...even without dork surgeons.
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