(We're a) pain (in the ass) scale

This is not medical advice.

Pain is a subjective matter. It’s hard to tell how much pain someone has. The pain scale helps us be a little more objective.

When I started in the 90’s, we weren’t using the pain scale. We just asked how much pain you were in.

Now it’s more likely required to be asked across the healthcare spectrum.

Photo by Raimond Klavins on Unsplash

The arguments

Presumably, the pain scale is here to help us be more objective, and measure how much we are helping people.

And there is some truth to that. How else will I know if what we are doing is working?

I think the more sinister reason is data collection. Medicare and the government have millions of people to “track.”

It’s funny how some people will ask me if Medicare will read my note and then know what to do. Uh, no. No notes are actually read unless there is an audit or a lawsuit. There are a billion claims and notes. No one at Medicare reads the notes and decides to help do something.

The one way you can track pain on a mass scale is to assign it a number. Now we can collect data.

Impersonal

It’s funny what we put up with when we don’t know any better, vs our reluctance to change. Because I started without the pain scale, I don’t always want to use it. I find it to be very impersonal and patronizing. “Oh we lowered you pain rating from an 8 to a 6.5…”

Wait, I have an idea! What if our goal was to have no pain! As in zero. There are many times where we all agree, doctors and patients, that that may not be possible. But shouldn’t we strive for that?

Let’s fix your pain. Let’s not nickel and dime your pain with some numbers.

Photo by julien Tromeur on Unsplash

“Pain management”

This has traditionally been my least favorite course of action for patients. It usually involved work comp, and the narrative is that the patient needs to learn to live with the pain forever.

Therapy people can also be very cavalier with other people’s pain. Sometimes we say we need to “desensitize” you from the pain. I can guarantee you that the people who say this are the least toughest people when it comes to their own pain. They are yuppies with no callouses on their hands, who drive Subarus.

Relative to generations

I’ve met 90 year old women with a fractured pelvis, who just brush it off, and want to walk. I’ve also met many people in the 20’s who are absolutely crippled with an unfound reason for pain.

10 means you’re dying, and there is no 11

If you are asked about your pain in numbers, keep in mind that “10” is reserved for arrows through the head. “8” should probably be a nail through your hand.

I worked with one PT years ago who would immediately stop treatment if you said 10, and send you to the ER.

I did work with one patient who refused to assign a number to their pain. It was mildly annoying, yet at the same time, I admired their response. But since I couldn’t determine pain progress, I decided that we were going to exercise extremely hard. Maybe that will elicit some feedback.

And then there are people who have no concept of pain.