Thursday, January 5, 2012

The Medieval Pain Scales

The art of medicine has evolved immensely in the past few decades in general. We have new treatments that give people with a number of diseases, like cancer and HIV/AIDS a chance at a life longer than a few months.

And yet, there is so much still to be redone and changed for the better... like the pain scale. Or, more specifically, the pain scale for chronic pain patients.

You may be wondering to yourself why this even matters.



Because my pain doesn't always fall into this damn scale. My 'little bit' is considerably different than that of a 'normal' person. And my no hurt has visited me a total of maybe 5 times in my life when not getting jiggy with it (yep, too much information, but I don't care!).

Do you really know even know what the scale above means? I sure as hell don't.

Do doctors really even pay attention to this scale? And to our answers to it? What if I'm perpetually at a 3-4?

In doing some research, I found that those of us talking about pain scales right now are not alone in wanting this to be revamped. Back in 2002, a guy named Jack Harich with the International Pudendal Neuropathy Association developed his own pain chart. And I kind of like it. It seems to be more in tune with how I see my pain than any other I've found so far.

First, you try to determine if your pain is mild, moderate, or 'holy shit I am going to die'/severe. Thankfully, Jack included descriptions so you don't have to guess! I don't know that I exactly agree with all the descriptions. I think you can be 'disabled' in the moderate range, but you have to be constantly hitting those high numbers. And I think you can live independently while being disabled. I've seen it in my family, and in my RA family.

He included descriptions of each pain level, which I agree with for the most part. I don't know about the dental descriptions on some. But that's because I had horrible wisdom teeth coming in and going back up for years.

I generally sit at a 5-7, jumping up to 8-9 probably a few times a week. Fun tidbit: today, I actually left work early because I was at an 8. I was 7-8 pretty much all day yesterday and ended up staying in bed most of the day.

To be honest, I don't know that I've ever been at a 10. Maybe once or twice, but not that I can clearly remember.

Is this type of pain scale going to make it more difficult for patients to describe their pain with a number?

I don't think so. I think that, along with the paperwork you're sent for a first visit, you should be sent a copy of this pain chart. You should be keeping a general record of your pain for a month or longer before your appointment, according to the chart. Then, when you are asked what you current pain level is, you should be keeping this chart in mind.

Can you imagine how much easier it would be with a chart that is actually explained and uniform? And without those damn faces mocking your pain?

Even without this scale being implemented and explained to others, I'm going to use it to refer to in my own personal health. I may even print it out and bring it to my rheumatologist in order to better explain how I'm feeling. Because otherwise, you and I both know, those numbers don't really mean a damn thing.

2 comments:

  1. I think I am going to print it out too. Thank you so much for sharing this.

    Since my relapse, I stay at 4-5. Hopefully my biologic kicks in again and I can get back to 1. =)

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  2. I'm currently living with someone who is experiencing chronic pain as a result of two identical injuries (that happened several months apart). He has had surgery on one injury that has left him with more pain since the surgery than prior to it. He has a (presumed)surgery pending on the second injury which continues to impose unbelievable pain as well. He is & has been undergoing PT for the injury for more than 7 months, with another 6 to go, and a "reasonable expectation" of a successful (80%) outcome. The surgeon passes off his chronic pain, & the opiate Rx for PT doesn't doesn't even touch it. I found Hariach's pain scale several months ago as I was researching pain management & believe it is the best one out there in regard to accurately describe the intensity of each level. I am in complete agreement with you, that the happy face/sad face and similar types of pain scales are pathetically useless in the clinical field. Pain in subjective. Life determines the pain level: today is a "bad" day, thus pain is felt/experienced at a lower level than on a "good" day. Both days are accompanied by underlying 24/7 pain that is at yet another level. I have witnessed, on a weekly basis, pain at Harich's 10. All in the same patient; several times a session: 3 sessions a week. Pain that brings the patient to the edge of loss of consciousness, where he begs for them to stop...his voice already weak, and "the black spots (in his vision) are getting bigger". He too, lives at a Harich level 6-7 on a daily basis, increasing to 8-9 intermittently throughout the week. There is no reprieve from the pain for sleep. None of the "allowed" medications provide relieve on any level. Cryotherapy provides comfort immediately following therapy, but is only temporary. Heat treatments also provide temporary comfort. It's the opinion of his surgical team that he should not be needing pain management. They don't live with him to experience life in his shoes. They don't really care, either.

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