The Painful Truth

Having rheumatoid arthritis for going on 20 years something I have discovered and am fascinated with is the way we are asked to define or quantify our pain.  I am sure you have been asked at some point to "grade" or "scale" your pain in some fashion.  I always find this challenging.  First of all, on any given day the same pain may well be scaled differently depending on a number of factors beyond the actual perception of pain.  If I am feeling especially fatigued or stressed the perception of pain may be higher than if I have gotten some rest and been able to relax or de-stress in some way.  Which begs the question, why even ask this question?  What exactly is the goal of the physician asking this? Why not ask us to give a more body wide accounting of the pain that takes into consideration those outside factors?

If the goal is to come up with a treatment, than getting a bigger picture would certainly inform that decision a great deal more if one got a more complete picture of the pain.  Even if the goal is to compare it to previous inquiries to assess the success of treatments prescribed doesn't it make more sense to get at least some anecdotal information?  I would suggest that over the years my pain ratings have been all over the map and very likely not consistent. Beyond that I would further claim that giving some random pain rating may in fact be a misinterpretation of what is really going on and not at all indicative of my actual pain level.

Pain is such a subjective sensation.  How often have you heard someone talk about their own "threshold of pain"?  If that is related in any way to the regularity of pain one experiences than those of us with RA have VERY HIGH thresholds of pain!  That said, does that mean when I give my pain rating as a 6 how exactly does that compare to anyone else?  I would argue that RA patients likely underestimate their pain based on the fact that a 3 or 4 for us would mean that we could function with our pain but it surely is still present.   On the other hand that same rating for the "average person" not used to chronic pain would mean they are pretty uncomfortable.

For me to give a rating of 8 or 9 to my Rheumatologist means I am flaring pretty badly, have several swollen joints and am struggling.  Yet someone else may think that an 8 or 9 means you are incapacitated and unable to even function.  It really is all relative.  I would prefer if pain management practices relied more on the whole picture of pain.  Include the factors surrounding our perception, including any pain medications or other treatments that are part of the profile.  Clearly if I am still rating my pain at an 8 or 9 and I am also on medication, using braces, ointments, etc. versus if I rate it 8 or 9 with no treatment the strategy for dealing with it should be different.  Yet often in the interest of expediency those pain scales are relied on quite heavily.  In my opinion this is a practice that should be used with caution and only as one measure of the pain that we endure.  The painful truth is discomfort is a challenge to gauge when it comes to chronic diseases like RA and treating the whole body is the sensible and most appropriate approach.

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