The Pain Scales We Need
The 10-point pain scale commonly used in medicine can be frustrating for those of us living with painful, chronic conditions. For starters, it is completely subjective. To a person who has never experienced a lot of pain, the descriptor for the scale’s maximum that says “worst pain possible” is going to mean something quite different than to the person who has endured excruciating pain.
Furthermore, studies have shown that some people are more sensitive to pain than others.1 For those of us who have some level of pain every minute of the day, we develop strategies to tune out mild pain in order to carry on. Lastly, for people with an unpredictable disease like rheumatoid arthritis/rheumatoid disease (RA/RD), which features symptoms that can fluctuate in severity from day to day, stating what level of pain we are experiencing at a given moment in time may give medical professionals a misleading picture.
A new pain scale for RA is needed
Therefore, rather than be asked to rate my level of pain on a scale of one to ten, I would prefer a rating system that better reflects my current experience of the disease I have. I propose a new pain scale, or rather a set of scales, for those of us with chronic conditions. Here are the questions I would like to see on a chronic pain questionnaire at each appointment:
What is your current level of pain? 1 – very little pain; 10 – worst pain I’ve ever experienced
- (Yes, this is a very similar question to the one I’ve just complained about. However, when it’s in the context of a series of questions about pain, rather than the sole query, I can see it having some value, especially if compared to a patient’s previous responses. Rather than the common “worst pain imaginable” it says “worst pain I’ve experienced.” When a doctor is assessing my subjective experience with RA/RD, it should be in comparison to what I’ve experienced before, not compared to hypothetical notions of a torture chamber or the like. Also, this scale starts at one, versus the standard zero for “no pain.” Rather than rub it in for people with chronically painful conditions that there’s a zero-pain reality some people are experiencing, let’s just start at “1”.)
How long has your pain been at the level it is today? _____ days/weeks/months (circle one)
What has been your average level of pain over the past week? (scale would range from 1: "very little pain" to 10: "worst pain I’ve ever experienced")
How does your pain level today compare with an average day for you over the past year? (scale would range from -5: "much worse" to 0: "same" to 5: "much better")
What percentage of your body is currently experiencing pain? (1-100%)
What was the highest level of pain you experienced over the past week? (scale would range from 1: "very little pain" to 10: "worst pain I’ve ever experienced")
What was the lowest level of pain you experienced over the past week? (scale would range from 1: "very little pain" to 10: "worst pain I’ve ever experienced")
A questionnaire such as this would provide doctors with a much more detailed and accurate picture of a patient’s current experience with their chronic condition. It would also provide patients with a sense that doctors have a clue of what it’s like to live with chronic pain.
When was your last flare?