On a Scale of 1 to 10
Is there anything more subjective than pain? Obviously, we know whether we are in pain, but when it comes to how much pain we are in, quantifiable measures are wanting. When a doctor needs to know our height, weight, blood pressure, pulse rate, blood sugar, etc., there are measures that give her an exact number. However, measuring pain levels is anything but absolute. In fact, for those of us who experience chronic pain, it can even be difficult to determine our own pain levels. When I am in mild to moderate pain, I routinely question it, asking myself, “Is it really that bad, or am I just making too much of it?” If I can’t always get a firm grasp on my own pain level, obviously it’s a tricky matter for a physician to assess.
Therefore, in the absence of a concrete measure of pain, the medical community has come up with that pain scale we have all become so familiar with, where patients are asked to rate their pain on a scale of one to ten. I do not fault doctors for using this scale, as I can’t come up with a better system. However, I think the pain scale can only measure a patient’s perception of his/her pain, and not the pain itself.
For example, during my second pregnancy my health providers were concerned about the large size of my baby once I was past my due date, and we decided to induce labor with Pitocin rather than allowing my baby to continue to grow. Pitocin is a synthetic hormone that causes uterine contractions. After my nurse started my IV, each time she came into my room to increase the units of Pitocin flowing through the tube she would ask me to rate my pain on a scale of one to ten. Early in the process, I gave the question the solemn thought that I always give when gauging my pain level, and I told her I was at a “2.” She responded, “Oh, you’re strong and honest. I have some women in here who say they are at a 10 but they’re still smiling.”
Her statement has stayed with me, as it highlights the arbitrary nature of the pain scale. Even deeper than that, it speaks to the different relationship people have with pain. I spend most of my days in the “2-4” range of the pain scale. It’s an exceptionally good day if I can say I’m at a one. Yet, I’ve also experienced the sevens, eights, and even on occasion the nines and tens. I know how awful pain of that magnitude can be, so if I’m having pain that is mild to moderate, I am not going to rate it above a seven. When I’m at a nine or a ten, it’s hard to breathe evenly, I can barely talk, and I can’t conceive of smiling. Yet, from the nurse’s statement there are obviously people who have a very different experience when it comes to pain and the pain scale. For someone who rarely feels pain and spends the majority of their days feeling at what I would rate a “1,” the pain of early labor contractions may seem such a surprise that they rate it at a 10 because they are strangers with the seriously intense pain that I would rate a 10. I, on the other hand, experience pain so regularly that when I am asked to rate my pain, I think, “Now am I really at a five, or am I making too much of it and I’m actually more of a four?” My former rheumatologist used 20-point scales that allowed half-points, and even then I would pause and reflect, “Now is this really a four? Maybe I’m actually at a 3.5.”
The fact that one person can be smiling and rate their pain at a “10,” while another person can be gasping and grimacing and rate their pain at an “8” speaks not only to the arbitrary nature of the pain scale, but also to how differently people experience pain. Unfortunately, for those of us with chronic, painful conditions, we spend far more time experiencing and reflecting on pain than others do. In doing so, I know that I often veer from self-assessment to berating myself for making too much of the pain, when in reality, I am probably handling my pain with far more grace than people unaccustomed to pain are able.
After the past 2+ years, how do you feel about telehealth appointments to manage your RA?