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Rate your pain on a scale of 1 to 10

“Please Rate Your Pain On A Scale Of 1 To 10”

Aside from actually dealing with pain on a daily basis, there are lots of things I don’t like about living with chronic pain. I don’t like the feeling I get in my stomach when people ask me how I’ve been and I just say “fine” because it’s easier than trying to explain the truth. I don’t like the way so many well-meaning friends and family always seem to be waiting for me to “get better.” And I really don’t like looking back at pictures from events and trips that were supposed to be fun and remembering how crummy I felt that day.

But I think what I hate most about life with chronic pain is when someone says this: “please rate your pain on a scale of 1 to 10.”

I hate pain scales. In my experience they are completely arbitrary and serve no practical purpose. Because here’s the thing: I deal with large amounts of pain on a regular basis. That means that I have developed a high threshold for pain. My ordinary, everyday 5 might be someone else’s 9. And even if I do feel like I have gotten to my version of an 8 or a 9 that doesn’t mean I’ll be rolling on the floor crying. Since I am stuck with this pain for the rest of my life I have adapted my attitude. I don’t let pain get to me as much as someone who isn’t used to dealing with it might. I’ve developed the ability to joke around and stay in a good mood despite being in large amounts of pain. It’s my coping mechanism so that I don’t end up depressed. So I can very legitimately be smiling and laughing and be in large amounts of pain.

Unfortunately, the doctor or nurse who asks me to rate my pain on a scale of 1 to 10 is usually someone who doesn’t know me very well. They generally have no context for my ordinary level of pain or my ability to cope. And, in my experience, these doctors and nurses tend to judge me not by the number I choose to answer their question, but instead by my overall demeanor when I answer.

For example, I was recently in the hospital after having a C-section. Shortly after the surgery, I developed a truly skull-splitting headache (a reaction to the anesthesia they used for surgery and a spike in my blood pressure). I told the day nurse as soon as I noticed this new symptom. She kept asking me to rate my pain on a scale of 1 to 10 and, as the day went on and the headache grew worse and worse, I kept giving higher and higher numbers – eventually getting all the way up to a 10.

However, for the sake of my newborn son and my own mental welfare, I tried not to break down over this extremely intense pain. I drew upon my years of experience dealing with pain and kept myself in as good of a mood as possible. I made an effort to joke with my husband and coo at my new baby. This was how I chose to keep going and cope with my pain. But, because I wasn’t breaking down and crying, the nurse didn’t seem to believe me about how much pain I was in, even though I honestly answered her question with a high number. So she did nothing to address my headache all day.

As the headache grew worse and worse I did eventually break down crying. I had just had major abdominal surgery after an extremely difficult pregnancy and, after trying to keep it together all day, I was frustrated and scared. The pain was so bad that I couldn’t even sit up in my hospital bed to nurse my newborn. But then a new nurse came on shift and everything changed – an IV was placed and I was given morphine, my other pain medications were increased, and they called for the anesthesiologist to come evaluate me. But did these changes happen because the new nurse actually believed me when I said I was at a 10? Or did she only believe me because I was crying instead of bravely trying to smile?

In the end I had to spend a couple extra days in the hospital recovering from the headache, and I can’t help but wonder if all or most of that pain could have been avoided if the original nurse had only believed me and acted sooner. Has something like this ever happened to you? How do you feel about the pain scale?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Samuel Githegi
    5 years ago

    Hey! I so relate to this! I have learn’t to deal with the pain just like you have. Only like Kathy P. says, my pain scale is based on a hyperbole. I number is accompanied with a statement on how limiting the pain has made me. At my worst. I cant use my hands for anything and my hand or whatever is there merely for show. Thats a 9 for me. A 6 or a 7 means driving is painful but doable. Anything less is a 4 and I never go below a 4. Probably a 6-7 for the average pain-free human.

  • Kathy P.
    5 years ago

    I love Hyperbole and a Half’s Pain Scale! I love the humor in it!

    I made my own pain scale, I guess along the same vein, but with symbols I had available in my graphics program. A great artist I am not.

    The pain scale goes with me when I go to a doctor. That way we can discuss what exactly a 7 on my pain scale means to me, relative to what I consider to be difficult to handle. The important this is that it opens a discussion.

    So, print out the one from Hyperbole or make your own, take it with you to your appointment, and keep a pain log that you can show. The thing is to open a discussion with your doctor, especially since our pain tolerance changes over time.

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Kathy ~ That’s a great idea – to talk about how the number relates to what you consider to be difficult to handle. Because how much trouble you are having handling the pain often matters in deciding what to do next. Something to try next time!!

  • Loretta Tweed
    5 years ago

    I hate it to…

  • Elizabeth Riggs
    5 years ago

    Hi Mariah (and everyone else)! I found a truly unique pain scale on a blog that I have shared with all my Docs. They think it is hilarious – and all too true. So I’m sharing it with you:
    It is on the blog, Hyperbole and a Half
    http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html
    Share with your docs, too! I carry it with me in my smartphone so that ER nurses will know just how bad or good I feel!
    Cheerio!
    Elizabeth

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Elizabeth – I LOVE Hyperbole and a Half and I have totally considered printing out her pain scale to carry with me. Hahaha that’s awesome that you have actually done it!! Honestly sometimes laughter is the very best medicine there is!

  • Jane Burbach
    5 years ago

    Hello, Mariah and all,

    I can definitely relate. Pain is something I’ve gotten used to and it is so hard to rate unless I can’t move and then it’s 9 or 10. Lately I’ve been having pain in the wrists and ankles. I’m used to it until I swat a fly with my hand or turn a joint the wrong way. Then it’s cringe worthy.

    I wonder if there is a fatigue scale. Fatigue is the worst for me unless I’m in a full body flare. Despite the wrist and ankle pain, the fatigue is minimal right now. Whew!

    I have a question that’s kind of related. If we still experience pain, how well managed is our RA? Is there a point that with the right med or combination of meds that we won’t have pain?

    I’ve had RA for a long time but was only diagnosed and prescribed meds for a year. My rheum prescribed methotrexate and plaquenil but the methotrexate doesn’t agree with me and I’m not very compliant. Bad I know.

    Any thoughts?

    Jane

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Jane ~ As subjective as pain is you may be right that fatigue is even more difficult to quantify. I also agree that sometimes fatigue can be worse than pain.

    As for your question, it IS technically possibly to find the right treatment that will put you into a “medical remission” so that (at least theoretically) you won’t be feeling pain. However (at least in my experience and most of the other people I know) most of us still have occasional flares of pain even when our RA is well-controlled by medication. So I guess, in a way, how controlled your RA is is also a scale of sorts. If you don’t like the treatment your rheumatologist prescribed or you feel it isn’t helping you enough I highly recommend asking your doctor for something else – there are lots of treatment options available. It can take some time to find the best one, so patience is required, but when you do it can make a huge impact on your quality of life. Best of luck to you and remember that we are here to support you!

  • Wren moderator
    5 years ago

    Hi, Mariah!
    I get my medical care through the VA. At every appointment, whether it’s with my rheumatologist or not, the nurse taking my vitals prior to seeing the doctor asks the pain scale question. I answer honestly, like you. And, like you, over years of coping with pain I’ve built up quite a high threshold. The thing is, the nurse notes the number I tell her/him, but there is never any further discussion about it–from the nurse OR the doctor. Why must they ask if they don’t intend to react to my answer?

    It’s useless, really. I understand the concept behind asking, but it seems to me that there should be some sort of result that comes from the patient’s answer, even if it’s simply, “Ow! Where do you hurt?”

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Wren ~ That’s extra frustrating to have to take the time to try and quantify your pain and then not get a reaction! Maybe next time you should ask the nurse or your doctor why they ask and what they intend to do with the records? Might be interesting to see what they say!

  • zainy k
    5 years ago

    This is so true, plus I hate the fact that your pain scale varies throughout the day.I mean I can be having an 8/10 in the morning and only a 3/10 in the evening.And my doctor would’nt believe that if I have an evening appointment!
    and I just feel sorry for myself and teary-eyed when I am rude to family and friends while going through all this pain.I think it takes a long time to get used to the pain as I’ve only had this for a few months.

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Zainy ~ It sounds like you have been recently diagnosed and that is a really difficult time. I promise you that, while it will still be hard, it will get better with time as you find a treatment that helps and learn to cope with the changes in your life. In the meantime I am glad you have found our community because we do understand what you are going through! Hang in there and remember that we are here to support you!

  • Robyn Sanchez
    5 years ago

    I can relate. I don’t care for the pain scale. First, the only pain scale I’ve ever received was when I was pregnant 12 years ago. I had to go look a pain scale up in order to complete my first pain scale and found I was often rating my pain too high. As you said, pain toterance is different for everyone. One persons 5 may be intolerable while 5 may be a walk in the park for another. I have a high pain tolerance. I just do, I go on because I have to. Only when the pain can’t be put away (ignored) as I go about my day do I say ok I acknowledge you, I’ll rest. As you mentioned, I find myself telling everyone “I’m fine” even when my hands and feet are swollen, red and hard to use because it’s just too hard to explain and I “look fine” continue to function (because I have no other choice) so who’s going to get it anyway? This whole rheumatoid arthritis thing is such a hard thing for people to grasp. The questions kill me…You have arthritis? No. Rheumatoid Arthritis. It’s an autoimmune disease. Your medicine is low dose chemo?? Yes. You’re losing your hair?? Yes actually, quite a lot. You have mouth sores?? Pretty often, yes. You could fall asleep driving the car if you let yourself close your eyes?? Yep. You’re so young!! Yes, but it doesn’t matter. Is your medicine working?? No, not yet, I’m newly diagnosed. Why would you keep taking medicine that doesn’t work?? I have rheumatoid arthritis. I can’t change it. I can only hope the medicine begins to help reduce flares and get me to remission. I just want to make and hand out an info sheet so I don’t have to say it all to every person who might inquire. Only once has my RA pain reduced me to tears, but I know it’s high on the pain scale when I snap at my loved ones or am impatient with others as that’s not the norm for me. It’s at those times I’m most frustrated.

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Robyn ~ The misconceptions surrounding arthritis do sometimes make it very difficult to interact with people who don’t know any better. And I see that you are newly diagnosed and that can be such a difficult and frustrating time. Unfortunately it can often require a lot of time and patience to find a treatment that helps, but I when you do it can make a huge difference to your quality of life. In the meantime I am so glad you have found our community because we do understand what you are going through. Hang in there and remember that we are here to support you! And we are here to listen if you need to vent! ~;o)

  • Marcia Parker
    5 years ago

    Thank you. This was so helpful. I began to wonder if I had become hypo-sensitive to pain. That my ability to cope had become null. In the past 3 years I have been through chemo, a bowel resection and a total knee replacement. I have been in a major flare for the last 8 months while trying to find the RA meds that might work. I finally saw a pain management doctor who totally understood and has helped me with my pain. What a relief to get a break from the constant pain. Everything you said I could so relate too. The hardest thing for me is when friends and family can’t understand that one day I might be doing OK and the next day not. I feel somehow I’m disappointing them. Does that stem from our need to want to fix things?

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Marcia ~ It sounds like you have really been through a lot in addition to living with RA. I admire your perseverance and I am so glad that your pain management doctor has managed to help you get a break from the pain. I also understand how frustrating it can be to deal with friends and family who don’t understand. With the people I care about the most I always try to take the time to explain it to them if I can, but I don’t always have the energy to do so. It’s those times that I am grateful to have this community – where others understand! Hang in there and remember that we are here to support you!

  • Lizette Carrion
    5 years ago

    This is so true! After fighting a migraine for 3 days I went to see pain mgmt. and then had a nurse intern who did not know me who asked me about the pain scale, I had been vomiting, my eyes were covered because of light sensitivity and sound bothered me, I told her I was at a 10, this woman yelled at me and said that if I was at a 10 I would be passed out! Can you imagine! After we got that corrected with the Dr. I never saw her again.

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Lizette ~ Wow I’m so sorry you had that experience. Sounds almost as bad as mine! It really seems like nurses should be extra sensitive when we answer their questions honestly but unfortunately that isn’t always the case.

  • Kathleen Hlavin
    5 years ago

    This has happened to me and I’m quite sure, besides being a woman, having had RA for 21 years has given me extreme tolerance. I was at a physical therapy appt. for a stiff neck I’d been living with for a year. She asked that very question, ‘1 to 10’, on how I felt that day. I told her about a 2 and she responded, “Wow, you are one strong lady. I would put you at a 5 or 6 at least!”

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Kathleen ~ How satisfying to find a PT who took you seriously and gave you credit for your pain tolerance. ~;o)

  • gretchen
    5 years ago

    Thank you, thank you, thank you. This is something that I have been trying to express for years. The pain scale is completely subjective, and as you said, what might be a five for me could be a nine for someone else. After breaking three toes, I pulled them straight, taped them up, and went back to karate class. No muss, no fuss, no tears or cries of pain. The pain was minimal, not because it didn’t hurt, but because I deal with that level of pain and continue moving on a daily basis. People don’t get it. If we cry it is because it has gone on for too long and is more of a hopeless, “this is enough” cry than anything else. Thank you. I just wish that more caregivers could realize this.

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Gretchen ~ It would be nice if more caregivers could realize that the pain scale is different for those of us dealing with chronic pain. Who else can break toes and go back to karate without crying? ~;o) We are strong but that doesn’t mean it doesn’t hurt!

  • Marcia Parker
    5 years ago

    Gretchen, You are so right on. Well said.
    “If we cry it is because it has gone on for too long and is more of a hopeless, “this is enough” cry than anything else.”

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