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Pain is Relative

We’re all familiar with that common and oh-so-subjective medical tool, the pain rating scale. “On a scale of 1 to 10, where do you rate your pain?” is a common question in doctor’s offices, ER exam rooms, and on posters on medical facility walls. This may be a helpful tool for a doctor treating the same patient over a long period of time, as she can then have a point of reference for whether symptoms are typical to the patient’s experience, or whether they are improving or worsening.  However, when it comes to a first encounter, I wonder how useful this tool really is.

Everyone has a different threshold for RA pain

There are people who rarely experience pain. For the person whose default is feeling good, a badly stubbed toe or sprained wrist might be excruciating and all-encompassing. For those of us living with rheumatoid arthritis/rheumatoid disease (RA/RD), learning to tune out pain is essential to survival.

Our brains use pain signals to tell us that something is wrong so that we will either remove ourselves from danger or tend to our wounds. However, when the thing that is wrong is not proximity to a hot surface or a broken bone that must mend, but rather one’s own misguided immune system, there is no immediate remedy. We can’t escape our immune systems, and no amount of rest is going to cure us (and too little activity actually makes RA/RD worse). Therefore, those of us with this disease start tuning out some of our pain signals, as it would be impossible to have any quality of life if we reacted each time we felt pain.

With regular RA pain, one becomes adept at tuning it out

I’ve become so adept at tuning out my pain, that I question my pain when it is severe and even doubt myself. I can be in agonizing pain and still catch myself thinking, “Why does it hurt this much? It shouldn’t hurt this bad. Maybe I’m making too much of it.” How strange that I push through pain on a daily basis to work, shop, drive, clean, exercise, and care for my kids, yet when it is so intense that I can’t push through I question my own self-assessment and the very sensations I’m feeling.

I’m working to stop second-guessing myself. The other day I was talking to a friend who is struggling to adjust to the pain and limitations a recent injury has caused her. When I walked away from the conversation, my hip had sparks of pain shooting through it. I took a deep breath and focused on not limping, as that throws my body out of alignment and makes everything worse, and then went about my day in a way that my friend is not yet able to.

I reflected on how good I’ve become at pushing pain to the outer boundaries of my awareness. Over the nearly two decades I’ve been diagnosed with RA/RD, I have strengthened my ability to not be overcome by mild to moderate pain. Therefore, when the pain is so severe that I cannot continue with my normal activities, the last thing I need to do is second-guess myself. Rather, I need to acknowledge that if the pain is stronger than my considerable coping mechanisms then my body needs a break, both from activity and from self-inflicted judgment and guilt trips.

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


  • kayjaybee13
    10 months ago

    I’ve begun basing my answer on the 1-10 scale question on how long the pain has been consistent or how many areas of the body are affected. Chronic pain has to measured differently than on a simple level of intensity.

  • LynnElliott
    10 months ago

    I agree and just sigh when I have to fill out the form each visit.
    First, Do you have pain? Answer: What is it like without pain-I have forgotten.
    Second: 1-10 scale-how in the world would I know. I have been denying the pain all day.
    Sigh—there has to be a better way.

  • Tamara Haag moderator author
    10 months ago

    Hi kayjaybee13 and LynnElliott,

    Yes, what you both say resonates a lot! Kayjaybee13, I wish they would develop a scale for chronic pain – perhaps with questions in the vein of “How bad is your pain today compared to how it is on an average day for you?” and “How many days has your pain been at the level it is today?” Those would be much more meaningful!

    Thank you both for sharing your perspective. It helps to know we’re not alone.

    Gentle hugs,

  • Lawrence 'rick' Phillips moderator
    10 months ago

    This may be why when I am asked to rate my pain on 1 – 10. I always say 6. At least I know if someone is faking my record. 🙂

  • Daniel Malito moderator
    10 months ago

    @tamara For years I have been saying that the ridiculous 1 to 10 pain scale is crazy. Everyone DOES feel pain differently, and just because it’s a 2 doesn’t mean that they feel it any less than I feel a 10. Plus, int he hospital, i always have to say I’m a 9 or a 10 to get pain meds! Keep on keepin’ on, DPM

  • Richard Faust moderator
    10 months ago

    Hey Daniel. You may have seen my say this about pain scales before – I have a huge problem that they are designed to ask patients to self-assess, but have a top end where by their own definitions the patient is incapable of competently assisting. For example: the Standford Scale (which may be the most widely used and can be found here: starts its description of pain level 8 as “pain so intense you can no longer think clearly at all.” If that is truly the case, this patient is not capable of assisting competently in their care. That level of pain should be reserved for ten or above, where the doctor is assessing and treating the patient immediately because the situation is so dire. A further problem is that if a patient reads the scale properly and believes they can assist the highest they should say is seven, which is usually then interpreted that they don’t need much assistance. The scale is designed to fail the patients. Best, Richard ( Team)

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