As medical providers, we have been trained to ask patients to rate their pain on a scale. In the case of adults, that is a numerical scale from 0 to 10. Meanwhile, visual scales have been developed for children who use faces to express pain at different levels.
But what does the placement of pain on a scale really mean? What does that number actually signify? Does it help with diagnosis?
Well, no, it doesn’t. I have on a few occasions had patients with the same injury or illness, but with wildly different ratings on the pain scale.
Pain is inherently subjective, shaped by personal, psychological, and cultural factors. This limits the reliability of pain rating scales, as they do not provide a fully objective measure of pain intensity. With this, clinicians must combine pain scores with functional assessments, patient history, and objective findings for a more comprehensive approach to pain management.
Really, the only thing that is valid about the pain score is that it is very useful for tracking pain over time. For example, if you are having cardiac chest pain rated 8/10 and on reassessment 5 minutes later after receiving nitro, you report your pain is a 2/10, we can be confident we are seeing improvement.
People tolerate and therefore rate their pain very differently. It seems to me that older people are better able to tolerate pain. Maybe that comes with life experience, having endured painful episodes in their life, they no longer perceive situations as something catastrophic and realize that it will likely pass. In addition, older people may have a decline in nerve function, central processing of pain, and a weaker immune system – all of which decrease sensitivity to pain.
The subjective nature of pain presents a challenge to evaluation. I have seen teenagers involved in minor car crashes brought in by ambulance secured to a spinal stabilization board because they were distraught, and complained of pain everywhere that they reported as a 10/10. After careful assessment, no significant injuries were found.
On the other extreme, I once saw an elderly patient with a pathological fracture of his hip limp into the ER with a 6/10 pain.
Anxiety and phobias play a huge role in the experience of pain. For example, many people are phobic of needles. It always struck me as odd that the biggest, roughest-looking characters brought in by police after a bar fight always seemed to be the ones who would refuse local anesthetic and sutures because they were afraid of needles. Yet, they were covered with tattoos! They only fear medical needles – a very selective phobia.
Knowing that emotions have a significant effect on the experience of pain, we can then make pain more tolerable by cognitively reframing our thoughts about pain. Instead of thinking,
“This pain will never go away,” or “I can’t take it,” think more positive thoughts like, “I have ways to manage this, and it will pass.”
You can also distract yourself by thinking about something pleasant. Sometimes, children can be distracted by a toy or cartoon on a screen device. Another technique is to focus on slow, deep breathing while consciously relaxing your muscles.
Nothing is going to take the pain away, but getting yourself calmed down will make it more tolerable and you will be less distressed.
