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AIBU?

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To not understand the 1-10 pain scale (lighthearted)

87 replies

Fink · 15/02/2020 12:27

Just to claify, I'm just mildly bemused by this, I'm not actually up in arms about it, so by all means help me to clarify it but don't act like I'm trying to destroy the NHS or anything (I know AIBU can be brutal at times).

I have never understood when medical professionals ask me to rate my pain on a scale of 1-10 what the scale is actually suppposed to correspond to. I know that pain is subjective, but even so I would really appreciate some guidance as to what level of pain goes with what number. I mean, if I'm only supposed to used integers (because it would seem a bit picky to say 3.72 or whatever), then 1-10 isn't giving me a lot of leeway to distinguish between types of pain.

I'm assuming that 0 is supposed to mean no pain at all, and 10 is the worst pain imaginable: excruciating near-death agony, e.g. crucifixion (suffocating, nails through hands and feet, deep lacerations elsewhere, emotional pain etc).

Ok, so I would rate my first experience of childbirth at about a 6 at its peak, going down to maybe a 4 at times. It was an awful, long, labour resulting in a forceps and ventouse delivery without pain relief and with a large episiotomy. And I was hooked up to machines for over 30 hours so not allowed to move positions. It was by far the worst pain I have ever been in. But I can't put it on a level with hours and days of physical and emotional torture until actual death which I see in cases of abuse on the news, for example. So even though I personally have never been in worse pain, so it would be a '10' on my own experience, it would seem stupid of me to use up a 10 on that when there are clearly worse pains out there. And it was only physical pain, I had emotional support.

Another experience of childbirth was more straightforward, although still the second worst pain of my life. I would put it at about a 4, in that it was by a very long way less painful than the bad labour, but still terrible. But if I said 4 when they asked where it was on 1-10, they seem to assume that means that it's not too bad, in that I still have numbers 5-10 that it could be, but that just seems ridiculous because how could childbirth, even at its absolute worst, ever be comparable to the worst pain it is possible for a human to suffer? Obviously I didn't have the energy or inclination to have that argument at the time, I could barely speak at all, but over all the pain that was what I was thinking.

So that means I've got numbers 1-3 to play with for all other pains that are less than childbirth. I've had various infections and illnesses over the years, thankfully none too serious. But there are definite degrees of how painful they are, from 2 day migraines and third-degree burns to gastroenteritis (very unpleasant, but in waves) and milder headaches.

This scale just doesn't seem to make sense at all. There's massive uneven jumps in between numbers. You have to squeeze almost every type of pain from mild to severe into 1-3 so that you have enough numbers left for the really agonising torture. How could I go above 3 when I can see things in the news which are clearly so much worse? But on the other hand if I tell a health professional that it's a 3, the assumption is that's it's barely any pain at all, because, you know, it seems to sound like 30% pain, and that sounds low.

Has anyone ever seen any actual NHS advice on this? I would really like a chart where the average experience of different illnesses were ranked on this 1-10 scale. What I would really like is for them to use a wider ranging scale, say 1-100 or 1-1000. But given that the 1-10 things seems very widespread, what I'd like as a compromise is proper guidance on what the numbers are supposed to correspond to IRL.

OP posts:
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steppemum · 15/02/2020 12:32

you're over thinking it.

It is just a way for medics to see how bad things are.
people in pain who need pain medication will say 7/8/9 etc, people who are a uncomfortable but managing will say 2/3/4 etc.

so, does it hurt a lot and you want pain relief? Then say it hurts!

They are not using 10 as the worst pain in the world, more like the worst pain you can imagine. On that basis your childbirths were probably both at 8/9/10

AdoptAdaptImprove · 15/02/2020 12:32

I love the detailed analysis you’ve made here. I think the main issue is that HCPs offer 10 as the worst pain you’ve had, not the worst you can imagine. Fine if you’ve given birth, had gallstones or a burst appendix, for instance; less helpful if you’ve never been sick a day in your life before and the worst thing that’s happened to you is stubbing your toe. I know they need some frame of reference, but I wonder if we’ll ever get an objective measure which can be used in an instant.

raspberryk · 15/02/2020 12:37

It's clear you don't understand it, childbirth is generally accepted to be 8/9 I believe.
I would have rated my broken ankle at a 9 a I screamed, couldn't speak when I did it, and went all faint, could hardly breath. Then when I tried to walk on it I again almost fainted and was nearly sick.
That was worse than child birth which at its peak was probably an 8 for me. But the Labour wasn't generally painful I was at 0 for in between contractions with DD. With DS I had shooting pains that were 8 maybe 9, the birth part was a 7 or 8.

raspberryk · 15/02/2020 12:40

No there won't be an objective measure of pain, it isn't possible.
This might help though ...

www.prohealth.com/library/what-the-pain-scale-really-means-34982

MereDintofPandiculation · 15/02/2020 12:40

I've stubbed my toe and had gallstones - actually the stubbing toe was worse for the first few seconds than the gallstones - except of course that pain went on for longer.

UndertheCedartree · 15/02/2020 12:42

The point of you giving your pain a number is that it can then be monitored based on further reports from you. We can see if your pain is going up or down. It also gives you the ability to rate your own pain as everyone experiences it differently rather than the professional deciding how much pain you are in.

Gatehouse77 · 15/02/2020 12:43

It doesn’t matter what it relates to it’s about the pain you feel. If childbirth was a 9 for you that’s what they respond to.
The only threshold is how you feel and how you relate it to a number.

Sirzy · 15/02/2020 12:45

It’s impossible to get an objective view on pain but it does tell the staff how you are coping with the pain.

Ds is autistic and struggles to verbalise pain but we have a 1-10 chart with faces so he can pick where he is on the chart and we can manage the pain suitably

OhYouBadBadKitten · 15/02/2020 12:47

I totally get you on this. I end up rating things that leave me in tears as about a 6. I've had HCP who inflate my pain rating when they write it down. I've also ended up as being undertreated as a result of other HCP who take my rating as meaning it's not that bad.

TellMeWhoTheVilliansAre · 15/02/2020 12:48

9/10 is completely unbearable and you need pain relief. 7/8 is very strong and you could do with pain relief. Anything 5-6 or under is discomfort.

user18463585026 · 15/02/2020 12:51

It's not about the average patient, it's about how it feels for you in this moment. Not how it feels for you in this moment compared to some hypothetical alternative future pain scenario you have in your head.

Rating your pain as eight or nine or ten today doesn't mean if something "more extreme" happens in future and you also say it's eight or nine or ten that medics will refuse to believe you or remind you of what you rated your pain as eight years ago in a different scenario!

If you're in so much pain you feel like you're going to die, that's a ten.

Generally if your pain is a four people will expect you to be able to move around fairly easily without pain impeding or restricting your mobility. IME HCPs will be aiming to keep your pain at four or below, so if you feel your pain is too high/unbearable for you but then tell everyone it's a four (because you don't think you should be allowed to rate it more ?) they will assume you're relatively comfortable.

It is about you, in this moment.

dippyeggsandham · 15/02/2020 12:53

It’s about how you feel, so if that pain is a 10 at the moment then they know you require pain relief

user18463585026 · 15/02/2020 12:53

Oh, but ultimately if you need more pain relief because whatever number is not manageable or bearable to you then that is what HCPs are supposed to respond to. Tell them that instead if you want.

Bagofoldbones · 15/02/2020 12:54

I hate this as I hold pain really well.

I’d see a 10 as dead!

I was having a ruptured eptopic and the idiot doctor asked me and at that point it was a 6 because I was able to talk and he gave me paracetamol Confused

Then I had to crawl in the floor in to the corridor before I passed out and an amazing woman consultant came to the rescue and filled me up with morphine. I was actually in a bad way and they took me straight to theatre!

NewCatMummy · 15/02/2020 12:56

I was in hospital once at the woman in the next bed rated her pain as 10 despite making coherent phone calls, texting her friends, eating full meals and watching tv. I was hallucinating with the pain and rated mine as 8!

LakieLady · 15/02/2020 12:57

It's very subjective, isn't it?

When I broke 2 ribs, it was most painful about 36 hours later. I'd score it as an 8, although there was one night when, for a few hours, I'd have gladly opted for euthanasia.

A torn ACL and partially-dislocated kneecap only reached 4, maybe 5 though. I was able to go to the pub, get into and out of bed etc and genuinely thought it was just a sprain.

A friend sustained the exact same injuries in a (drink-related!) fall. He scored the knee pain as 9 and the ribs as 5.

thegreekgoddessofcheese · 15/02/2020 12:57

In a previous life I was required to use the pain scale with people. With many people it worked well, but with some it was just quite bemusing. I'd get told that their back pain right now was 10, but they hadn't felt the need to take paracetamol, could move / twist / bend (but only when they didn't realise they were being observed). They basically weren't telling the truth. I really did not understand what they thought they would gain by lying Confused

ChristmasFluff · 15/02/2020 12:58

I explain it as 0 is no pain and 10 is a pain so bad you die. that's because in my experience, there's always a possibility of more pain. And it also flags up people who will say '10' without thinking. I just raise an eyebrow and they realise what they've done.

The pain scale is only a part of the pain assessment though - you are also looking for other indicators. I found it really useful myself, because I dissociate when in pain - so I look and act fine. So for instance I was told to have a bath and a paracetamol when my contractions were an 8 if anyone had asked - but I sounded very calm on the phone.

QueenH · 15/02/2020 13:00

I’ve had this exact same worry and definitely always overthink my answer. So the last time I was asked to rate my pain between 1-10 in hospital I asked the nurse what an example of a 10 might be to give me some guidance. She said “getting hit by a bus” would be a 10.

VivaLeBeaver · 15/02/2020 13:03

There are a few different smiley face charts which break it down a bit.

To not understand the 1-10 pain scale (lighthearted)
LikeTheFruit · 15/02/2020 13:03

I do think you have a point OP. I'm an anaesthetist and we're moving more towards a no pain, mild, moderate or severe in terms of scale for post-surgical pain. Much easier to self assess and doesn't exclude anyone (inc children, learning difficulties, cognitive impairment etc)

MitziK · 15/02/2020 13:10

Being asked such things can result in a Hard Stare and a reply somewhere along the lines of;

'On an average day, I'm on a six and half to seven as soon as I wake up. So that leaves me three points with which to express everything from a broken fingernail to being ritually disembowelled. Shall we just say that this (indicates source of pain, such as an ankle the size of a Galia Melon) is causing me additional discomfort considerably over and above the usual?'

People with chronic pain tend to get pissed off with the question, as it fails to differentiate between the usual and acute pain - if I haven't just dislocated a joint, in terms of acute pain, I'm at zero. But I'm not, am I?

QuixoticQuokka · 15/02/2020 13:11

I really struggle with it too. I didn't experience any of my labour as pain, more waves of pressure, certainly intense but not painful. I was physically assaulted and reported my pain as zero to A&E. I don't know if I experience pain the same as other people. It would be much easier for me to say if I need pain relief, then if paracetamol or similar doesn't work, to say that I need something stronger, than to use a pain scale.

Sirzy · 15/02/2020 13:11

Much easier to self assess and doesn't exclude anyone (inc children, learning difficulties, cognitive impairment etc)

It does. They have to be able to comprehend those words and be able to apply it to themselves. My 10 year old autistic son would have no idea, as I said earlier he needs the visual (similar to the one viva la bever posted but simpler) to indicate his pain levels

Toddlerteaplease · 15/02/2020 13:13

I'm a nurse and this is correct!

I'm assuming that 0 is supposed to mean no pain at all, and 10 is the worst pain imaginable: excruciating near-death agony, e.g. crucifixion (suffocating, nails through hands and feet, deep lacerations elsewhere, emotional pain etc).