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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

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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5
SlippersAndThePaper · 15/02/2020 13:14

It’s subjective.

It’s about the pain you are feeling at the time, it’s not comparable to anyone else’s or what anyone else has been through.

We use other tools as it’s about looking at the patient holistically. So there may be other signs of pain, behavioural changes, the patient’s observations, colour, movement, breathing etc.

For me I would rate childbirth as a 10 as it’s the worst pain I’ve ever experienced. A person who hasn’t experienced much pain in their life may rate their pain as a 10, even though you may think it should be less.

Culture, gender, society, religion, all have an influence over how we view pain. It’s not a one size fits all thing.

So even though the teenager posting on Instagram may report their pain as an 8 when it blatantly looks like it’s not, we have to take it as that and treat accordingly. Doesn’t just mean we chuck painkillers at them though.

Slothkin · 15/02/2020 13:15

I’m a big fan of this alternative pain scale 😄:
hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html?m=1

To not understand the 1-10 pain scale (lighthearted)
FreiasBathtub · 15/02/2020 13:16

I agree, and recommend this alternative pain scale. I've been thinking of printing it out and carrying it around with me just in case. It is more interpretable.

hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html?m=1

SpokeTooSoon · 15/02/2020 13:17

I’ve always thought it is stupid because unless you experience pain regularly how do you know what a 10 is?

Tomselleckhaskindeyes · 15/02/2020 13:22

I have fibromyalgia so I am used to having to document my pain. Childbirth for me was quite painful but I recently tried to ice skate and that was the most horrendous pain imaginable!! I think I did one lap and realised my skating days were over when I recorded my first ever 10!!

HelloViroids · 15/02/2020 13:25

I count 10 as the pain I felt when I shattered my femur - appreciate most people haven’t been “lucky” enough to have experienced that though...Grin

Slothkin · 15/02/2020 13:29

@FreiasBathtub I think we’ve just found our doppelgängers!

Bagofoldbones · 15/02/2020 13:35

Also I wonder if it’s so entrenched in us as women to still have to get on with shit at home if we are in a bad way. Arms hanging off - kids still need feeding though, just had a C- section - must get out of bed and start walking around - in pain? Take a paracetamol love its only major abdominal surgery!

Bagofoldbones · 15/02/2020 13:37

10 = dead.

Serin · 15/02/2020 13:37

I'm a HCP and it is amusing sometimes how people rate pain at 10 when they have caught the bus to their appointment. Grin
I've had 3 births, I would rate 2 of them as 6s and the middle one as a 9. Bloody awful that was.
DS snapped his hand off, both ends of ulna and radius sticking out. He rated the pain as a 7.Confused
I think of 10 out of 10 pain, as pain that cant get any worse, so if for example someone was to stab you, you probably wouldn't even notice as you are already in complete agony.

maddiemookins16mum · 15/02/2020 13:37

I struggle with this, 10 to me is being in such pain I’m sobbing in agony whereas a 6/7 would be nasty period pains with strong painkillers. Pain under 5 for me is a cuppa, two paracetamol and a kit kat.

Witchend · 15/02/2020 13:44

I agree.
Of my dc, one would probably not go above 3 in total agony, another would be 9-10 most of the time and the other would probably debate what actually the scale meant. 😂

Minai · 15/02/2020 13:49

I find it confusing too. Both my labours were excruciating. Non stop contractions with no break between them and before then I had no idea that level of pain was possible without dying. So when I had appendicitis the pain was nothing like as bad as that. I was asked to rate my pain and it was about a 3 or 4 to me (compared to labour) and I don’t think the doctors thought it was anything serious until they did several tests that indicated it was appendicitis. By the time it was removed it was gangrenous 🤢 and about to rupture. But the pain to me wasn’t awful. I agree it is quite confusing!

userabcname · 15/02/2020 13:54

Christ I must be an absolute wuss- I'd definitely rate childbirth as a 10. Thought I was going to die pushing out dc1 - felt like I was being ripped in half and turned inside out simultaneously. I didn't know it was possible to be in that much pain! Must have a low pain threshold!

SlippersAndThePaper · 15/02/2020 13:57

Heh.

To not understand the 1-10 pain scale (lighthearted)
Persu · 15/02/2020 13:58

It's all relative.

I'd rate injuries and operations I've had (broken arm, ankle sprain, foot surgery, gallbladder disease) at 5/6 on the scale - bloody painful and I needed pain meds.

But my endometriosis pain is 10. It's absolutely unbearable, and at times when it's really bad, I honestly would rather be dead than suffering.

And 2/3 I'd rate as what I experience after a tough training session at the gym or after a race - sore and stuff but manageable.

Totally personal, and to a point, psychological. The Endo pain is worse as an experience for me perhaps because I know it comes every month, time and again, and I know painkillers don't help and it lasts for days.

LoveNursing · 15/02/2020 14:06

Whenever I used the pain scale I would say, "what would you say your pain score is, if 0 equals none, and 10 is the worst pain you've ever experienced?"

It was a great measure before injecting morphine, and the best job in the world when every few minutes the pain is reported as 10, then 8, then 6, and now 4. Usually when it rests at 2 or 3 people want to stop the morphine and see how it goes. Within minutes they're sleeping peacefully!

Without experiencing the worst pain known to man, how can you rate it's score? Common sense tells you it has to be specific to you, just like childbirth is, for example. Some women give birth in a field and then pack the baby in their back and carry on working. Others scream and demand epidurals before they're 3cm dilated. Most of us sit somewhere in the middle, which is why it's hard to even go by what's causing the pain, but, as nurses are taught; 'pain is what the patient says it is'.

AlunWynsKnee · 15/02/2020 14:15

My 10 is still howling after morphine so it skews everything a bit.

vintagesewingmachine · 15/02/2020 14:18

As McCaffery says " pain is what the patient says it is, and exists when the patient says it does". However, I really struggle to believe those who tell me, for example, their sore throat is 10/10 pain when I had to call their name 3 times in the Waiting Room as they were too busy chatting or scrolling through their phone while eating Mars Bar from the vending machine. Then they tell me the haven't taken any painkillers as it's just to sore to swallow. 🤬🤬. I need to get out of healthcare...

BertieBotts · 15/02/2020 14:20

It's so they can ask you again later and see if it's gone up or down without you having to remember how bad it was before.

Lunafortheloveogod · 15/02/2020 14:33

It’s 1-10 10 being ripped apart by a bear.. best way I’ve heard it described Grin.

Pain is objective but it does help weeding out dramatics too.. 10/10 deathly pain but they’re playing candy crush, having a nap, laughing away on the phone etc usually makes it clear that it’s not a deathly pain.

Childbirth isn’t a good comparison since one labour could be a full 72hours no pain relief back to back labour eventually given an emergency section and the next could’ve been “my back hurts” and 10 minutes later there’s a baby.

You can obviously say it’s a 3/4, paracetamol didn’t touch it at home etc to elaborate.

bridgetreilly · 15/02/2020 14:40

The scale a pp posted which explains it in terms of its impact on your function is really helpful. Childbirth generally is sufficiently painful that you cannot do other things or 'get on with normal life' at the same time. That automatically puts it at least at a 6 or 7. Some parts of it will probably be even worse, at an 8 or 9. Thinking of the pain in terms of your ability to cope with it also helps: can you manage it without intervention, does it need some painkillers, do you need high doses of morphine?

It's not meant to be a comparison with all pain suffered by anyone anywhere. It's a guide to help the health professionals know what you need and how your pain is developing/improving.

DecemberSnow · 15/02/2020 14:43

I think its stupid

Because everyone has different pain thresholds...

If my mother in law said 7, she would be in agony....
If i said 7 its fairly bad...

Years ago, a doctor said to me, Have you got kids, I said no...
He said, ok, imagine you have, imagine 10 is labour and birth, Now rate your score...
Seriously 😱😂

Bagofoldbones · 15/02/2020 14:45

Back to back labour is bad. That was 10/10 if I could have flung myself out of the window to end it - I would have.

Endometriosis pain is savage. That’s 9/10 10/10

Andromeida59 · 15/02/2020 14:46

As someone with a chronic illness, I find I am often dismisses when I give my pain scale number. I'm used to being in pain so do not sit there crying etc. Sometimes I will even play games on my phone or read as it's something to distract from the pain.

What frustrates me is when you give a pain score but the nurse in triage puts it down as a three because I don't appear to be in pain. If I wasn't in pain I wouldn't be in A and E.

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