How do you measure pain?

[Katie]

I'm always a bit confused about how to describe the 'pain levels' when asked at the doctor's office. What exactly is a 2 or a 9?

For women, or others who have had a serious accident, a broken leg, car accident, etc., it is a bit easier. For me, nothing beat child birth , and the second worst was when my horse jumped on my foot when I stupidly decided to get off and cross an icy creek and lead him across. He decided that if I was on that spot, then it was obviously safe, so he should be there too Compression pain after 1100 lbs lands on one foot is memorable.

I consider those a 10. But the sciatic pain that has left me crying on the floor is right up there too. The never ending lumbar pain from three herniated discs and compressed nerves has me saying that it's an 8 or so, and everyday pain goes from a 3 to an 8 depending on the level of pain meds.

I guess what I'm asking is whether you class pain like the earthquake scale, that is each level is multiplied by 10? Otherwise, how can you judge the difference between a 4 and a 5?? This has always bugged me. My husband, on the other hand, thinks a headache is a 10 most days (bless his wonderful big heart) and we're not talking migraine, we're talking caffeine withdrawal

[dshobbies]

Katie,

I suppose the difference between a 2 & 10 is up to the individual. I considered my disc rupture to be a 10 pain but I was still thinking and talking, albeit about the pain and how to get rid of it. Childbirth was more like a 20 when if the pain didn't end, I wanted to die. I understand passing a kidney stone is off the charts too. A stubbed toe is like an 8 or 9 but usually passes quickly.

Think about how tolerable the pain is. Can you completely function with it in the backround, then it's low. Does it affect what you do or want to do, it's midline, does it interfere with your life, still higher... is it your whole life, 9-10

Men (generalizing) who haven't experienced real pain do tend to be more dramatic about it (bless their wonderful big hearts) but maybe that's because women are so good at mothering

[Jakea222]

I also find that I hard question sometimes because my tolerance level to pain has increased...

[Katie]

Jake, yes, I've been told that I am functioning much better now than at the beginning of all this, even though I should be in total oblivion with all the meds ;-)

But that's the point dsh; if all pain is on a scale of 0-10, and childbirth is in there somewhere, it has to be compared to what we are dealing with now. Does it interfere every day with what I want to do? Absolutely, with no breaks except a bearable relief with the meds. So I am pretty incapacitated with the pain, but not screaming my lungs out on a bed asking someone to rip it out at all costs

[mmglobal]

Here is a pain evaluation form I found several years ago. This is a difficult topic. I know people who say they have average pain level of 8, yet they work full-time and are highly functional. I know people with average pain level of 5 who are functionally disabled.

I am NOT endorsing this pain scale. There are aspects of it I like, and aspects of it that I don't like. I do agree that 9 and 10 are NON-FUNCTIONING pain levels. You are not at work, reading the forum or typing an email if you have a pain level above 8.



0 - Pain Free
1 - Very minor annoyance – mild aches to some parts of the body. No pain medication needed.
2 - Minor annoyance – dull aches to some parts of the body. No pain medication needed.
3 - Annoying enough to be distracting. Over-the-Counter paid relievers (such as Naproxen Sodium, Acetaminophen, or topical treatments) take care of it.
4 - Can be ignored if you are really involved in your work, but still distracting. Over-the-Counter pain relievers remove pain for 3-4 hours.
5 - Can’t be ignored for more than 30 minutes. Over-the-Counter pain relievers help somewhat (bring pain level from 5 to a 3 or 4) with pain for 3-4 hours.
6 - Can’t be ignored for any length of time, but you can still go to work and participate in social activities. Stronger painkillers (such as Ultram) relieve pain for 3-4 hours.
7 - Makes it difficult to concentrate, interferes with sleep. You can still function with effort. Stronger painkillers (such as Ultram) are only partially effective. (Stronger pain killers bring pain from a 7 to 4-6.)
8 - Physical activity severely limited. You can read and converse with effort. Stronger pain killers (such as Ultram) are not effective. (Narcotic pain killers do bring this pain down to a level 3 or lower.)
9 - Non functional for all practical purposes. Cannot concentrate. Physical activity halted. Panic sets in. (Narcotic pain killers bring the pain level down from 9 to the 4-6 level.)
10 - Totally non-functional. Unable to speak. Crying out or moaning uncontrollably – near delirium.

[Kathy]

Mark- I think that is a pretty good description, probably as close to good as it gets.
Childbirth for me was off the chart. I did not scream, yell or curse... I cried, whimpered and prayed for the child to come out, an epidural or death. I didn't even want to touch the baby for a good 30 minutes, I was so worked up from the ordeal (this was where all the foul language took place). In my opinion, if you can yell or talk, it isn't hurting that bad.

My day to day pain level is between a 2 (with meds) and a 7 (meds wearing off). I do have occassional days where the pain is an 8 or 9 and all I can do is lay in bed and pray for death (literally). All I can think about is the pain and how to make it stop, I can't move and just tense up due to the pain. I have hurt so bad that I couldn't even get up to get my medication to make it stop, knowing that the medicine would help and still could not get up, so I laid there and suffered until my husband got home to help me.

I think the pain level is hard for us to define because we are very tolerant to the pain. We don't know life without some level of pain at all times. Then, we are on a bunch of medication to hide the pain. So, yeah without drugs, it would probably be a 10 all the time; but with them it is usually manageable. I always tell the dr. the pain level I experience without drugs as my pain level (I then tell them what it goes to with drugs).

[Terry Allen Blackburn]

Mark:

That is an excellent pain scale. It would be nice if you could put that in an Excel Spreadsheet and put it in a sticky that people can print from here. This is a very useful tool. Thanks for posting it.

Terry Newton

[Katie]

Yes, I agree with Terry! Mark, that is exactly what we need.

Reading that, I am between an 8 and 9, and the meds take it down accordingly to exactly the way that describes it. Excellent chart, thanks!

Kathy, pain does not incapacitate my ability to yell or say foul things (only a 10+ of course)! I go quiet when the pain goes away and peace sets in

[johnb]

I've also described to my PM the amount of movement I can do before pain comes on and what kinds of movement. I've also described pain at rest vs. pain while doing things. The 10 pt scale doesn't really encompass our experiences. Then there are different types of pain. Stabbing, burning, throbbing, excrutiating interupting your thoughts types of pain.

I thought I knew 10 pain but I had to adjust my personal scale immediately after the dynesys was removed. That was the worst pain I'd ever felt for about 2 weeks. I went back to the emergency room 2 times as my heart rate was high and I couldn't sleep. I suppose the pain was pushing my anxiety that something wasn't right.

John

[Maria]

Thinking of offing myself...
edit to add that's not what I feel now but what I had felt when the pain was at this level all the time due to failed back surgery in '92

0 is I want to run around and do and undo until I'm ready to drop into the sack and sleep the sleep of the dead..
1 is who cares, I can still run around and do and undo..
2 is still running around but very minor annoyances
3 is starting to notice this sh*t is bugging me more than I like
4 is dang stop this nonsense
5 is wtf
6 is where are the med
7 is oh no I didn't
8 is wahhh
9 is wahhhhhhhhhhhhhhhhhhh
10 is FFFFFFFFF........K!!!!!!!!
and the rest~ (hope I've not offended anyone tho that's my truth)

[Terry Allen Blackburn]

Originally Posted by Maria

Thinking of offing myself...

I have definitely been there. Not a good place to be, as it also represents hopelessness.

Terry Newton

[Maria]

and that's exactly how I felt. Thankfully I feel far from that now and hope to stay this way

[Katie]

Ain't that the truth...maybe we should have a poll about that....how many have or have not felt that way at some point.

My last visit with a 'specialist' ended when he said that "pain is not a reason for surgery".

Reeeeeeally! What the heck are the requirements? Pain isn't glamorous enough for the hospital administration, my PM doc said one day. One poor fellow tried to kill himself with a cross bow, she said, which finally got him enough attention to get him some help.

Why does it have to go so far?

[Magrego]

Hey guys,

I too have problems with my pain scale. All my life I have injured myself. Fallen of car roofs, stairs, fighting , rugby ect. I was a small male that I must admit thought was almost invincible. Some of the thing I have done I am lucky to be alive.

Pain has never been an issue for me before sacroillititis. I think the only pain that has compared was when glass severed my main nerve and minor arteries and over 8 tendons in my arm.

The biggest pain was not when it happened but 1-3 months after the injury when the nerves were trying to grow back. I still have limited feeling.

Now I was treated with morphine ect and people showed they cared for me because they could see I was in pain. To be honest I never needed the support as much as I do now for sacroillitis.

Whole point of my story is I rate sacroillitis 9 or 10 ( I may have other disease but there still testing.) I rate my arm a 10 when the nerves were growing back.

Now even though the pain rating is Higher than sacroillitis I would prefer to have my arm sliced open and almost cut off lol. Sorry for the ugly description but yes my muscles were hanging out of my arm. I could also open and close my hand as the muscle was sucking in and out of my arm. Was ridiculously gory 2 police officers had to leave the room lmao.

Anyway I just wanted to show pain levels mean shit too most of you. It's the fact it takes away your life. I am not saying pain isn't bad and may is actually the very reason we complain. But it is not why we complain it is because I miss being able to do the things we enjoy. And people keep saying there is nothing wrong or they treat you like you are over reacting.

Not to be pessimistic but most people are not understanding. I call most of these people one eyed. There is a big difference between pain that goes away and pain that stays forever.

When I had my knee reconstruction. When my knee crunched it was a 7 . Tore acl ligaments .

I remember when I was a kid I said" I hope i don't ever kick my toe again"
if I knew about sacroillitis I would have peed my pants lol.

[Magrego]

Well I re read my message was a bit all over the place. I think what I have learnt is pain rating is very subjective. I don't think you can rate pain levels unless you study other illness and disease to give accurate readings. I gave a rating 10 out if 10 for nerve regrowth from a severed arm. This 10 out of 10 pain would only occur for 1 split second or a second. It was a pain that was shooting, electrical vault like lightening pain. It would come every hour or so. I had other pain that throbbed etc. But this particular nerve pain through my arm was bad and I am sure many others have experienced this to a degree where it would last more than a second. Also the occurrence could be every minute instead of every hour.

I cannot imagine living with that sort of pain continuously, it would be impossible for me to fully understand their pain without feeling a small amount myself. I bet half the people in the world would rate it 20/10 if it never stopped.

So I believe pain scaling Is a terrible system to assess. I am no doctor but this method seems a inaccurate and totally subjective and personal. There must be other ways to assess pain.

I thought that possibly understanding other people's pain could help you assess the level of your own pain. But again every persons particular case is very different. so I guess subjective opinions is the only way but to make these more accurate a scale from 1 to 10 is too simple for such a complex issue. Words and sounds I believe are better at rating pain than a number. But the rating should not be as simple as writing a few words. It needs to be written and documented when you are feeling the worste and when your feeling your best. Pain varies in my situation so I'm not sure about others.

Anyway just wanted to say my 2 cents after the crap I went through trying to explain my pain. I learnt not bothering to explain helps me. Not only is pain hard to rate it's hard to explain which I believed progresses illness from the inappropriate comments from doctors related to pain. Some doctors even told me to lift weights there is nothing wrong. Lol I had sacro and possible AS. Lol if I had of listened to half the docs comments about pain I am sure I would be far worse.

If you are in serious need of assistance and you are not getting the assistance why not grab a cross bow lol

[Sick & tired]

Originally Posted by Terry Allen Blackburn

I have definitely been there. Not a good place to be, as it also represents hopelessness.

Terry Newton

I couldn't agree with u more ! Just spent a week in hospital. My pain level was a 20, yes even though that isn't even on the scale, I was in that much pain! Taking pain pills I had, tylenol3's, flexeril, ultraset, and double the dose prescribed. Back history for me, I have ms dx13yrsago...weak side is on the left. back problems are on the right started 1yr 8 mos ago.and at the first of 2113went down hill....
In January of this year started having having pain and muscle spasms, the more I did the worse it got, then in April my lower back started in being an everyday occurrence ! Had to use my wheeled walker to get around in the house, when for the last 10 plus years I had used a forearm crutch to walk with and keep my balance with the weakness and drop foot my ms caused on left side. Doctor had did ex rays and said arthrtis and lumbar region getting pretty wore out, sent me to pain management clinic received 3 steroid injections about a month apart. In the mean time reg doc put me on 25 then 50 mcmg phentoynal pain patch to control pain. I could not get into any position for the pain to stop. Walking hurt, laying down hurt, tried ice and cold packs, if I could lean forward while sitting or standing and get in a certain place it would take the pressure off the nerve and laying as curled up as a big woman can get would help too. Can't live life quite like that.also have been giving 2 or 3 shots of steroids&dose packs of steroids and take 1 10 mg of it daily .
The pain started right in the middle of my lower back felt like someone was twisting with a wrench, then spread down my right butt area around my hip down the back and front of my leg right back side of calf, some days it was tight and numb the worst when the muscle spasms started. I had my extra 4 th steroid injection at the pain clinic on July 5 had some relief for about a week then all hell just broke loose, had to have help to do everything, had been using a chair to sit to prepaid dinner to put dishes away standing getting in and out of the shower ect was excruciating ! The 4 th injection was pointed more towards the nnerve bundle.. Ok end of this long story was advised by my primary physician to go to Er, the did MRI examined me gave me deluded and found my right foot had drop foot admitted me.
Then did a ct scan same day. Gave me Valium for muscle cramps, told me only get out of bed with assistance. Then was told I had something very abnormal outside of l5 which was herniated. It was either a cyst infection or calcification something but the thought the should biopsy it, then the said it was my ms flailing up, so they gave me a 3day solumedrol IV drip, 4docs in 2days said yep lets. Biopsy and the afternoon of the second day the said nope just appears to b air your ms is causing all the pain,,,! Ok at this point I am atWTF?
Then 2docs including my pain doc said well why is their air in her back, u have loaded her up on steroids her pain is still 8 or 9 lets biopsy, then yesterday the air was tuned back into a cyst and I was then told it was insignificate and wouldn't be the cause of the pain. But 2 or 3 of my lumbar discs were bone on bone and surgery would be a50-50 chance of fixing the problem, I DIDN'T WANT OR COME INTO THE HOSPITAL FOR SURGERY I wanted to be rid of the pain so I could get mor of my normal life back...what did I get? Told this pain is more of my ms showing its ugly head,note: never had pain just spacticty, and trouble walkin, urinary problems cloudy thinking ect. All on left side , to now having unbearable "they shoot horses" pain in right back, hip, leg calf pain?? Strong muscle spasms in right hip, numbness pins and needles going over the top of my thigh I can't rub out, when th docs lifted my right leg it would make me cry, when they lifted my left leg so high same
Thing same if the lifted my arms when I lift my right one so high the back starts to tighten up. No one addressed all the crackling and popping in that area I eas havin except the nurses. When it pops it goes like pop hurt pop hurt ect, like when people crack their nucles except this is pain.. So I have an appt with my pain magenta doc tomorrow, but it is so frustrating to spend 1 week in the hospital with all most as much pain as I started with no conclusion..and a question why didn't they do a biopsy on something they called a cyst then said it was an air pocket but yesterday was back to an cyst? And when or how do they help me or fix the problem? Hopeless in detroit metro area. Any suggestions before I see my pain doc tmmrw?

[Maria]

It takes way more than a week in the hospital to diagnose exactly what is causing the pain(s) and sometimes if enough tests are done and they're the right tests to rule out things and rule in others or exclude/include you may get lucky.

For your PM visit I'd have your sequence of events listed clearly and succinctly. Hopefully at least you can get some adequate pain management to hold you over until the best diagnosis and treatment plan is determined.

My spine journey has been going on since around 1981. I still have problems but not to the horrendous extent I did before or at least I am medicated and have adjusted to what I live with and without.

Then again I've not had an MRI since 2006 so maybe I have more going on than I realize but at least it feels well managed.

Talking with Mark (mmglobal) here may be very helpful to you as he's a spine patient advocate and many of us have utilized his services and been very glad we did!

Please update us with how things progress for you. I also recommend if surgery is recommended to get more than one opinion (at least 2 and maybe 3 or more). Sometimes you know you really like the one person you're seeing and you may not feel like getting other opinions however I think it's a good thing whenever surgery of any certain magnitude is recommended.

Good luck~ Maria

[jsewell]

I am so sorry you went through with all that and came out the same way you went in.
I agree with Maria, get it all written down in order of what went on in the hospital.
Explain what was tried for your pain and did not work in order as well as i am sure she said.
GEt that pain under control, hopefully this pain doc will be excellent and will be able to do this for you.
Then start on getting opinions on what would best help you if regarding surgery.
I recently was all set to have a certain type of anterior fusion on my thoracic spine as the posterior failed miserably last Aug/sept. My nerves got involved with screws which were pulling out and i was in bed or a wheelchair for 6 weeks in horrible pain near a 10 waiting for surgery to remove all the offending hardwear.
Well i went for a second opinion and a whole different type of surgery was recommended. It made much more sense to me. Back to the original doc and presented this to him,, now he is presenting my case to a group of spine surgeons that meet every 2 weeks and next week i will find out what they came up with. Kind of like getting a bunch of opinions without all the running around. So my point is really get at least a second opinion.
Good luck with this and now that we are thinking about you, please let us know the outcome.
You could also start your own thread so it could get more attention
Judy

[theBadCormorant]

I think pain is a very difficult thing to measure, and during my recent problems I tried to keep a daily note of pain levels, then the following happened and it made me think..

There was one day a month or so ago when I was in astonishing amounts of pain, buttock and calf pain due to S1 nerve being squashed by slipped disc at the Lumbosacral junction. I was putting this level of pain down as 7 or 8. Anyway it was a nice day and I hobbled out into the garden to lie in the sun (was only capable of going about 10 yards on my feet before the pain would win and compel lying down) And just typical of how my luck was going, I stood on a Bumble Bee and it stung the sole of my foot on my good leg. The wife burst out laughing and I could not help but join in, how funny, how utterly ridiculous but still very funny.

Anyway, as I lay there with a bee sting on my left foot, and nerve pain affecting my calf and buttock of my right leg, it was interesting to compare the pain levels; I would say the Bee sting was equal in magnitude to the Calf and Buttock pain. Now I wouldn't describe a Bee or Wasp sting as all that painful (may be a 5 tops ?), so was my Calf pain not really that bad ? So presumably any measurement has to be "pain X duration".

I guess a Bee sting that could arrive several times a day and persist for many hours rather that a few minutes, would get a much higher score than the actual pain merits.

[jsewell]

That sure was a bad luck day. I would have had to laugh as well. What else can you do in that situation. I am going to have surgery next monday and do dread the question of what level from 1-10 or 0-10 my pain level is. One time i just made up a bunch of numbers and told the nurse to use those for the next day instead of asking me. I always have to compare it to previous pain . It changes as I have a discography or last summer when my nerves were wrapping around a screw and i couldn't put my leg down for a second. so what event do i compare it to for next week!!
judy

[theBadCormorant]

Originally Posted by jsewell

That sure was a bad luck day. I would have had to laugh as well. What else can you do in that situation. I am going to have surgery next monday and do dread the question of what level from 1-10 or 0-10 my pain level is. One time i just made up a bunch of numbers and told the nurse to use those for the next day instead of asking me. I always have to compare it to previous pain . It changes as I have a discography or last summer when my nerves were wrapping around a screw and i couldn't put my leg down for a second. so what event do i compare it to for next week!!
judy

Best of luck with the operation next week, I will keep my fingers crossed for you. Can I ask why you have so many problems throughout your spine, is there one single cause or catalyst behind it all?

I nearly had surgery 5 years ago but the surgeon changed his mind at the last minute, at the time I couldn't make my mind up if I was happy or disappointed with getting sent home, but in hindsight I think he was right not to go ahead.

[jsewell]

My spine battle does not seem to have one factor in it, just a series of bad luck and maybe some weak bones thrown in there. I first had severe degeneration in my cervical spine which ended with weakness in my left arm when my surgeon said it was time for surgery after the conservative measures had been exhausted. that was fusion of C4 thru C7. Then i started having some pretty bad pain at certain times when i had run uphill for like an hour. At first rurning around stopped the pain , at the point of surgery maybe 2 years later i couldn't even make it through the flat grocery store without needing to leave in pain., I had discography to prove that some discs in thoracic area needed to be removed. It just went on from there, I have had lots of fractures, big and small, developed severe kyphosis in my spine that was effecting my lung capacity. I already had damage through the doc who did the thoracic surgery damaging the nerve that controls the diaphragm muscle so i didn't tolerate any more. Then i needed extensive surgery to repair a bad broken neck i suffered. I won't bore you with them all, i probably already did. But they are all kind of for different reasons and none were adr's as i already have osteopenia.

Anyway thank you for the thoughts for Monday, i am kind of excited and kind of scared, i have never had anterior surgery so it is all new to me!!!