Health care providers use a scale of 1-10 to gauge people’s pain to assist with triaging. The typical pain scale cheat sheet (in case you didn’t know what a five is) rates things between mild and severe with hints to help you determine your number, like the extent to which it interferes with your life.
I prefer the modified, humorous ones that make the rounds among folks who deal with pain on a daily basis.
Ten is relative. Like spinal tap, you can dial it up to 11.
But like so many other measurements, the pain scale only captures one axis. On the blog, Minor Revisions, the author illustrates a migraine pain over time.
http://minorrevisions.blogspot.com/2006/11/please-see-figure-1.html
Did you know that there actually is a medically defined separate axis for pain over time?
- Pain < 1 month = acute.
- Pain 1 – 6 months = subacute.
- Pain 6 months – forever = chronic.
You hardly need to have graduated from preschool to understand that persistent never-ending ANYTHING increases your negative feelings exponentially. This holds true for annoying things like being trapped on a plane with a screaming child to enjoyable activities like mint chocolate chip gelato on a hot day. A small amount can be savored (mint chip) or tolerated (obnoxious child). You continue consuming or being exposed to the same continuous thing over time, however, and it becomes torture. You multiple that a few times and your graph is soaring.
So now imagine even a trifle sensation: lets say a minor but nagging itch and think about how it would feel after a few hours. Then imagine trying to sleep with the irritation. You wake up, and guess what? Yep, still itches. What about another whole day or two? Think about how it would wear at you, distract you, disinterest you in other things. Let it really get to you, day in and day out. Imagine going to the doctor repeatedly over the next week or two, trying creams and ointments that may reduce the itch for a bit, only to have find yourself scratching an hour or so later. Picture the relief when you Benadryl yourself into an itch-free slumber. Think about how creative you might get about changing everything in your lifestyle – your diet, your clothing, your products, your routine all to try to oust the source or allergen. What has it been? three maybe four weeks. It sounds horrifying, doesn’t it? Guess what? You’re still only in acute pain, buddy.
Once you move to sub-acute you begin to find that doctors’ schedules are suddenly busier and getting your follow-up appointment becomes tricky. This is around when you start considering alternative practices and ‘whole body’ work. In parallel you are seeking both diagnostics and treatment. You want to know why this is happening so you can prevent it, but you need to continue to treat the symptoms. At a certain point, I believe it must be before you even get to the chronic category, you stop caring about the reason for the itch, and you just seek the relief of what ever symptom reduction you can get.
What also happens over time? People get tired of hearing you complain about your itch. It may be the only thing you can think of, but it’s tedious for everyone else around you, too, now. So, what do you do? You hide it the very best you can.
But sometimes, that itch gets the better of you, and you break down crying and scratching and maybe even head to see the doctor. The doctor tells you that she cannot keep prescribing you the steroid cream that helps the itch go away because long-term use of the cream is bad for your health. Secretly, she suspects that at the rate that you’re going through the cream, you must be selling it to someone else. Of course, there’s really no other alternative, so she suggests you go back to over the counter ointments to deal with the itch.
An itch experienced for a few days or weeks will get you sympathy and treatment. The same itch experienced over months gets dismissal and suspicion.
You and I both know that it’s impossible to imagine what it might be like to have an itch that lasts for days, weeks, months or longer. It is just as unlikely that you can envision what it is like to experience pain for months or years. We cannot expect doctors to have any better idea than us, but the point of the scale is to inform the care provider the extent of the problem. So what if it were a two axes scale? What might that interaction look like?
What is the number of your pain? A four you say, ok. Now tell me, how long have you been feeling this four rated pain? Oh, ten months? Ten months???!!! Oh My God, that’s like a 400 on the pain scale. Nurse, get me the morphine STAT!!
Unfortunately, what tends to happen is that over time, doctors extract themselves from patients they cannot fix. Leaving the patients untreated, suffering, and turning to whatever eases the pain. You can read the numerous articles on the opioid ‘epidemic,’ but consider that unless medicine provides alternatives, what other options do patients have?