Why Rating Your Pain is Important

When patients complain of pain to their doctors, the first question usually asked is "How would you rate your pain on a scale from 0-10?"  Although on the surface, this appears to be a relatively straight-forward question, there are actually many factors that impact the individual's response.

Why do doctors ask about pain ratings? Doctors are interested in your pain rating for a number of reasons.  First, the quality of your pain can help give hints as to what is the pain generator.  For example, burning, tingling, and shooting types of pain can be indicative of nerve damage or compromise.  The location of your pain is important as well, as this can give a doctor valuable information about the medical issue.  Poorly localized pain described with the words squeezing, cramping, pressure, or deep can point to organ dysfunction, fibromyalgia or lupus, while well-localized pain described as dull, achy, throbbing, and sore can foretell a musculoskeletal injury, or CRPS.

Besides the quality of the pain, doctors want to know the intensity or strength of your pain.  Questions of intensity help make pre and post-comparisons of various treatments as a way to objectively describe pain levels.

Visual Analog Scales ask the patient to draw a line to signify the intensity of their pain that is then measured with a ruler.  Solves the ratio problem, but patients generally do not use the full length of available values.

 

 Visual Analog Scale

Numerical Rating Scales ask patients to quantify the strength of their pain using numbers spaced at fixed intervals.  Although this is a very common method of rating pain intensity, there is a misconception that differences between numerical labels are equa (ratios), making direct comparison difficult.

Functional Pain Rating Scales tie pain levels to functional activities.  These occasionally offer a much richer description of how the pain is impacting your ability to live life and care for yourself. Below is an example of a comparative rating scale adapted from from A. Rich, Lucile Packard Children’s Hospital.

 

So, the next time your doctor asks you to rate your pain level, keep in mind what he or she is really asking and use a pain rating scale that fits your needs.  For more information go to restrainyourpain.com or follow us on twitter @painrpa

Comparative Pain Scale
	0	No Pain. Feeling Normal
Minor Does not interfere with most activities. Able to adapt to pain psychologically and with medication or adaptive equipment	1 Very Mild	Very light, barely noticeably pain, like a mosquito bite or poison ivy itch.  Easy to forget about the pain
	2 Discomforting	Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using fingernails.
	3 Tolerable	Very noticeable pain, like an accidental cut, a blow to the nose drawing blood, or a doctor giving an injection.  The pain is not so strong that you cannot adapt to it.  Eventually, most of the time you don’t notice the pain
Moderate Interferes with many activities. Requires lifestyle changes but patient remains independent. Unable to fully adapt to the pain.	4 Distressing	Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma or part of the body, such as stubbing a toe.  This is like firmly pinching the fold of skin between the thumb and first finger with the other hand, using fingernails.
	5 Very Distressing	Strong, deep, piercing pain, such as a sprained ankle or mild back pain.  Not only do you notice the pain all the time, you are now so preoccupied with managing it that your normal lifestyle is curtailed.
	6 Intense	Strong, deep piercing pain so strong it dominates your senses and impairs cognition.  Difficulty holding a job, maintaining normal social relationships.  Similar to a bad non-migraine headache
Severe Unable to engage in normal activities.  Person is disabled and unable to function independently.	7 Very Intense	Same as 6 except pain completely dominates the senses causing unclear thought more than 50% of the time.  Similar to average migraine headache
	8 Horrible	Pain so intense you cannot think clearly at all, and experience significant personality change similar to behavior during childbirth.
	9 Excruciating Unbearable	Pain so intense you cannot tolerate it and demand pain medication or surgery, no matter the side effects or risk.  Complete absence of joy, similar to throat cancer
	10 Unimaginable Unspeakable	Pain so intense you will go unconscious shortly.  Most people have never experienced this level of pain.