The Adult Pain Scale
Misusing this assessment tool makes me feel like my eye is going to start twitching
Being in pain is difficult for many reasons. Pain hurts, prolonged pain is exhausting, and new pain can be scary. Unfortunately, pain is subjective, and healthcare providers need to know what your pain is like and how severe it hurts by asking you.
Many factors go into how someone feels pain- its really not cut and dry. Certain conditions will cause different qualities of pain, which is why providers need to know if your pain is achy, stabby, sharp, etc… Providers need to know when it started, what makes it better or worse, and how severe it feels for you.
There is truly no way to know how much pain someone else is in. Cultural upbringing can influence how someone shows pain outwardly, especially if they are more stoic. Someone with chronic pain will probably tolerate acute pain better than another person who is not used to pain as part of their daily life, and may continue to function despite hurting significantly. On the other hand, if someone is feeling anxious, they may respond more dramatically to the same amount of pain.
Healthcare providers have a challenging job when it comes to assessing and managing your pain. I remember years ago, I hurt my back and couldn’t sleep that night due to the pain. I went to the ER the next day, and couldn’t even drive myself. Thankfully, the hospital gave me a room pretty quickly. When the doctor walked in, I smiled because I was so happy to see him and have my issue fixed. I told him my pain was 7/10 and described it to him.
The doctor assessed me for a few minutes, told me it might be sciatic pain due to the location of my pain, told me that most people with that condition have severe pain and that I didn’t look like I was in that much pain. My heart sank. We spoke for a few more minutes, I was given a shot that did nothing for my pain, my friend picked me up, I took my Rx for muscle relaxers, then thankfully slept soundly the rest of the day and felt better after about a week.
Other than childbirth, that was the most pain I had ever been in, but I didn’t look like I was in a lot of pain? Probably because I compartmentalize well, and was hopeful for relief when the doctor first walked in. I 100% do not blame the doctor for not understanding my pain, because pain is SUBJECTIVE. You cannot tell how much pain another person is in.
I also do not blame the doctor for misunderstanding my pain because patients misuse the pain scale all… the… time.
When I ask someone how much pain they are in, on a scale of one to ten, I keep it simple because I try to be compassionate and professional. However, I wish that I could tell people that a 10/10 (ten out of ten) pain is like having a baby, or being mauled by a bear.
Things that make my eye twitch:
- I ask you how much pain you are in and your family member answers. No. Just no. I will not document a family member’s answer if the patient is a competent adult.
A family member may be able to tell that their loved one is in pain, but not how much it hurts or what the pain feels like. This is a hill I’d die on because pain is subjective! Now, if a family member wants to help, tell me if you think something is having an impact on their pain- did they take or refuse to take medication or other substances for their pain? Do they have a history of chronic pain or other medical conditions that may influence their pain? Do they have a habit of trying to be strong? That’s great information! But don’t tell me how bad their pain is- you don’t know.
- I ask you how much pain you are in and you tell me that it’s a 20/10. I guarantee you that if you understand the pain scale, your pain is not a “twenty out of ten.”
On the adult pain scale, a “1” is mild pain, a “5” is moderate pain, and a “10” is the worst pain that you’ve ever felt in your life and that it couldn’t be any worse. Being stung by a swarm of bees while being struck by lightning wouldn’t make a difference because you’re already in too much pain to notice. If you tell me 20/10 pain, I will document a 10/10 and report to the nurse or doctor that you have 10/10 pain.
- I ask you how much pain you’re in and you tell me “a little bit.” When I ask for clarification, you tell me it’s a “7.”
I always document what my patient tells me, but a 7/10 pain is not “a little bit,” it is actually worse than a moderate amount of pain but not quite the worst pain you could feel. If you have a little bit of pain, tell me something between 1–5 to be accurate.
- I ask you how much pain you’re in and you tell me 10/10 while playing on your phone or snacking.
Actually, this last scenario is tricky- as I’ve said before, people who live with chronic pain function despite being in pain. However, the number of people who tell me they have 10/10 pain while having completely relaxed body language and patterns of speech astounds me.
I often wonder what makes a person give me whatever number they choose. I remember a patient told me once that they had a little bit of pain, then gave me the number 7. I tried to clarify that a 7 really isn’t a little bit of pain, so he told me that he tolerates pain well, and that to another person they would probably be a 7/10, so that’s what he told me.
Honestly, I was thankful for an explanation and took a few minutes to educate him.
We need to know how YOU feel, not how you think someone else in the same situation might feel. As I’ve said many times already, we all feel pain and respond to pain and tolerate pain differently.
My husband thinks that I have a low pain tolerance, because I often complain whenever I have a headache. I reminded him that when I had our baby, we showed up at the hospital and I was already dilated 7 cm, and was initially told that I waited too long to come to the hospital to get an epidural. It was our first (and only) baby, and I never went to the hospital thinking I was in labor before I was actually in labor either. His response was that “that’s different.” Despite the fact that I tolerated contractions for most of a day- went to work even, he still thinks that I have a low threshold for pain because I don’t like headaches.
As I’ve said before- a family member cannot know how much pain someone else is truly in!
Another reason I suspect that so many people are quick to tell me that they are in 10/10 pain is because they want pain medication. Please, please, please- just give us an honest answer and ask for pain meds! If the doctor thinks it is appropriate, they will give you medication. If they don’t think it is appropriate, they will not- saying that you have 10/10 pain doesn’t guarantee pain medication. Please, just give us an honest answer!
Pain treatment is tricky- is it muscle pain? Nerve pain? Cancer pain? Does the patient have a medication tolerance? Are they drug seeking? Is their anxiety making it worse? Would heat, ice, elevation, compression or a different position help? Which type of medication is most appropriate?
All I ask, is that the next time you are asked how much pain you are in, if you think it’s a “little bit,” pick a number between 1–4, or if moderate, 5–6. I don’t like to see anyone in pain, but we need an accurate answer to help you!
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