Madwolf, RE: Rating pain

Discussion in 'Fibromyalgia Main Forum' started by karen55, Jan 29, 2003.

  1. karen55

    karen55 New Member

    I was reading your post under the "pain diary" post and you wrote:

    "Rating pain is difficult, and varies with each patient. I have one retired Green Beret who says a 5 is having to sew up his own machete cut without anesthesia. For me, real pain is 98 degrees, 98% humidity, 98 pounds on my back and 9.8 miles of a hike left to do before I can rest."

    This really made me think. Personally, I think I have a high tolerance for pain. I've been through endometriosis and all that goes with that, suffered from migraines for over 20 years, had 2 ruptured disks, 6 surgeries in a 10 year period, so many other things, I can't name them. And now the dx of FMS and CFS. I honestly believe that the pain I rate at a "4" would be considered much more severe by a "normal" person, if you get my meaning.

    So my concern is this: When patients are asked to rate their pain, they are telling the medical professional what THEY consider it to be. Who's to say that the medical professional won't perceive a pain rating very differently from the person who is IN pain? Am I making any sense here? In other words, people who don't regularly have pain, who suddenly have, say, an injury like a broken bone that is causing them a lot of pain, would probably rate the pain at a 9 or 10. Okay, those of us who have been in pain daily for months or years "get used" to feeling the pain, and IMO, the rating they give their daily pain is probably less than the average person would. So, having said that, isn't it very possible that there's a lot of room for misunderstanding the severity of someone's pain?

    I've had doctors who have told me "oh, well you've had endometriosis and been through childbirth, you can live with THIS pain". How callous! My neurosurgeon once told me "you know what the ruptured disk feels like, so anything you feel now is nothing compared to that so you can handle it".

    I went to the ER a year ago after accidentally slicing the tip off my index finger with a sharp knife. It hurt, obviously. The person who was taking down my info told me to rate my pain. Then she sarcastically said "I just know you're going to tell me it's a 10, right?" I think I shocked her with my response, which was "I KNOW what a 10 feels like and this isn't a 10, but that doesn't mean it doesn't hurt a lot".

    With so many opinions/perceptions/ideas of exactly how severe pain is to each individual and what it "should" feel like at a 4, 6, 8 or 10, even with the rating, how can you be assured of conveying the severity of your pain?

    Did I totally lose you on this one, or is this making any sense to you?? I really would appreciate answers, from you or anyone else here.
  2. Annette2

    Annette2 New Member

    Every time I go to my rheumy, I fill out a questionnaire that also asks me to rate pain. Even though I also think I have a high tolerance for pain, I don't use that as a guide. If I feel really bad, I put a 9 or 10. I don't see the point in hiding how bad I feel from my doctor - if I do that how can she treat me? I don't feel I am "used to" this pain - it's horrible and it's not like going through surgery or childbirth. It's daily pain that almost NEVER goes away. I want her to know that! I WILL NEVER GET USED TO THIS PAIN!

    Annette2
  3. karen55

    karen55 New Member

    what both of you are saying, I guess I'm just wondering if, for example, one caregiver may mentally feel that a "5" is not so bad, whereas another may mentally feel that it is. I know that a "5" is considered moderate pain, but I guess what I was trying to say above was, if *I* say my pain is a "5", in my mind, I want relief, because it's constant pain, but in someone else's mind, a "5" might be controlled with OTC medications. I guess that's were I was going with this, how medical people feel about what to use for pain control at a given pain level.
    Geez, seems like I'm still not really saying what I'm trying to! I just think there's a lot of room for error, or misunderstanding on the part of medical personnel in giving adequate treatment for pain control.
    Like today, the nurse asked me what my pain level was at that moment, and I told her it was a "5", and she said "oh, not so bad then". Well, it was a "5" two hours after a Lortab and a Soma, and that's about as good as it gets lately. [This Message was Edited on 01/29/2003]
  4. tandy

    tandy New Member

    Give MY example of a 10.
    For instance I'll rate my pain a 6 or 7,with 10 being childbirth!!because for me....thats some rough terrain!
    I think I have a high tolerance too. I have endometriosis and FM,herniated disks,arthritis in my neck,muscle contraction headaches,etc. One time when I FINALLY went to the ER for stomach pain(2 yrs ago).I walked in a said"I have real bad stomach pain, I think its my endo but I'm not sure because its on the right and I usually have this endo pain on the left"..... So this pain to me,I felt just as severe many times~ Well thru bloodwork and a ultrasound it was my appendix about to rupture.I was taken right away to surgery and remained in the hospital for 5 days!! Now,if you read the symptoms for appendicitis,THEE number one symptom would be severe pain on the right,fever,nausea,etc....I have that severity of pain all the time.Too me thats not severe!!weird huh? so your right,everyones rate of pain can be entirely different from the next person. I guess its sorta good and bad to have a high tolerance for pain. I waited it out with my pain that day...all afternoon and into the eve.Its a good thing I decided to get it checked out~ It could have been worse~
    regards,
    Tracey
  5. starstella

    starstella New Member

    Especially when you are told, "if a ten was the worst pain you could imagine...." Well gee, it I was stabbed with a butcher knife, that could be a 10, or when I woke up from anesthesia after having a surgical incision from breastbone to pubis, that was sure a 10,so how do I equate my pain with that? Any number I would give would sound minimal compared to "the worst pain I could imagine" and then I might be told my lower number pain didn't merit a pain med prescription. What a dilemma.
    I prefer the smiley faces also, at least they convey something regarding how you feel emotionally.
  6. SCARLETT415

    SCARLETT415 New Member

    Having been asked that question hundreds of times over the past 20 years, I have to agree that Madwolf's smiley face ratings have been the best I have been able to relate too. My physical therapist's office uses this method and I's alot easier. I know exactly what you are trying to say Karen.

    Annette(3)
  7. karen55

    karen55 New Member

    everyone would use the smiley faces rather than the numbers. I've never personally been anywhere that DOES use them, but I can relate better to that than a number. Mine would be frowning this morning. :-(
    [This Message was Edited on 01/30/2003]
  8. tandy

    tandy New Member

    That is too funny!!LMAO I won't even try to imagine that pain! Heres one more example of mine....(it'll be shorter than the last I promise!!)
    Having being used to pain over the yrs,...when I delivered my last son,I walked into the ER at 4:20 am and said "I'm ready to deliver"....I was holding my baby boy at 4:42!!!The dr. did'nt even make it there,the two nurses delivered my baby~ (obviously I had thought we had more time.....glad we did'nt thou!) I've seen the face rating used after two or three surgerys of mine-That seems to be the best way to go~
    Good day to everyone!! The sun is shining here!!!
    Regards,
    Tracey
  9. karen55

    karen55 New Member

    Now why didn't *I* think of that?!? Seriously, I think I'll start doing that.
  10. PAT

    PAT New Member

    I don't know who Madwolf is, but you all seem to value his/her opinion. Here's how I feel.
    I saw a new doc and he asked the question.I said my current, and daily pain was probably an 8, sometimes a 9. He LAUGHED. He replied that according to his scale, a ten would have me curled on the floor in fetal position begging for a lethal injection. He was totally serious about this.

    He said if my pain was an 8-10, I would not be sitting in his office with a 'flat affect' on my face appearing as normal as anyone else in the waiting room. I would be in an ambulance screaming for IV drugs.
    I left the office in tears, and a few days later sent him a letter.
    I explained that I have grown quite used to appearing 'normal' while I carry on with my daily life. If I ACTED the way I truly FELT, I would, by golly, be in a corner, in a fetal postion, begging for death.But I can't very well raise 5 kids and behave this way. That is why I take Ultram 3 times a day, and way I have a flat affect; to keep from screaming.
    I have had 5 children WITHOUT an epidurals. I didn't cry, I didn't scream, I didn't make a single sound at all except for the sound of my breathing as I zoned out.Labor pain IS A TEN on my personal scale. Ask any woman who does it drug free. And don't ask her after the baby is born. Ask her WHILE she is delivering.
    I also grew up in a home where I was not allowed to show emotion. I actually got kicked out of a select school choir for singing with such a bland look on my face. So, doctors need to know a person before judging them. How many chronic pain sufferers really go around with a perky smile on their face?

    So, when I say, I am having a level 8 day, you'd better believe I am hurting, and I don't need to have a public display of agony to prove it.
    I hate those stupid scales.
    Patti G
  11. PAT

    PAT New Member

    hello, I just read your profile, glad to meet you! I used to come to the board a lot; now just here and there. It's nice to be in a place where others understand this warped place we're in.
    I had to laugh about the smiling level 8 patient. She is fortunate to be capable of grinning through the pain!
    I meet people, and most first impressions of me are that I am unfriendly or a snob. I am not. I am just concentrating so hard most of the time on a comfortable sitting/standing position, whether or not I took my pain pills lately, hoping I don't say something goofy, or forget what I was saying... It is sad that I have to spend so much mental energy on my physical self, that I am not seen as a friendly person until someone gets to know me.
    I am in a little bit of a depression right now, so I guess I am thinking "darkly."
    It is helpful to keep the spirits up, and I try to most of the time!
    This time of year is rough on my body with the MO weather, wet and cold, then warm for a few days, then cold again...
    Well, have a good day! Patti G
  12. looneytunes24701

    looneytunes24701 New Member

    i totally understand what you're saying because i have lived with this pain for at least 20 years now. so i am used to some of it. but that doesn't mean it doesn't wear me down. i would rate my pain around a 5, but in all reality it is probably an 8 or 9. what type of meds do you take for pain if any? (if you don't mind me asking.) thanks-tina
  13. karen55

    karen55 New Member

    I take Lortab 10/500 and Soma 350, 3 to 4 times a day. At night I take Zanaflex and Elavil to sleep. For the first time in my life, this week, I had to take 2 of the Lortab 10's at once for pain relief, 2 days in a row. This seems like a lot to me, but I know there are others who take stronger meds. It's frightening to me that I had to do that; does it mean my pain is worse or that the meds aren't working? I believe the pain has been at it's worst the last few days, no idea why, but I'm also concerned about the effectiveness of the meds. So far this morning is not shaping up any better. I've been at an 8 for a few days now. Hoping for things to get better this weekend.

    Karen