I've been lucky, pain-wise. The worst pains I've experienced have not been chronic; the pains that could reasonably be called chronic are not really that bad. And yet, reading what Elizabeth has written about variations in pain scales from person to person resonates with me. When I'm asked to rate pain, what do I rate it relative to? The worst I've ever felt, in which case I'll (hopefully) never again describe anything as being above a 5 or 6? Or on a continuum where 1 is nothing and 10 is "about as bad as I've felt recently"? And since my experiences with pain - both first and second hand - have probably been more extreme than most people, do I need to worry that if I rate something as X, when another might rate it as X+2 or X+3, I won't get adequate short or long-term treatment?
The Wong-Baker pain scale is a popular one, and defines each number in terms like "hurts a little bit", "a little bit more", "even more", up to "hurts worst". And they call this objective? Bull. Other scales define their points in terms of functioning - here, you're a bit distracted. There, you can't focus at all. Over there, you're writhing in pain, unable to even communicate coherently. This, too, is problematic; people's tolerances for pain are incredibly variable, in part based on their past experiences with pain, in part based on the kind of pain (for me, at least, a given amount of inner-ear pain is far more debilitating than the same amount of hip pain), and in part based on the phase of the bloody moon. While in some sick way, it makes sense to treat pain with a goal of allowing people to be functional, that just doesn't cut it. Someone with a high tolerance for pain may be - or seem to be - perfectly functional while they're in a great deal of pain. That pain may still need to be treated!
It's perfectly understandable that the medical community wants a way to record pain, to classify and track it. Unfortunately, pain is not a symptom that lends itself to objective verification, and attempts to approximate that need to be sensitive to the wide range of needs and experiences a patient may be coming in with. Anything else, however well-intentioned, runs the risk of alienating the populations that are most at risk - and failing to adequately treat their pain.
The Wong-Baker pain scale is a popular one, and defines each number in terms like "hurts a little bit", "a little bit more", "even more", up to "hurts worst". And they call this objective? Bull. Other scales define their points in terms of functioning - here, you're a bit distracted. There, you can't focus at all. Over there, you're writhing in pain, unable to even communicate coherently. This, too, is problematic; people's tolerances for pain are incredibly variable, in part based on their past experiences with pain, in part based on the kind of pain (for me, at least, a given amount of inner-ear pain is far more debilitating than the same amount of hip pain), and in part based on the phase of the bloody moon. While in some sick way, it makes sense to treat pain with a goal of allowing people to be functional, that just doesn't cut it. Someone with a high tolerance for pain may be - or seem to be - perfectly functional while they're in a great deal of pain. That pain may still need to be treated!
It's perfectly understandable that the medical community wants a way to record pain, to classify and track it. Unfortunately, pain is not a symptom that lends itself to objective verification, and attempts to approximate that need to be sensitive to the wide range of needs and experiences a patient may be coming in with. Anything else, however well-intentioned, runs the risk of alienating the populations that are most at risk - and failing to adequately treat their pain.
posted by ismith at 7:15 AM
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