Pain needs an objective measure

As someone who suffers from chronic pain it is one of my great frustrations when doctors/nurses ask you to rate your pain out of 10 without providing any context to enable an accurate reporting.

The problem is if I say that my pain is a 7 I am providing a response based on my history and experience of pain and what I 'think' pain at that level would be like given my history. It is an appalling measure because it actually tells the clinician very little about what the pain is actually doing and how it affects the individual - and I have repeatedly seen and experienced zero follow up questions to gauge why the person rates it that way.

Why is this so bad? Mostly because it provides a subjective response by the patient, which is then subjectively interpreted by the clinician based on their own (different) experience of pain and what they believe any particular rating means.

What's the problem with subjective interpretation of a subjective rating?

Glad you asked.

The problem is the clinician may feel a rating of X is no big deal, and take the view that someone is over-reacting and just needs paracetamol tablet. What they fail to understand is that the individual who rated their pain as a X interprets that to mean that their pain has passed the point of being bearable and is having a major impact on their lives - they don't rate higher because they have experienced a major trauma in the past which was more painful than this - so they base their rating on that experience which the clinician knows nothing about.  In this scenario, the clinician if they were experiencing the same pain may have rated significantly higher - but they hear the number X, roll their eyes and tell the person to go home and rest... Yes, I have experienced that.

So what is the solution? If everyone experiences pain differently and reports pain levels based on previous experience etc. how do we get a measure that is more objective?  Well pretty easily actually.  

What we need is for all doctors, nurses and clinicians to be reading from the same script.  What we need is for them to ask patients to rate their pain on how it actually affects their ability to function in day to day life.   

I first saw a similar rating system to this provided by a member of a chronic pain support group I am a member of, but this is by far the best I have seen.  Yes it still gets a rating out of 10, but the rating has a clear explanation of what that actually means, which gives the patient an objective way to report what they are actually experiencing and the clinician some actual context and understanding.  It also gives a starting point for clinicians to ask further follow up questions. 

Now of course this rating system isn't perfect. However this is a million times better than a smiley face chart or a question asked without context.   It allows the patient and the clinician to both understand what is being said when a patient rates their pain.  

If all hospitals, GP's specialists etc used a standard pain chart like this, I believe it would see a huge leap in understanding.  When everyone is working with the same understanding we may actually see treatment appropriate for the pain. 

Some will want to point out to me that medical professionals are given training to understand pain like this chart describes - the problem however is that they never show their patients the chart and as a result patients report based on subjective experience, which doctors then misinterpret.  How do I know? I have been a pain patient for 16 years and have never seen anything like it before today, even in a pain specialist's office. But I have been asked countless times to rate my pain out of 10.  Without a clear understanding of a scale like this, very few people for example are going to rate their pain as a 4 out of 10 if it is so bad they can't adapt to it and it never goes away as described in the chart, without the context provided 4 would to many seem a very low for that kind of pain. 

I know that using a tool like this won't be a magic fix.  I have seen and experienced the doctors who refuse to believe your pain level no matter what you say.  I have seen the doctors who refuse to prescribe medication no matter the clinical need and make excuses about how the government sends nasty letters.  I have seen the doctors who are more interested in assuming people are addicts and giving them lectures rather than helping them. Having a chart like this to work from won't stop the lazy and incompetent doctors/nurses do better, but for the vast majority who genuinely want to help their patients it will be a good objective place to start as they work together to find the right treatment.

So I intend to copy this picture, take it to my doctor, encourage them to use it with me and with other patients when discussing pain.  I intend to explain I want to use it because it provides a clear objective place for us to start a conversation about your pain. Maybe you'd like to as well?