4 Helpful Way To Communicate About Pain Beyond the
Pain Scale
Let’s talk about the Pain Scale today, shall we? As a patient, I HATED them. I would go into an appointment hoping to talk about how the pain was affecting me and my life and my ability to function, and instead, I would be asked for a number. It felt like I had to produce these numbers all the freaking time – and it became clear there were rules about the numbers you could and should give to be taken seriously. Know what I mean?
A common experience I had as a Patient
Medial Professional:“On a scale of 0-10 , 0 being no pain at all and 10 being the worst pain you have ever experienced, what would you rate your pain today.”
Me: “9/10”
Medical Professional:” Are you sure? A 9 is really quiet bad and it would be hard for you to be talking to me at a 9…..”
Me: “ How about you pick a number then? You said 10 being the worst pain I have ever experienced, I was answering your question.”
Seriously, I had more than one conversation like this throughout my years in pain. Clearly 9 is too high, 3 is too low. The sweet spot seemed to be a 7. High Enough to get attention and treatment, but not so high that they thought you were faking. 5 low enough to keep getting treatment at Physical Therapy, but not low enough to be discharged while still not functional.
I have had enough other conversations with people in pain to know I am not alone in thinking this is not a very helpful way to communicate with anyone about pain. Ever wonder why we are asked seemingly endlessly to rank our pain on a number line with smiley faces?
So, why is the pain scale used all the time?
In the late 1990s, the VA hospital system had a concept of pain as the 5th vital sign. By 2001 a Joint Commission decided this was a terrific idea and a great way to improve the problem of pain in America.
The idea was hospitals were under-treating pain, and by constantly assessing pain, medical professionals would be able to closely monitor and treat their pain. Sounded like a good idea at the time, I am sure.
However, it has had a cascade of unintended consequences. One of those consequences was a cultural shift in the hearts and minds of people to think that all pain should be able to be erased immediately at the hands of a medical professional.
A second consequence would be that the right amount of medication or treatment should “fix” the pain. Amongst a bevy of other issues for another blog post! If you are a curious one like me, take a gander at this blog post here on the other issues. Super fascinating if you ask me.
As a result of all that, we get asked, because pain is now a vital sign and it must be taken, every shift.
What about the Pain Scale obsession and my Physical Therapist?
Remember medicine doesn’t happen in a vacuum, it all works with similar rules and overlap. So, when you go in for a PT evaluation because of your pain, I would be fairly certain in most clinics one of the goals that have been set for you is a pain goal. Not all, but many will have one.
Whatever number you gave at your eval then becomes a goal for discharge. It is a way to tell an insurance company how you are progressing. This becomes an issue when our function may be improving faster than our pain number is changing.
See what I mean? That number we toss out has meaning to someone, just not us.
Another Unintended consequence of the pain scale is loss of focus
Focus is an important thing. So I ask you, would you rather your medical professional focus on your pain, or focus on returning you to function? When the focus of care is on lowering a subjective number, treatment becomes about procedures and medications. However, when care is focused on returning to activities, hobbies, and movement, treatment becomes about how to move, pacing, and problem-solving. Pain can’t always be solved, but life can always be improved.
The approach I use is to help you change your pain by changing the focus of treatment. I want you to return to the things of value to you. I don’t want you to be in pain either, but honestly, if that approach had worked, you probably wouldn’t have found my blog looking for a way out of pain. Right?
I recently read a fascinating case study on a teenage girl in crazy making amounts of pain. Her whole life had been disrupted by pain, She was on a medical merry-go-round equal to that of many of the adults I have spoken to. Cool thing was, someone decided she needed a different approach. Less focus on pain, more focus on living.
This young lady went from needing her mother to bathe and care for her to return to sport! It took some time for her to learn, but as she applied and practiced what she was learning, her function increased and her pain decreased. Within a year after her program, she was living life as a “normal” teenager without pain.
WHAT?! Yup… read it here – so interesting and so applicable to you and me.
An improved pain scale, Let’s have a CHAT
As a clinician, I strongly dislike the pain scale. However, I had to ask. Almost every patient had a pain goal at all the places I worked as a PTA.
When the focus is on a number it’s hard to focus on what really matters. Helping you get back to the things you love! Having to use a pain scale at work, became very frustrating so I combined a bunch of them and made my own. I wanted to know HOW pain was affecting their lives, not just a number.
So let’s CHAT about pain! Here are 4 ways to improve on the pain scale and our ability to communicate about our pain. Thanks to Pelvic Healing on Instagram for the acronym!
C: Capacity
Firstly, describe how does the pain interfere with your function? What is it you can’t do anymore because of the pain? Sitting for more than 15 minutes, driving the kids to activities, where you park to grocery shop. This is about what you have stopped doing due to your pain.
H: History
Second, give the facts. How long has it been going on, where is it located, what treatments have you tried, and the results? Think bullet point list.
A: Analogy
Third, describe your pain any way you want to communicate how it feels to you. Fire ants, stabbing knives, cracking your skull open, annoying neighbors – use analogy or comparison. “It’s like giving birth but the baby never comes.”
T: Timeline
Finally, Explain how your pain behaves. What is it like in the morning, afternoon, or evening? Anything that makes it better? What makes it worse?
These 4 elements should now enable you and your providers to have a more robust conversation about how your pain affects you and not just a number on a pain scale. As a result of your conversation about how your pain is affecting you, you give the number context. Because at the end of the day, if we could figure out how to do the things we love and miss, I’m confident in saying our relationship to our pain would also change.
Perhaps we would learn to move beyond it.
I’ve made a cheat sheet for you so you can CHAT with your Medical Team about your pain.
If you would like help returning to the things you love and care about like the young lady in the case study, book a coaching package with me, and let’s get you on the road to healing.
1: Click on work with me
2: Choose the Coaching icon
3 Book your discovery call
And I’ll be in contact with you. Can’t wait to meet you and start the next part of your Journey!
For those interested the conclusion of the study I referred to was the following:
“Although Andrea’s case is an extreme example, her experiences of spending years seeking a satisfactory medical diagnosis and treatment to eliminate pain, and progressive disability in multiple areas of functioning mirror that of many adolescents who experience chronic pain.
Fortunately, Andrea was ultimately referred to an interdisciplinary treatment program encouraging her to discontinue medications causing side effects and helped her and her family learns and implement strategies of increased coping in the context of pain and re-conceptualizing the treatment goal to be fully functioning.
For the millions of individuals experiencing chronic pain, it is imperative to have discussions about comprehensive approaches to pain management and the importance of including quality of life and overall functioning as treatment goals, which are just as important, if not more so, as alleviating the pain itself.”
