Pain

Despite efforts to make people’s perception of pain quantifiable or more objective (think all of those pain scale ratings, zero being no pain and 10 being the worst), how people experience and rate their pain is totally subjective. Some of us have higher thresholds for pain, while others are very sensitive to any discomfort. I don’t know where I fall on this spectrum, but I do know being asked to rate my pain is challenging and often useless.

For one thing, I know the numbers I give will affect Medicare’s coverage for procedures, especially for PT. So, I have to start with a relatively high number so I can show progress (or lack thereof) to justify my treatment. At one pain clinic where I was being treated for back pain, I was encouraged to rate myself high on the pain scale before receiving treatment and low after to indicate that the injection was successful. What no one ever told me there was that, at one point they wanted me to fail to justify a more expensive procedure, so they did not give me anything more than lidocaine. Once I saw what the plan was, I found a new doctor.

A quote I particularly like, often attributed to Einstein but probably originating from William Bruce Cameron, tells me, “Not everything that counts can be counted, and not everything that can be counted counts.” I usually apply it to standardized testing, but I think the pain scale is also a reasonable application. I often ponder if 6 is good enough to be taken seriously. Should I say 7 or 8 or even 9 to get some treatment?

While I appreciate the need to measure pain to assess progress or lack of it in treating something that is hurting me, especially as I age, I find the need to quantify it bewildering. Also, if the answer I give relates to the medication I will receive for pain relief, I fear some of my doctors are too quick to prescribe opiates if the number I give is on the high side, while others will only suggest only Tylenol for a rating of 5.

All of this leaves me confused when asked, “How do you rate your pain?” Recently, I had a very sharp pain in my shoulder that rendered my left arm useless. For that one, I told my pain doctor’s scheduler I was a 9, which resulted in an appointment in a few days. But at my age, something always hurts, and living with a lower level of pain is the norm. The number I assign to my pain depends on the result I hope to achieve in seeing a doctor and receiving treatment.