Perception: The Pain Scale

I lie in my hospital bed, shaking and screaming in pain! Alarms are blaring. My heart rate is in the 160's, my blood pressure is 200/120 and my breathing is too ragged for the vital's monitor to record. My pancreas is erupting in pain. I think I may just die. I can feel the digestive enzymes eating away at my pancreas. I have pressed my call light button. I pray, "Please God, send someone quickly!!!"

Ten, twenty, thirty minutes pass. Finally my nurse enters my room. I have my knees to my chest; tears streak my face. I struggle to speak from the intense pain overwhelming my senses. I choke out the words, "PLEASE...I'M...IN...PAIN! PANCREATITIS...ATTACK! WORST...PAIN...OF...MY...LIFE!" My nurse seems unconcerned. She asks, "On a scale of 0 to 10, zero being no pain and 10 being the worst pain of your life, how would you rate your pain?"

And let's stop the story right there. The above encounter has happened numerous times when I have been in excruciating pain--bowel obstructions, pancreatitis attacks, sepsis, etc. I try not to get aggravated by the pain scale question, but somehow being asked, when I am clearly in severe distress, what my pain level is on a pain scale really annoys me. I know, I know the pain scale is used to gauge a person's pain. But really, when you get to around an eight, nine or ten, pain will start to manifest itself in tears, screams, shortness of breath, an inability to speak without screaming or gasping for breath, etc. Additionally, one's vital signs will begin to signal the patient is in distress.

I can see the benefit of the pain scale when a person's pain is a one through seven. The pain may be annoying or very troublesome, but it is not exhibiting itself in obvious outward signs. A person with a frown on his face may be in pain or may be in a bad mood from a night of little sleep in the hospital. Until pain can be recorded as a vital sign, the pain scale is often helpful in these situations.

Moreover, the pain scale is mostly one of perception. The number ten on the pain scale is supposed to be "the worst pain of your life". I have issues with this terminology. I have been in many situations of EXTREME pain which I rated as ten. Now, were the pain events actually "the worst pain of my life"? The answer is no. Were the events such traumatic experiences in which you would give up all your possessions at that moment for pain relief? The answer is yes. Does it really matter if the pain you are experiencing is actually the worst pain of your life? The answer is no. You are in debilitating pain and are in desperate need of urgent pain management.

Also, there are some folks who have never had bad accidents, infections or injuries. A person may be in the worst pain of his life, and rate his pain as a ten. However, he is calmly watching television and visiting with family. Next door to this patient is a person with numerous fractured bones who also rates his pain as a ten. He is screaming in pain and has vitals which signal he is in severe distress. An important lesson to note, the pain scale is just a guide. The medical professional reviewing the information must use common sense if the pain number given corresponds with signs and symptoms.

And this is where I will leave this post: if you are a medical professional, and see a patient writhing in pain, in clear distress, screaming, crying and vital's monitors blaring, don't ask what number they are on the pain scale. Simply say, "It looks like you are in a great deal of pain. Do you think this might be a ten on the pain scale?" The patient can nod his head if the answer is yes. If the answer is no, he can correct you. Either way, you will give tremendous comfort to the patient with these kind words which exhibit your understanding the patient is in significant pain.