Why the Ten Point Pain Scale is Useless

By: Jason Reid, Journalist

February 22nd, 2010 • Patient AdvocacyPrint Print

After spending 30-years with Crohn’s disease, a painful inflammation of the intestine, I have had more emergency room visits than many people have had summer vacations.  I have had kidney stones, gall stones, abscesses, intestinal blockages, dangerous fevers, toxic shock and acute arthritis pain just to give a few samples.

Inevitably, one of the first things an emergency room doctor asks me to do is to rate my pain on a scale from one to ten. Unfortunately, this scale says much more about a patient’s tolerance for pain than it does about the pain itself.

We all have different pain thresholds. Because of my illness, my threshold has always been rather high. I once went six months with a perforated intestine without missing a day of school. It was my last year of high school and I was determined to stick it out to get good grades for college.  When I did finally seek treatment the doctors were surprised I had been able to do anything- even walk- considering the rough shape I had been in.

This brings me to an important point. If you have never been in extreme pain, how would you even know what a ten-scale pain feels like? If a bruised toe is the worst pain you have ever felt, it may feel like a ten to you, but is that rating really useful to a doctor?

Let’s compare the same bruised toe to the upper end of my pain scale:

10 – Unconscious. I react to the most extreme form of pain like most people do. I pass out. If I am awake to hear the question – it’s not a 10.

9 – Shock. The pain is so bad that it ceases to feel like pain, but triggers a message to the brain that something is seriously wrong. All feeling seems to shut down. It is like being in a dream. What’s going on around you doesn’t seem real. All you can think of is that something is desperately out of sorts with your body.

That means, if I can answer the doctor – it’s not really a 9.

8 – Vomiting.   This is another common reaction to extreme pain. If the pain is an 8, I still can’t answer the question because I’m too busy keeping myself from losing my lunch.

As you can see, the doctor won’t likely get a response from me if the pain is any higher than seven. Seven is my threshold for even the most basic communication. This means at a seven I’m usually screaming my head off if I’m not doped up on morphine or some other opiate.  I associate this type of pain with things like acute kidney stone attacks.

So to sum up, if I can answer the question and keep from screaming at the top of my lungs, it’s likely a maximum of six on my pain scale.  But if I tell the doctor it’s a six, she likely won’t take the pain too seriously.

Moving to the lower end of the pain scale, I can’t honestly tell you what a zero feels like. I have been in some sort of discomfort for as long as I can remember.  I’d view my standard discomfort on a good day as a two or three.

The final problem with the pain scale is that it doesn’t differentiate between chronic pain and acute pain.  While pain at a four or five level is tolerable for me in the short run, after weeks or months it can really mess up my mind and body. It’s easy to get worn down day after day when dealing with pain. Not being able to sleep well, or even relax, tends to hamper my ability to deal with almost everything.

Unfortunately, short of getting into another person’s body, there is no accurate method of measuring most kinds of pain. Doctors can rarely do more than guess based on what they see and hear.  All I can hope is that when I ask for morphine they won’t laugh at me and imply I’m faking the pain to get drugs like one doctor did to me ten years ago.

More recent experiences suggest that hospitals are getting better at recognizing and treating pain despite the flaws in the ten-point scale. But I still sometimes worry that my biggest obstacle to getting pain relief is my own thick skin.

Jason Reid is an award-winning journalist and former news manager. He writes on success and chronic illness issues at Sick with Success. He also does public speaking and consults with business on these same topics. He works from his house on the shores of Lake Ontario near Toronto.


Heather Freeman February 23rd, 2010

YES. I have been trying to explain this to people for so very long, and you may have just given me the words to do it. My “10″ is measured against my experience with what was described to me as “the most painful labor complication possible” – the actual delivery was more like an 8. Like you, if I can talk without crying or screaming, it’s a 7. I have often wondered how much of my care has been compromised because doctors interpreted a 7 as less bad than it is.

Aviva February 24th, 2010

OMG. I’m printing this out and taking it to my doctors (and the next time I end up in the ER too!). I’ve been complaining, pretty much since I started dealing with chronic pain 15 or so years ago, about that damn pain scale.
I think it would be MUCH more useful to be able to just explain that my pain is my “normal” level,  moderate, severe or worse than anything I’ve ever had before.
Also, I think I’ve adjusted to what I find tolerable pain-wise. When I first developed my current health problems, the pain was unbearable unless I was heavily medicated. These days, I don’t take pain meds on a daily basis unless I’m flaring far beyond the levels I’ve learned to live with. It’s not that I hurt less than I did three years ago. But I’ve adjusted, and this is now normal.
Thanks, Jason, for a fabulous post!!

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