Nov 3, 2009

The Purpose of Pain (Why the Painscale Doesn't Work)

Last week I answered a question by explaining the trouble with how doctors interpret your painscale. Doctor D confessed that he doesn't like the painscale at all. Today I will tell you why even if used perfectly the painscale still just won't work:

The 1 to 10 painscale ignores the way the human body uses pain in the first place. The scale assumes that we can observe the sensation of pain and then compare and contrast it to other pains we know or imagine. Your analysis of pain is supposed to produce a number that doctors and researchers can use to make calculations. There are a lot of things the human mind does a great job analyzing, but pain isn't one of them.

The purpose of pain is to get your attention. Pain is your body screaming, “Something is wrong!” It doesn't take much pain to completely capture your mind's focus. Pain functions as a useful warning system. It tells you to pull your hand out of the fire or not to walk on that broken ankle. Your brain pays close attention to pain and obeys its commands. So what if being burned at the stake is a 10 and your broken leg is only a 7? Trust me the broken leg will get and keep your attention till the bone is set.

Asking the mind to quantify pain is like asking it to assign a number to love or fear. It simply doesn't work that way. This is the reason that so many patient's say their pain is 10 of 10. No they aren't feeling the worst imaginable pain, but the pain does have their full attention.

Doctors want hard facts from painscales. We scoff at patients who say things like, “My pain is still a 10, but it's better than the 10 I felt before,” or “It's a 10, but not as bad as when I delivered my baby!” We demand hard facts and we get irritated when patients give us flawed and subjective data.

The worst pain Doctor D ever felt was probably about a 6, but subjectively it was miserable enough to get my attention and keep me from hitting my finger with the hammer ever again. We should listen to patients' descriptions of pain and seek to relieve it, but we shouldn't demand they to turn their pain into a number. The human experience of pain just doesn't work that way!
Doctor D is always talking about the natural purpose of things like hunger, laziness, anxiety, and pain. His theory is that understanding the natural functions of the feelings helps us respond when these feelings give us trouble. What do you think? Would understanding the useful warning function of pain help those of you that suffer from pain problems?


Helen said...

I do think it's important for me to be able to pay attention to my arthritis pain and not simply mask it - this is why I don't often take painkillers and have never taken a narcotic. I want to be as fully aware as possible of the state of my disease, so that I know how well my diseasae modifying treatments are working. That doesn't necessarily make it easy when I'm having a really bad day, but I don't like the idea of ignoring my pain and, as a result, my illness.

On the other hand, when I've been in pain that I know is transient and has a directly attributable source - like post-surgical pain, or the pain from my ruptured cyst - I'm happy to treat it with whatever will do the trick.

Anonymous said...

I'm glad to see that SOMEBODY realizes this!

WarmSocks said...

Understanding why usually helps. It makes sense that pain gets our attention and usually means "hey, don't do that" so you then avoid the painful activity and have time to heal.

Too bad it doesn't always work that way.

Maha said...

I've noticed that a lot of my patients use adjectives instead to describe thier pain and I find that to be a lot more telling than a number. I also find that when I am given a number, I have a tendency to compare it to what would prompt me to choose that particular number.

Btw, I love your blog Dr. D! It's well written and informative! Keep on answering those questions :)

MLee said...

I hate the pain scale used for children. Of course they will pick the crying face if they hurt. I ask kids if it hurts more then a pinch, more than when they cut their knee, and normally ask parents what other injuries they have had in the past that I can help them use as a comparison.Pain can be hard and tricky for most to explain.

Devorah said...

I prefer the pain scale used for kids. It makes much more sense to me as an adult then trying to put a number on my pain. If I'm not crying then I'm not going to point to that picture.

Doctor D said...

The tricky thing with a lot of painful conditions is that the "pain alarm" off switch is broken. You get the warning even when there isn't danger.

This is the hardest thing to do: tell your body to ignore the alarm and keep going.

Anonymous said...

Your post on pain was great! For me, pain is subjective. I pay attention to how my body feels but I try to push through it when my joints ache. Maybe I'm just stubborn but rarely do I find myself seeking a pill for relief. Now a good deep tissue massage is another thing ...

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