Pain - and how you quantify it?

[cygnet]

An experience I've not had to deal with much, is another person asking

On a scale of one to ten, how much pain are you in?

I have no idea what scale this is supposed to be, or what 10 is.
Is the scale exponential, logarithmic?

So I just pick a random figure as I have no boundaries to measure against, figuring that it's not actually a scale of 1-10 but is it better or worse than last time.

How do professionals understand and quantify this?

[Kim]

'Inconsistently'

The better pain scales qualify each level in terms of how distracting/impairing the pain is.  "It's there if I think about it" vs "I can't concentrate" vs "Can hardly speak" sort of thing.  This also goes some way to allowing for different types of pain (eg. I have a lot more tolerance for trapped gallstones than partial-thickness burns to the hands, though in absolute terms the pain level is similar).

Obviously the top and bottom of a scale should be relatively easy to calibrate (no pain and unconscious, respectively) but some of them don't even manage that.

And that's before you account for the professional's biases wrt the age/gender/class/race/disability of the patient.

[arabella]

No idea as such.

But when having <procedure> done and without any painkillers the officiating nurse remarked I was taking it well/had a high pain threshold.  Which suggests I should probably exaggerate when asked how much pain.

Thus: get a reference, somehow, as to here you are on the scale in general. 
I presume the opposite of me (also me) gets told to eg: stop complaining and start pushing.

That's no help at all, sorry.  Kim's reply is more useful.

[Kim]

Oh yes, I've been misdiagnosed on account of not performing pain properly.  The consultant told me afterwards that I should have been screaming.

The efficacy of painkillers is another issue.  Apparently some people find that paracetamol reduces pain.

(Top tip: Never attempt to quantify your pain in terms of the dose of painkiller that would help it.  This is 'drug-seeking behaviour' and once you've been labelled with that, you're screwed.)

[TheLurker]

I use a similar system to Kim.

 What pain?
 Mild swearing / grumbling.
 Bad swears!
 Too painful to even *think* about swearing.

ETA
"...Apparently some people find that paracetamol reduces pain."
MrsL told me some while ago that things like paracetamol & aspirin work better for blokes.  Don't know where she dug that up from.

[Lightning Phil]

[hellymedic]

The efficacy of painkillers is another issue.  Apparently some people find that paracetamol reduces pain.

So I am told. I was first given paracetamol for toothache when I was 8.
It didn't work, unlike the Disprin I'd had before and I've been sceptical about it since 19966 though I've prescribed it for Others.

I have never needed Controlled Drugs for pain so I don't think I've had really severe pain.

I think it's all very subjective both on the part of the patient and the health bod but pain that prevents the sufferer doing anything other than scream or writhe must be high.

[Kim]

I suspect that - assuming they're well enough to do so - some people are inclined to screaming and writhing while others are more inclined to sit extremely still and concentrate on not making the pain worse.  And some might do either, depending on the type of pain.

[ian]

Pain is perceptual and in a good part psychological, because the brain is doing the conversion of a nerve signal into sensation. There's no absolute wiring, it's not an electrical circuit that lights a bulb in proportion to the current. We've all hurt ourselves – perhaps a cut or a bruise – and not notice it until we do notice it and then ouch, thereafter it really hurts. An unnoticed insect bite doesn't itch. Things also hurt at a level we expect them to hurt, even if they're physically the same impact.

Forgetting about a headache is just as effective as any painkiller. If you think a painkiller won't work, it probably won't. If you tell someone that something will hurt more, it will hurt more. If you tell them it won't hurt, it probably will, because they won't believe you.

It ties into sensory hypervigilance, where a person focuses on something, and the more they focus, the more they notice and feel. Generally, for instance, unless they're uncomfortable, you don't feel your clothes. Or rather you do, but your brain elides what it considers to be not a very useful qualia. But it you put some effort into feeling your clothes you can. That can become pathological when you really start to focus on something, become hypervigilant, start obsessing on a sensation. Pain is the same, a little itch or ache, can grow to serious, chronic pain that is generally only temporarily relieved with even the strongest painkillers.

There's a good, strong theory that a lot of psychogenic issues are, to a degree, caused by sensory hypervigilance. If you're constantly assessing how tired you feel, it's no surprise you come up feeling tired a lot, chronically fatigued in fact. If you're forever wondering about bowel activities, wondering about every rumble, then yes, it does seem to be irritable. Those are longer-term issues, like chronic pain, but it's still the power of the mind.

Of course, it goes the other way, where people can either convince themselves or be convinced (by hypnosis) to undergo radical surgery – up to and including limb amputation – without anaesthetic and state that they felt no pain during or after the procedure.

[Peter]

It's so difficult to get an appointment these days, so just tell them 10 - or you won't get another one for a year - or even three.

[cygnet]

I suspect that - assuming they're well enough to do so - some people are inclined to screaming and writhing while others are more inclined to sit extremely still and concentrate on not making the pain worse.  And some might do either, depending on the type of pain.

I think similarly, different people have a different response, so even though Lightning Phils Lego post sort of sums up the problem from
2- Can be ignored
To
6- Interferes with concentration
is a massive range in terms of health, and seems to me to depend entirely on the perspective of the person experiencing said pain in any given circumstance.

[Peter]

Of course - it can hardly been anything other than subjective.  I hope you are ok, Cygnet.

[yoav]

Pain is perceptual and in a good part psychological, hronic pain, but it's still the power of the mind.

That's not the half of it. To quote modern parlance, pain is a bio-psycho-social experience. Pain is something you have to learn. Babies don't know what pain is. If they get hurt, they won't like it but they have no understanding what it is they're experiencing. It takes till about the age of 2-3 years to learn what pain is.
Pain can be measured in a semi-objective way in experimental research but in real life, asking someone what their pain feels like on a scale of 1 to 10 or to describe it as mild, moderate or severe is as good as we can do at the moment. I was always bemused by pain scales that described a score of 10 as 'the worst pain imaginable' which would require the ability to imagine pain.

And that's only so-called acute pain, perhaps as a result of an injury, illness or surgery. Chronic pain is a whole different ball game which would require a whole forum to itself.

Oh, and many doctors don't understand pain any better than their patients.

[Peter]

Good post, yoav - yo 'av made a good summary, I think.

[Peter]

But we must also remember that after 1 - 10 there's "giving birth", which may well be true in some cases.

[cygnet]

Of course - it can hardly been anything other than subjective.  I hope you are ok, Cygnet.

Well thank you Peter

As people have responded, it appears to be a bit of a rubbish question. And I have difficulties dealing with rubbish questions. So everyone's replies are helping me to understand how to answer this one

Birthing offspring will remain outside my experience.

[cygnet]

yoav, I am also interested to understand why you think chronic pain is different to acute pain.

Maybe people conflate the two. Could you explain why you would separate them (if it's possible without going to a different forum)?

[mrcharly-YHT]

Top of the scale pain?

You can't even think. You are panting like you've sprinted up a hill. Possibly vomiting. The only sensation is the pain, and sight is dimmed. Possibly will pass out; certainly you'll wish you could pass out. I've experienced those levels of pain when I had the worst kidney stones (I've had 5 bouts of kidney stones, one of them put me in those levels of pain). I worked with someone who suffered from chronic migraines; her acute attacks made her pass out from the pain. One time she said she woke hours later, in a pool of her own vomit.

Chronic pain affects perception, people become used to chronic pain.

[The French Tandem]

(Top tip: Never attempt to quantify your pain in terms of the dose of painkiller that would help it.  This is 'drug-seeking behaviour' and once you've been labelled with that, you're screwed.)

This. Someone (not me) was asked by a nurse, a short time after a surgery, the OP question:

On a scale of one to ten, how much pain are you in?

Not knowing what a pain of "one" or "ten" was supposed to be, the person replied 5. She was then given morphine by said nurse. Fortunately for her, the morphine end up in the bin, as the pain was bearable without relying on that kind of stuff, but I can imagine easily that half-conscious persons after a severe surgery or disease would take whatever they are given.

It's so difficult to get an appointment these days, so just tell them 10 - or you won't get another one for a year - or even three.

And then your doctor will give you drugs strong enough to kill you!

A

[FifeingEejit]

Just been asked this by a physio, i had to think and decided it was a 3 to 4, but maybe on reviewing thelego scale it was a 2 to 3.

I remember when my appendix decided time was up and the surprize that I refused morphine twice.
It wasn't that sore...
In fact walking on pebbles bare foot is way sorer, but I think that's just my extremities being weirdly sensitive compared to the rest of me.
But then that raises the question, did I as a premature newborn get invasive interventions without anaesthetic or not, and if not what's the lasting impact?

[ian]

yoav, I am also interested to understand why you think chronic pain is different to acute pain.

Maybe people conflate the two. Could you explain why you would separate them (if it's possible without going to a different forum)?

They're both on the spectrum of perception – I'd say chronic pain is a disorder of acute pain perception (generally, the sensation of pain should being to dissipate once the source has been removed, but continual attention keeps it in the conscious mind).

When I learned to walk again, after a period of strong painkillers (because that was what I was given), it really hurt until it didn't, which was mostly down because I expected it to hurt (as you would). That was, in part, I think because they gave me the drugs. They wouldn't have given me the strong stuff if it wasn't going to really fucking hurt, right?

There's a good anecdote I read (trying to remember where) about a woman who had amazing pain, painful enough to collapse, because she'd been told she had minor slipped disk, but in her mind, she imagined it was pressing into, cutting into, her spine. This became such an obsession that she became functionally paralysed and confined to a wheelchair; whereas the disk issue had resolved itself, was nowhere near her spine, and even if it did, it was too far down to affect her legs.

[Kim]

I can imagine easily that half-conscious persons after a severe surgery or disease would take whatever they are given.

BTDT.

It's usually liquid paracetamol, which is a gateway drug to functional painkillers, so it's prudent to down the stuff as soon as possible while the effect of the anaesthetic has knobbled your sense of taste and anything wet tastes nice.  Less vomiting that way.

Except the time it turned out to be Oramorph.  As I determined many hours later, after the effects had worn off sufficiently to declare a moratorium on painkillers, and persuaded $friendly_nurse to go through my chart and work out WTF they'd given me.  I was in, at most, 30mg of codeine worth of pain, though I appreciate there's a benefit to being sufficiently stoned that you're happy to lie there and doze for a few hours, rather than wriggle uncomfortably and risk pulling stitches.

[L CC]

It isn't just the severity of the pain, but how long you may be expecting to have to put up with it.
Childbirth is pretty painful-but you know it's finite. Chronic arthritic pain when you walk/sit/wake in the night is eternal.

[ian]

I remembered the book now, It's All In Your Head by Suzanne O'Sullivan, not specifically about pain, but an interesting discourse on the influence of psychology on physiology (or more specifically neurology).

[TimC]

I've been unlucky enough to experience extreme pain, both acute and chronic.

As someone mentioned above, kidney stones - for me - resulted in pain that was (unfortunately) just short of losing consciousness. Unfortunate because I'd far rather have been unconscious! I was in China at the time, and was taken to a big hospital in Shanghai. The A&E doctor, not being an English speaker (I had an interpreter with me), diagnosed the problem by effectively punching me in the kidney. That did result in losing consciousness.

I also had a motorcycle accident which caused some pretty serious injuries (9 months excused walking). The hospital decided the pain would justify regular morphine access. That replaced pain with a bizarre feeling of contentment and not caring about anything much! The after-effects of the injuries (now 26 years later) are that I have very severe arthritis in my foot and ankle, which gives me pretty much constant pain and sometimes it is enough to make any activity impossible. Ibuprofen is fairly effective at dulling the pain, but it doesn't take it away. The NHS, after around 5 years of effectively ignoring the issue since I sought help in 2013, eventually offered me the prospect of amputation. They weren't joking. I've stuck with the Ibuprofen, and I doubt now I'd succeed in getting any further attention to the issue.