When the doctor tells you to rate your pain on a scale of zero to 10, do you know what to say? Here's a much better way to explain pain to your doctor.
When the doctor says, rate your pain on a scale of zero to 10, do you know what to say?
A zero is pretty easy to figure out, and a 10 is the worst pain you’ve ever had. In between, who knows the difference between 3, 4, 5, and 6?
For a short-term intense pain, say in childbirth, your best guess at that moment may be fine. And all you need is relief. But if you’re among the estimated 50 million adults who experience a lot of pain over months, your doctor really needs to know how that pain is affecting your life and help you come up with a package of solutions both to reduce pain and cope.
In a New England Journal of Medicine editorial, Jane Ballantyne, MD, and Mark Sullivan, MD, argued that the sole focus on pain in the early 2000s pushed doctors into prescribing high dosages of painkillers to patients with daily pain. As a result, patients ran the risk of side effects, including overdosing and death, and may not have fully explored other options.
After all, a more potent prescription may reduce your pain but, if it makes you groggy and you can’t drive safely at night and end up feeling isolated, your pain could get worse when you’re unmedicated, and you’ll need more painkillers to cope. Addiction and a downward spiral could follow.
That’s one reason the American Chronic Pain Association created a quality-of-life scale to replace the pain-intensity scale, which you can print for reference. In the scale, zero corresponds to “stayed in bed all day,” while four means “Do simple chores around the house. Minimal activities outside of home two days a week,” and so on, up the scale.
To judge your number on the scale, you can look at your calendar and ask your spouse. Bring it to your appointments. On repeat visits, your doctor can see whether you’ve improved in the way that counts most — staying engaged.
Don’t be ashamed of taking drugs if you need them. Your chance of becoming someone who abuses painkillers are tiny if you have no previous history of substance abuse. But if you do have addictive tendencies, that number goes up to around 11 percent. Either way, see a prescription as only one step.
Many chronic pains begin with an acute pain — from an injury. When pain signals are repeated over and over, your brain may begin a process that is something like encoding them. As studies using brain-imaging technology suggest, over time you may also begin to experience pain from emotional triggers. Those are both reasons chronic pain can last long after an injury heals.
That sort of pain is harder to diagnose and treat, and pain sufferers are too often met with disbelief. Chronic pain isn’t imaginary. The truth is that a link to emotions doesn’t make a pain more comfortable or mean you’re not eager to pursue your life. It does mean that you may need to address emotional issues directly and guard yourself against letting pain push you into depression.
Women shouldn’t compare their experience to their husband’s. Women may become dependent on prescription painkillers more quickly than men. They are also more likely to have chronic pain, get a prescription painkiller, be given higher doses, and use them for longer time periods.
If a different prescription will allow you to work more hours or have a social life, it’s a good idea. If changes in diet, a support group, meditation, massages, or spending time with a dog also move you up the quality-of-life scale, that’s even better.
Foods that are generally good for you are often anti-inflammatories that fight pain. Examples include:
- Spinach and kale
- Almonds and walnuts
- Fatty fish like salmon and sardines
Also consider eliminating your consumption of sugar and alcohol.
September 22, 2023
Christopher Nystuen, MD, MBA