I got this information from http://www.tipna.org/info/documents/ComparativePainScale.htm which tells a lot more about pain and how it is perceived by patients and by doctors, and various treatments for pain It's worth reading. It states that what might be a level 8 pain to one person might be a level 5 to another. Pain is subjective, affected by so many different factors that may be happening at the same time. For example, if you are doing a challenge with someone to see how long you can keep you hand in ice water, the pain might be intense,(because the very nature of the challenge is to do something painful, so you feel it as painful). But on a very hot day when the heat is making you suffer, putting your hands in ice water may be refreshing, and not considerd painful at all. Also, what might feel distressing one day, might become very intense on a day that you are tired and stressed with other things.
One thing a Dr. taught me, is that if you say that your pain is a 30 or 50 or 100, they feel you are not being serious, (they will not take your claim seriously) and they will automatically label you a drug seeker. Later I saw this happen in the E.R. A man was saying his pain was about a 20, and they gave him very little help, but when one woman kept repeating in pain "10,10,10", she was given prompt pain control. They knew that she understood that 10 is as horrid and unimaginable as possible, and was serious about her description.
Comparative Pain Scale
0
No pain. Feeling perfectly normal.
Minor
Does not interfere with most activities. Able to adapt to pain psychologically and with medication or devices such as cushions.
1 Very Mild
Very light barely noticable pain, like a mosquito bite or a poison ivy itch. Most of the time you never think about the pain.
2 Discomforting
Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails. Note that people react differently to this self-test.
3 Tolerable
Very noticable pain, like an accidental cut, a blow to the nose causing a bloody nose, or a doctor giving you an injection. The pain is not so strong that you cannot get used to it. Eventually, most of the time you don't notice the pain. You have adapted to it.
Moderate
Interferes with many activities. Requires lifestyle changes but patient remains independent. Unable to adapt to pain.
4 Distressing
Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma to part of the body, such as stubbing your toe real hard. So strong you notice the pain all the time and cannot completely adapt. This pain level can be simulated by pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails, and squeezing real hard. Note how the similated pain is initially piercing but becomes dull after that.
5 Very Distressing
Strong, deep, piercing pain, such as a sprained ankle when you stand on it wrong, or mild back pain. Not only do you notice the pain all the time, you are now so preoccupied with managing it that you normal lifestyle is curtailed. Temporary personality disorders are frequent.
6 Intense
Strong, deep, piercing pain so strong it seems to partially dominate your senses, causing you to think somewhat unclearly. At this point you begin to have trouble holding a job or maintaining normal social relationships. Comparable to a bad non-migriane headache combined with several bee stings, or a bad back pain.
Severe
Unable to engage in normal activities. Patient is disabled and unable to function independently.
7 Very Intense
Same as 6 except the pain completely dominates your senses, causing you to think unclearly about half the time. At this point you are effectively disabled and frequently cannot live alone. Comparable to an average migraine headache.
8 Utterly Horrible
Pain so intense you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time. Suicide is frequently contemplated and sometimes tried. Comparable to childbirth or a real bad migraine headache.
9 Excruciating Unbearable
Pain so intense you cannot tolerate it and demand pain killers or surgery, no matter what the side effects or risk. If this doesn't work, suicide is frequent since there is no more joy in life whatsoever. Comparable to throat cancer.
10 Unimaginable Unspeakable
Pain so intense you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain and not blood loss, have experienced level 10.
Thanks Sheila. I personally hate the 1-10 scale because it is too subjective we also all have different tolerances to pain. Like your example - the guy saying 20 might be trying to let them know the pain is off the charts and he is doing his best to tell them this.
If we are going to be asked to rate 1-10, perhaps we should be given this chart first and then asked where they are on the chart. Or better yet - why not ask us if the pain is "discomforting"(a 2), "intense" (a 6), etc. Maybe they would get a better idea of where we are at on the scale.
Thanks for this chart. Until I saw this I had no idea what those numbers meant other than no pain (0) to the worst pain (10) and then trying to relate it to other times I felt pain.
Well shoot Elaine, I wrote a reply to you, and I was sure I saw it here, but now I don't see it. Maybe a moderator didn't like what I said, and deleted my message. I'll "be careful" this time. I agree with you. I agree that it would be so much easier if they asked how severe is our pain, is it unbearable, or could we still function with it or any other description. The rest of what I wrote was about how to communicate with doctors more effectively, because many of them seem to want us to say the words they've been taught to listen for. It's often hard to find doctors who are willing to go outside the box to try to understand if we say things in a different way.
I actually like the 1-10 scale. pain is so subjective, and words can have various interpretations, that the best means of communicating severity is using a number scale.
The only thing better, in my view, would be a prolonged Q&A that basically takes this chart (which is wonderful, by the way, thanks for posting it), and instead of the number the medical professional is talking them through each level. However, if medical professionals did that all the time, we'd all be screaming about why it takes so long to be seen, because every visit just expanded its length of time due to the fact that a quick question turned into a long, drawn-out conversation.
I always looked at the 1-10 scale based on how it impacted me and/or my life. If it was merely an annoyance, it was in the bottom third. If it was impacting me but I could still deal with it and get through a "normal" day, it was the middle third. If it was actually forcing me to have negative repurcussions on my daily life (missing work, skipping commitments/appointments, going in a dark room by myself and screw the outside world), then it was the top third.
As a teenager, I shattered my ankle to the point where my toes touched the back of my calf. So, basically point your toes toward the ground, and then imagine that your feet keeps going until it bends all the way around and touches your calf. That I would have put at a 10 because I did temporarily go unconscious. In other words, 10 is reserved for zero functionality at all.
That's my interpretation of it though, but knowing that ahead of time has made it much easier to communicate how I feel on a day to day basis with others.
Nice to see you here again! Since 10 means the worst pain you can imagine, your 10 would be your experience with your ankle, but for someone who had never had a surgery or bad injury, a bad TN attack IS the worst pain they could imagine...so yes, it could be confusing if you and that pereson had the exact level of pain and you called it an 8 and that other person called it a 10. I do the same as you, I call it a 10 when I can't even move or talk, completely non-functional, too late to go to the hospital because I am in too much pain to get there and explain my problem and wait for treatment. If I want treatment, I have to get there during an 8 or 9 level of pain or I just won't get help.
Hi Sheila I am here because after5operations it has returned with such an powerful surge from jaw to head it made me cry out with the pain which I give it 10 or perhaps go up the scale. Unless you are a sufferer of TGN Despite taking my med lamotrogine 50gm. I took another npill but my daughter was so distressed with me in pain she phoned the Doctor. on seeing him I told him what I had done he said I had done the correct thing by both seeing him and taking another pill he then said I could take up to 400 grms in any one day. When I got home as as usual the pain was not present when I saw him I took another pill in 3 hours then another at night before sleeping. I got through the night and took a pill at 6am another at 2pm another at 10pm. Now I am afraid to try and reduce the dose in case that at pain comes back. I feel for you Sheila and I know how you feel. I say anyone who has experienced that pain will sympathise others I say to them I dont wish you any harm but experience it once you will not want it again
I don't think anything has been deleted by a mod Sheila, I am without broadband at home as my line is down:( It must be a Ning glitch. Sorry love!
Sheila W. said:
Well shoot Elaine, I wrote a reply to you, and I was sure I saw it here, but now I don't see it. Maybe a moderator didn't like what I said, and deleted my message. I'll "be careful" this time. I agree with you. I agree that it would be so much easier if they asked how severe is our pain, is it unbearable, or could we still function with it or any other description. The rest of what I wrote was about how to communicate with doctors more effectively, because many of them seem to want us to say the words they've been taught to listen for. It's often hard to find doctors who are willing to go outside the box to try to understand if we say things in a different way.
I have heard so many people say that TN pain is so intense that it can cause Post Traumatic Pain Disorder (PTSD), so that even when the pain starts to come and might start veery mild, people stop on theur tracks and fear that the pain will get as bad as it can get.
You're the first person I ever heard of who just takes their anti-seizure med when they have an attack. I didn't even know it would help. Did it help? I've always been told that it is used daily to prevent the attacks.
I am SO sorry to hear it has come back after 5 surgeries. WEre they all MVDs? I was told that can happen, because you develop scar tissue, and the electrical nerve impulses travels along the scar tissue, which gets thicker after time.
Did each surgery work well for you? Is that why you had the courage to do it again and again?
If that was a random attack out of the blue, you may not have that level of pain all the time if you lower the dose,but I sure understand the fear of it. Your meds are to prevent attacks, so if you can handle the side effects, you could stay on it.
Thanks Jackie, that's good to know for sure. When I get time, I'll probably edit my discussion to include the original things I said about how to communicate better with your Dr.
Sheila
Jackie said:
I don't think anything has been deleted by a mod Sheila, I am without broadband at home as my line is down:( It must be a Ning glitch. Sorry love!
Thanks for this. There are times I wish people had to be tested on this information. I know someone who so often says her pain on a scale of 1 - 10 is a 20 but she continues to carry on a conversation. She says she's been in pain so long she's just become good at hiding it. At a 10 you can't comprehend whats going on around you, let alone carry on a conversation. At a 6 or 7 I really just want to be left alone. OK a little sour grapes here with my saucer of milk.
Yes hippie, at 10 you can barely think of your name. Sadly, people who say 20 and are still carrying on, will be treated as "exaggerators" by doctors. maybe you can help her by showing her this chart, maybe copy and paste it into a document and preint it off (or email it to her) and tell her she will be taken more seriously by doctors if she uses the system that the doctors want to hear accurately. I live at a 5 or 6 , so any other stress will bump the pain up to unbearable really fast.
The sad truth is she is a drug seeker. If she read this post she would only become better at putting on the necessary front to acquire the narcotics she wants. She does have legitimate pain issues and the exposure to narcotics that were prescribed in good faith have taken over her life. I sometimes forget that makes her a victim of circumstance. I have tried to guide her in the right direction so many times, I find myself angry at her. This is one of those times that all you can do for a friend is pray.
I guess I understand why such a chart is not made well known to patients.
OIC Hippie. It's so frustrating when people like that destroy the credibility of people like us who need help for severe disabling pain and who take their meds carefully, responsibly. You're right. Don't tell her this hint. Maybe the right information will get to the right people so the doctors will treat us with more respect and will recognize the drug seekers/exaggerators.
An interesting thought came to mind after reading the ensuing discussion: it might be a good thing for some to "abuse" the pain scale, because it would make it easier for medical professionals to determine who is legit and who is simply drug seeking.
Let's say you are in the ER for breakthrough pain and nothing at home can even touch it. They ask you your pain level and you say 8, 9 or 10. The rest of the Q&A it's obvious you are having a hard time keeping any train of thought going because the pain is just too horrific.
Then someone else comes in saying they have similar symptoms. That person is asked their pain level, they say "20," but then carry on a semi-normal conversation.
I think a well-trained medical professional would be able to take the whole thing in proper context, and is likely trained to not only pay attention to what you say your scale-number is, but to also read between the lines and in context as well.