Mastodawn

Periodic reminder that “rate your pain on a scale from 1 to 10" is bullshit without reference points. People with chronic pain, tough guys, people with intense periods, and people who struggle with interoception all struggle when the endpoints are nebulous.

Let me introduce you to the DVPRS: https://www.va.gov/WHOLEHEALTHLIBRARY/docs/Defense-and-Veterans-Pain-Rating-Scale.pdf

It even works if you substitute pain for general impact. If you're asked to rate a symptom on a scale from 1 to 10, this works too.

0 = No pain
1 = Hardly notice pain
2 = Notice pain, does not interfere with activities
3 = Sometimes distracts me
4 = Distracts me, can do usual activities
5 = Interrupts some activities
6 = Hardto ignore, avoid usual activities
7 = Focus of attention, prevents doing daily activities
8 = Awful, hard to do anything
9 = Can’t bear the pain, unable to do anything
10 = As bad as it could be, nothing else matters

10 is still pretty subjective there, but "nothing else matters" is clear enough, and really 9 or 10 isn't really a big difference in how much it matters clinically. (It tells the clinician if an intervention helps though)

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myrmepropagandist 3d ago

@aredridel

When my foot and leg were broken they put a cast on my foot. My foot became swollen in the cast and started to hurt from being pinched. It was the worst pain of my life. Worse than when my appendix burst, worse than the broken leg.

After SIX HOURS I got them to cut the cast and just sat there crying since the pain had stopped.

But they just didn't understand how much it was hurting. I still don't understand why it was so bad.

I was on some painkillers but it still hurt.

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Aethon 3d ago

@futurebird

The pain from the compression of the swelling was possibly caused by the ischemia (blood being cut off) in the foot, so you might have been getting a loop where blood flowed in, tissue swelled, compression meant the blood couldn’t flow out and so forth. Ischemix pain is very very real as not only is the swelling causing pain but the damage to the tissues is as well. And, as someone else said, there can be nerve compression as well.

I’m glad they opened the cast, often we used clamshell casting to allow some space for the limb to swell for that reason.

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myrmepropagandist 3d ago

@tempusfelix

As far as I know there was no obvious dammage once the cast was removed. The foot seemed fine, it still had several broken bones with pins in them (this was after a major surgery, it was a very bad set of broken bones) but it wasn't like the foot was blue or numb or anything.

I think it may have just been a pinched nerve.

But good lord that pain.

It was so intense, just in your face blocking out everything else, impossible to ignore or escape, or get used to.

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myrmepropagandist 3d ago

@tempusfelix

I did have a deeper point here!

We think about the "level" of pain, but the duration and how it ebs also matter.

Low grade pain that never stops could be more disruptive than intense pain that mostly goes away.

Pain is a signal from the body. Pain is not the natural result of damage to the body, it's how we know to protect our body from damage and it helps us to stay still and allow for healing.

Pain may force us to rest, stay still, or "do something" about injury.

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Aethon

@futurebird

Absolutely agree. The pain that lurks in the background, constantly gnawing at your soul can be more debilitating that short lived acute pain and can be much harder to manage. I have seen pain etch away people, neurogenic from spinal injury but very real in every sense. As you say, it changes them.

Always believe the person when they tell you, they know themselves best.

And sometimes the hardest thing is when there is no obvious solution to that pain, it can be really hard to admit that.