Mastodawn

Mx. Aria Stewart

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)

Mx. Aria Stewart 1d ago

This is a tool to COMMUNICATE impact of pain. It's not just expressive, the goal is not just to assign a number, it is to communicate the impact of pain or discomfort to a clinician or caregiver so they can know it needs treatment, and to understand if treatment is working.

Accuracy helps that, but remember the point is not to have the NUMBER, but to COMMUNICATE.

@aredridel
things described on that DVPRS below 5 are considered pain? "able to limp short distances when taken 2 paracetamols" was a 2 for me, since it's about 20% on the way to conditions like "cold sweat hyperventilation, tunnel vision, unable to move, on the edge of fainting"

Mx. Aria Stewart 1d ago

@adorfer YES IT IS

Eric Schultz 1d ago

@aredridel interestingly, that makes my chronic back pain much higher on the scale. I usually say it's a 1 because it's really not all that bad. But it definitely affects what activities I do, so here it's a 4 or 5.

Mx. Aria Stewart 1d ago

@wwahammy EXACTLY.

So get your doctor to treat it like a 4 or 5! And tell them you're using the DVPRS and were surprised at how much that changed things. Maybe your pain can be treated better ... and maybe other patients will be treated better too.

@wwahammy Yeah, when I compare straining my neck a few months ago, that would have been a 7 cause I couldn't comfortably lie down or move my left arm much, but hurt much less, while I was avoiding activities, than headaches that I treat as a 3 or 4.

Björn 🌸 Starkimarm 11h ago

Just thought the same, 5 maybe 6 😐

Cassey Lottman 1d ago

@aredridel I was recently asked (by an insurance provider, adding insult to injury) to rate how each of several symptoms have been recently on a scale of 1 to “the worst it’s ever been”. They asked no further questions about say, how bad each symptom has been for me in the past, or how it affects me now or how much my supposed level 10 may have affected me…

Mx. Aria Stewart 1d ago

@cassey Or even if 10 is "the worst it's ever been", just implying the scale goes to ten. So much bullshit in all of this, especially for the literal-minded. (I really really REALLY like the DVPRS despite it being such a small tweak on the usual presentation)

Stephen Bannasch (316 ppm)1d ago

@aredridel @cassey

I like this scale … and I’m a very literal person and know I need to adapt. I once had bad kidney stones, drove myself to the ER and it provably was an 8. Maybe a large bad burn once might have been a 9.

Many years ago I broke my two front teeth and my parents took me to an emergency dentist.

1/2

Stephen Bannasch (316 ppm)1d ago

@aredridel @cassey

After inspecting my teeth, without any anesthesia, and without telling me he pulled the dangling nerve roots out. That was orders of magnitude more painful than anything I’ve ever experienced.

It took me much longer it should have for my very literal self to realize that it didn’t represent a “10” — that truly it was off the scale! Realizing the scale is for communicating to medical folks helped.

2/2

SomeVeganCheeseIsOk 1d ago

@stepheneb Jesus fucking wept. I should have taken your hiding the text more seriously. Holy shit.

I won't reply with what a dentist once did to me but it was not as bad as what was done to you.

Jesus wept. Dude.

If anyone looks at this PLEASE understand that you should be wary of uncovering *that* hidden text.

Stephen Bannasch (316 ppm)1d ago

@SomeVeganCheeseIsOk

It was incomprehensible … and when he stopped the pain was gone, there was no refractory period. I have absolutely no way to understand the experience. I don’t remember what I said to him.

Stephen Bannasch (316 ppm)1d ago

@SomeVeganCheeseIsOk

Reflecting on my post.

I should have added a more clear textual warning in the content of the first post and added the warning gate to just the second post.

I apologize for not making it easier for you to make a more informed choice.

I don’t feel traumatized but I should be more careful. Most of the things I share are sweet or fun.

SomeVeganCheeseIsOk 1d ago

@stepheneb no man you warned us!!! It's just that a lot of people use warnings for less grievous things.

I am sorry that happened to you.

@aredridel Thank you for this, I now know how to talk to medical folks on my Dad's behalf; his chronic pain has been happening and worsening for decades and he never knew how to answer "what's your pain level" even *before* he had cognitive issues.

Mx. Aria Stewart 1d ago

@twenty20sight YAY!

Tell 'em you're using the scale. It gets everyone on the same page! And ideally, they can start spreading the word a bit.

@aredridel See also the Kip scale for migraines and cluster headaches specifically!

@aredridel see also https://xkcd.com/883/ while we're here

Pain Rating

xkcd

11. Screaming and writhing, doesn't answer question.

@aredridel

Also a note from the loved one of a tired nurse.

Please don't respond to

"Rate your pain on a scale of 1-10"

With anything higher than a 10. Some nurses will get it and not be mad. Some nurses suck and will write you off as being dramatic and it might impact care.

Related note, if you say you're at a 9 and they give you medicine that works, don't respond with 9 when they ask again. They're likely to start losing trust in you and might avoid giving more meds out of fear that you're drug seeking. Being honest when you're feeling better let's them know this is a med that can help.

The 1-10 scale is standardized as much as it can be for a subjective chart, but there are physical queues nurses are looking for. So if you say you're a 9/10 and then they find you acting completely normal, able to function with very little help, then they may think you're drug seeking.

Hopefully this info is helpful

🇺🇦 Anna Filina 1d ago

@aredridel I kept saying 7 when I should have been saying 9 or 10 on some occasions. No wonder triage almost let me die more than once.

I was basically just comparing it to the worst pain I knew: giving birth.

lizzzzard 1d ago

@afilina @aredridel yeah, the "imaginable pain" scale definitely gets stretched by life experience...

Stephen Collins 1d ago

@aredridel as both a first responder first aider (volunteer firefighter) and someone who has been asked more than once to rate pain and not been able to respond in a way that accurately reflected the injury (I rated a dislocated ankle + fractured tib-fib and a torn MCL at different times as “5”), I am a fan of this. What the pain distracts you from and to what degree is very useful.

Kyle Memoir 🍉🐧1d ago

I so wish I'd had this last year.

And I so wish the medical world had long ago internalized it.

@aredridel I have a very high pain tolerance and therefore have a hard time determining the level of pain. I've had level 10 several times, twice I blacked out from that pain. I understand the reason for trying to determine pain level, but it's, as Sheldon said at his driving test "A car length is not a standard measure of distance."

Drew wants a longer profile na 1d ago

@aredridel
This is a good tool, thank you.

myrmepropagandist 1d ago

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.

myrmepropagandist 1d ago

I told them it was a 9 and that I'd find a way to cut the cast off myself and that seemed to bring some more action.

SomeVeganCheeseIsOk 1d ago

@futurebird @aredridel oh the swelling was probably pinching a nerve or ten. That would suck.

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.

myrmepropagandist 1d ago

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.

myrmepropagandist 1d ago

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.

myrmepropagandist 1d ago

But pain can also be out of proportion, unhelpful or the result of a wrong signal.

Pain leaves a lasting impact on the mind. It changes you. Being in pain for a long time can make you a different person. I thought about this a great deal while recovering from the broken leg.

It's very odd how we allow pain to have a kind of moral dimension. Odd but not surprising.

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.

@aredridel Oh this is immensely helpful. I've always struggled with these.

Why don't they just post these in clinical areas for reference?

ShadSterling 1d ago

@solitha @aredridel a few places they do! Too few, but it’s a start. I wish it would catch on faster

SomeVeganCheeseIsOk 1d ago

@aredridel 10 is where I literally pass out. 9 is where I can see colors if I breathe through it and successfully disassociate. 8 is where it hurts enough to impair movement significantly. 7 is where it hurts but I can maybe move almost like a human. 6 is fine, I'm ok, we're good, but I might want to see a doctor like tomorrow or something. 5 and below are ignorable. 1 is FUCKING SPECTACULAR.

Mx. Aria Stewart 1d ago

@SomeVeganCheeseIsOk See the problem there is that doesn't _communicate_ much. The important part is to get someone to recognize the impact it's presently having.

ChookMother 🇦🇺🦘1d ago

@aredridel Thanks for this. Bookmarked.

@aredridel This is useful, thanks for posting it. The best I had found to date was the Mankoski pain scale (https://www.valis.com/andi/painscale.html). This one seems similar.

Mankoski Pain Scale

NilaJones 1d ago

The best response I ever got was when a doctor asked me to rate my pain 1-10 and I bust out laughing

I had to explain, we were just talking about the scale on the internet the other day, and how it doesn't make any sense without referents

It was one of those rare moments where you can see a doctor actually focus and be present, for a few seconds

-

Anyway, how am I supposed to rate pain that prevents me from doing 99% of my previously normal activities, and has been ongoing daily for decades?

Am I supposed to change how I define normal activities?

This is what I mean when I say the whole concept is stupid, for chronic pain

I am not super distracted. I am not unable to stop screaming (yes, I have experienced that kind of pain too). I just can't do any of my normal things

If I did 5% of my normal stuff, then yeah, I probably would not be able to stop screaming

But that's not socially acceptable, so I just don't do the stuff

Mx. Aria Stewart 1d ago

@NilaJones That is, in fact, 7+.

NilaJones 1d ago

I usually call it a seven. But it's complete bullshit. If I took the trash out to the curb I would not be able to stop screaming

@aredridel I have very high tolerance for pain. Two memories come to mind. After first abdominal surgery decades ago, surgeon after finding total mess inside commented, most people would have called 911, not said for TWO YEARS, "it will go away." The second was when I had such severe back pain I saw stars and fainted. Hubby still mad at me I didn't call him after I woke back up, levered myself up, dove from bathroom to bed and rolled myself along the sides until I could lay flat again. ;)

groff 🇺🇦1d ago

@aredridel Even 10 seems a bit soft there, in my experience. Where are "the thought of movement terrifies me, I will deficate where I lay" and "I'm only vaguely aware of your presence. Pain is everything If death is the only way to make it stop please kill me."

On the other hand I know someone who, after coming round after major lung surgery, was repeatedly offered pain medication because they "must be in a lot of pain" and didn't need any because it was "just a little uncomfortable".

Mx. Aria Stewart 1d ago

@geoffl That's the thing. That's not really a thing one needs to communicate: if you're at or past 10, there's not really more intervention to do, there's not more seriously to take it.

The point is not to give numbers to all possible pain, it's to communicate for intervention.

groff 🇺🇦1d ago

@aredridel In the case of the person i mentioned with a high pain threshold I'm sure it later lead to their premature death in hospital after a accident. The doctors didn't treat their injuries and deterioration seriously because they weren't in pain.

They probably would have classified walking on a broken ankle at 3. I worked with then for many years and saw them shake off hits, that would have crumpled me into a ball, without a second thought.

groff 🇺🇦1d ago

@aredridel Using the scale above I'd be classifying repeatedly hitting your thumb with a hammer, a sickening kind of pain, as 4, it wouldn't stop me doing anything but would be a distraction. About the same as treading on a weaver fish, or being bitten by a bullet ant. Crippling back ache after an injury, where it takes 20 minutes of careful manoeuvring to get to the toilet would be 8.

Are these representative of what you'd expect?

groff 🇺🇦1d ago

@aredridel I said 8 for the backache in that case because, when it flares up, I can find it hard to got out of bed and get to the toilet but I'm not unable to.

Violet Madder 1d ago

I know somebody who calibrates their 10 from the time they fell off a cliff and broke their spine in several places.

After foot surgery, they rated their pain at a 7, and the nurses gave them some Tylenol and left. Pain got so bad that night they were about hallucinating without the proper medication. Nurses didn't take 7 seriously enough without context.

@violetmadder @aredridel So clinical staff don't understand without context either - meaning that when they ask for a number they don't always pay attention to it.

Texan_Reverend 1d ago

@aredridel The DVPRS and similar versions of the pain scale which focus on the effects the pain is having have been a tremendous boon to communicating more effectively both in healthcare settings and in conversation with friends and family.

This page talks about the DVPRS, how it was created, how it's meant to be used, and so on:
https://www.disabled-world.com/health/pain/dvprs-2.php
At the end of the article, it also includes the supplemental DVPRS questions page which asks about impact on: activity, sleep, mood and stress.

DVPRS 2.0 Pain Scale Chart: Military & Veteran Pain Tool

Defense and Veterans Pain Rating Scale with functional descriptors and supplemental questions for pain impact, includes downloadable DVPRS 2.0 pdf chart.

Disabled World

deer witch 1d ago

@Texan_Reverend @aredridel Holy shit I always add +1 to my number because I know I minimize & am used to chronic but this makes me seem like I should’ve been adding +3-4 😭

10 is always described as worst pain imaginable to me and I’m like well I haven’t done and hopefully will never do birth or awake amputation so I would’ve put “nothing else matters” as my 7 but apparently not 🙃

L, friend of lizards 1d ago

@moss @Texan_Reverend @aredridel I have a chart with VERY UPSET frowny faces that basically distills this down into simple terms, and I always reference it if I'm asked that question. as someone who's operated a motor vehicle at a 10 I am not the best judge of this in a vacuum

deer witch 1d ago

@ldottxt @Texan_Reverend @aredridel Having it as a reference is so smart!! I need to put this into my planner so I can reference it too because lolsame twin

Texan_Reverend 1d ago

@moss @ldottxt I keep the various scale images in a specific gallery folder on my phone just for them. That way I can always find them easily when needed.