There is a significant component of fear and control in the perception of pain. Many people have endured horrible pain if they can understand it will end or be reduced at a certain point, or if it is serving a purpose.Another component of pain for me is that if I understand the why or what it is much easier to handle than pain from unknown causes.
But being powerless to understand why, or have any control over when or how much pain is coming makes it worse. Combined with the opposite of empathy, as Ed described, and the effect is predictably a worsening of pain. In fact, the pain may then be interpreted as torture.
Sure. In order to be useful, a scale has to have an upper and lower boundary, with repeatable results from the same observer over time and some degree of inter-observer consonance.Can you clarify what you said about my interpretation of a 10 point pain scale is? And in the next sentence you say It's also the most common interpretation by those who are asked the question.
Pain is also associated with psychic effects as your narrative of painful events reveal, and as I discuss above. These help create varying interpretations of where perceived pain lies on a 10-scale. But allowing patients to switch to a Spinal Tap "These go to 11!" scale deprives a scale of its utility.
In my previous post I tried describing pain in a Beaufort-like way, where outward manifestations of pain can help assign more accurate numerical representations. I'll try again here.
If a patient is speaking intelligibly at all times, uses correct syntax and a variety of sentence structures, pauses appropriately to listen, displays understanding and "tracks" a conversation normally yet shows vital sign abnormalities and reports severe pain with a known cause, I'd assign them a 5-6.
If they were highly pressured in speech, tearful, gasping but capable of orderly speech or ability to follow simple commands, I'd rate that a 6-7 based on how often they were out of it with spasms of pain.
If they were screaming occasionally, and only able to curse or say "please" repeatedly that'd be an 8. An interview may only answer a single question, so choose carefully.
If there were no comprehensible words in the presence of very concerning vital signs, plus a waxing and waning consciousness... that's a 9
And once they'd gone unconscious, developed arrhythmia or other similar life-threatening alterations in vital functions, that's a 10
I understand that no patient in pain uses this scale. Zero. It's just a clinical scale I use.
When I use it, anyone capable of higher-order thought process, like getting justifiably offended by an insensitive bedside manner, is no more than a 6. A patient's judgement is so distorted by the time their pain is a 7 that they can't really be trusted to make rational or fair assessments.
Anyone with pain of 8 couldn't be bothered with interpersonal communication except to beg relief, and a 9 can't form sentences, just guttural sounds.
Anyone with pain 5 or greater I'm 90% likely to give opioids +/- benzodiazepines during our interview, or just after I chat with them, so not only will they get some pain relief, I'll calm their psyche as well and reduce memories of one of the worst episodes of their life.
Anyone with pain 7 or 8 gets general anesthesia just as soon as I can establish it. They cannot sit or lie still for a nerve block or an epidural without powerful sedation, so that limits my options. If in labor, a woman may be able to cooperate between contractions so... maybe. Depends on their coping skills.
Anyone with pain of 9-10 is crashing and needs resuscitation.