Tuesday, May 17, 2011

Pain on a scale of one to ten

Gargoyle, Notre Dame de Paris
One of the questions they kept asking me in the hospital was how I would rate my pain on a scale of one to ten.

I'm told that diverticulitis is quite painful, and every new caregiver I encountered asked me with great concern whether I was taking pain medication or whether I wanted some.

After seeing my CT scan, one of the doctors in the surgical team went to find me on my gurney in the ER, expecting that a patient with such a acute condition would be in great distress.

He found me leaning back on my pillows reading a book. Yeah, I was uncomfortable. Yeah, it was painful. But when he asked me the "on a scale of one to ten" I had a hard time answering. Four? Six? Five?

So what is pain, and how do we perceive it?

Medical researchers studying pain have created several measuring tools. One rates pain on a numerical scale starting with 0 as having no effect on everyday activities of life, and 10 as so severe and disabling one is unable to conduct everyday activities of life.

Wong-Baker faces pain scale
Another pain measuring tool shows cartoons of facial expressions - smiling cartoons faces, slightly grimacing faces, and faces with agonized frowns and tears upon cheeks. Which one do you feel like?

Some tools ask you to describe the quality of the pain before rating it. Is it sharp, dull, piercing, aching? Does it shoot, cramp, throb, stab, or gnaw?

Street art, Williamsburg, Brooklyn, NY
Yet another tool asks patients to rate pain in the context of their own experience. How does this pain compare with the worst pain you've experienced - rather than comparing it with some abstract such as "pain so intense you will go unconscious soon."

It's an inexact science, to be sure. Almost every health care professional who asked me to rate my pain also confided that they didn't like the "one-to-ten" scale pain rating tool.

Personally, I think the context of pain is important in rating the level of severity and distress. If you skin your knee, it's painful, but you know why you hurt. It's a trauma and a break in the skin - of course it's going to hurt. If you swab it with Bactine, it's really going to sting, but you don't worry that it's going to kill you.

This isn't me. This is the New York Trapeze School on the Santa Monica Pier.
I fell from a trapeze at the age of 23 and twisted my left knee, blowing out my anterior cruciate ligament. That was surely painful, but more than the feeling, the horrible part was the sound it made - like the crack when you disjoint a chicken. I will always relive that sound more than the pain itself.

The cramping in my abdomen when my son was born was far more intense than the cramping in my gut this month from diverticulitis. Yet I was not distressed in the slightest by the pangs of childbirth - I knew what was going on. And while I was apprehensive and wondered just how intense it would get, I never feared for my well-being.

Three days after childbirth, my breasts became hugely engorged with milk, and that was a pain that totally eclipsed that of delivery. My boobs were grossly, ridiculously distended. It seemed so unfair. This wasn't supposed to happen after I'd done my job so well! If I were to rate that pain, surely indignation would have weighted the numbers.

Detail, Watts Tower, Los Angeles
The worst pain I've ever experienced, I think, to this day, is that of an abscessed molar, back in the 1980s. It didn't help that while it throbbed, I was crawling around in the overheated ceiling of a theatre focusing lights - the show must go on, after all. Something about the swelling infection contained within the unyielding shell of my tooth made it excruciating both physically and mentally. You can't soothe a tooth.  My chosen home remedies at the time - cocaine and Jack Daniels - had no palliative effect whatsoever.

By the same token, a bout five years ago with hemorrhoids stands out in my memory as a horrendous pain - but probably more for the embarrassment than for the actual pain. And isn't there something about hurting in a place you can't look at that increases the relative agony?

Column at the medieval basilica of Vezelay
This time, the pain in my gut from diverticulitis was relatively mild but even so, it frightened me. I didn't know its cause, and it wasn't following a familiar pattern. And it manifested itself oddly, too - the simple act of walking sent aching reverberations through my belly - something that would cause that must be bad, right? It was more uncertainty than anything else that made me pick up the phone and call my doctor.

So when my care providers asked me to rate the pain of diverticulitis, I had to rate it as "moderate." Not as bad as hemorrhoids or an abscessed tooth. And when they asked me if I wanted some medication for it, I had to say - No, I didn't need it. Not this time around.

It's pretty weird to think that the first major health crisis in my life comes in secondary, pain-wise, to a bad toothache.

What lessons have you learned in dealing with pain?


Karen (formerly kcinnova) said...

The two worst pains I've ever felt were a toothache and an ear infection. Both woke me during the night in pain that reduced me to tears. Yes, I was an adult each time.
I've always hated those rate-your-pain scales. When I am in pain, I cannot tell you what kind of pain it is -- I hurt too badly to think! And yes, worry has a great deal to do with perception of pain.

ifthethunderdontgetya™³²®© said...

Drink can make pain better and worse, I've learned.


Big Bad Bald Bastard said...

I had a job in which I handled numerous medical files, and I was really surprised when I saw those cartoon faces.

Gary's third pottery blog said...

oh gosh, best wishes, sheesh, the slings and arrows of growing older....

shrink on the couch said...

The emotional components of pain are fascinating and science is learning more and more about this. Phantom pains are the most intriquing.

Albug said...

I think I have posted before, that I rate all pain against childbirth. By far the worst pain I ever had. Definitely a ten on the pain scale. what I try to remember about that experience is I made it through. Oh yes, and I had a cute little slimy person to hold afterward.
I didn't have any pain when I had my colon blockage. I was asked that over and over too.

SUEB0B said...

Hyperbole and a Half had a hilarious take on the pain-smiley-faces chart earlier this week, but she has taken it down now. Dang it!

Things I know about pain:
1. It hurts less if you keep your eyes open, generally
2. The real pain and horror comes from anticipating other consequences ("I'll never be able to sit comfortably again..." etc.). The pain in the moment is all one should try to deal with.
3. The way I get through pain is to tell myself "Someday you won't even be able to imagine how this hurt."

Jenny said...

My diver is hurting like hell right now but like you said the show must go on. Just done a 3 km walk with it so its not that bad but this is not my first bout its my 12th. Hugs to you in sympathy.