Limits of the Pain Scale

“On a scale of 1 to 10, what’s your pain like?”

Those of us who are frequent flyers in the Emergency Department are very familiar with that question. Although the purpose of it is to give healthcare providers an accurate assessment of a patient’s pain by introducing an objective measurement tool, the standard pain scale does not succeed.

First of all, pain is always subjective. What I consider an “8” may not be what someone else considers an “8.” And providers, seeing a wide variety of conditions, have developed expectations of how much pain different symptoms can cause. If one patient claims they are at a “10,” he or she may be dismissed as dramatic if the provider has just treated a patient who he or she assumes is in worse pain.

Chronic pain is another challenge to the pain scale. Certain condition, including Sickle Cell Disease and Ehlers-Danlos Syndrome, leave individuals in a state of constant pain. These patients can become so used to being in pain that they no longer show conventional signs of a person in pain. Because these individuals appear to tolerate pain better, it may look like they are not, in fact, in pain. HCPs look for clues like body language and facial expressions to evaluate discomfort, but seasoned pain patients may not always show their pain.

That well-meaning question may be doing more harm than good for patients with chronically painful conditions.