C-Force: Is Measuring Pain on a Scale of Zero to 10 the Best We Can Do?

Before becoming a journalist and bestselling author, Elisabeth Rosenthal worked as an emergency room physician. As a graduate of Harvard Medical School and a physician, she had to make the same request to patient after patient: "Rate your pain on a scale of zero to 10." In a recent editorial in The Atlantic, she points out that the concept of "reducing these shades of pain to a single number dates back to the 1970s.

"Pain is a squirrely thing," she adds. "It's sometimes burning, sometimes drilling, sometimes a deep-in-the-muscles clenching ache. ... But unlike the other vital signs -- blood pressure, temperature, heart rate, and breathing rate -- pain had no objective scale. How to measure the unmeasurable?"

In the 1980s, a time when pain was "too often ignored or undertreated," Rosenthal claims, "the zero-to-10 rating system could be regarded as an advance." Doctors and nurses were encouraged to use the zero-to-10 rating system, according to Rosenthal. This was during what was called "a 'pain revolution' in the '90s, when intense new attention to addressing pain -- primarily with opioids -- was framed as progress."

Writes Rosenthal, "About 30 years ago, physicians who championed the use of opioids gave robust new life to what had been a niche specialty: pain management. They started pushing the idea that pain should be measured at every (doctor) appointment as a 'fifth vital sign.' ... The enthusiasm for narcotics left many varietals of pain underexplored and undertreated for years. ... This approach to pain management had clear drawbacks."

Beginning in the '90s, Rosenthal writes that some studies started showing that measuring patients' pain with the zero-to-10 scale did not result in better pain control. "Doctors showed little interest in or didn't know how to respond to the recorded answer," she writes. "And patients' satisfaction with their doctor's discussion of pain didn't necessarily mean they got adequate treatment. At the same time, the drugs were fueling the growing opioid epidemic. Research showed that an estimated 3 to 19 percent of people who received a prescription for pain medication from a doctor developed an addiction.

"Doctors today have a fuller understanding that they can (and should) think about treating pain," Rosenthal adds, "as well as the terrible consequences of prescribing opioids so readily. ... Researchers are now looking for biomarkers associated with different kinds of pain so that drug studies can use more objective measures to assess the medications' effect. A better understanding of the neural pathways and neurotransmitters that create different types of pain could also help researchers design drugs to interrupt and tame them." Despite efforts to create a better rating tool to describe patient pain, Rosenthal writes that none have proven capable of capturing "pain's complexity."

As reported by Wellness Wave HQ, while doctors continue to ask patients to describe their pain intensity on a scale of 1 to 10, many continue to find it "challenging to convey the severity and impact of their pain to doctors, leading to feelings of frustration and helplessness."

In a recent Johns Hopkins Bloomberg School of Health post focused on patient-doctor communication, Stephanie Desmon writes that when patients don't feel heard by their doctors, "there's an erosion of trust that can lead to serious health consequences -- even if clinicians have their patients' best interests in mind."

"Doctors will often ask you to describe your pain intensity on a scale of 1-10 -- with 1-3 being pain that doesn't bother you much at all and 9-10 constituting an emergency," a U.S. Pain Foundation article notes. "But people with chronic pain often downgrade their pain -- in part, because (they're) so used to dealing with it that it doesn't register the same way it might for someone who's just stubbed their toe."

The U.S. Pain Foundation recommends that patients using the pain scale should keep in mind that giving a range of numbers can be very helpful to their doctor: "'Well, I woke up at a 3, but after grocery shopping I was at a level 7," the article provides as an example. It's important to focus on the "functional impact (pain) has on your day-to-day life.

"You may know how pain has changed your life in a larger sense; how it's made you a different person or caused you to give up activities you loved. But your doctor doesn't. Here's a little secret: When you talk about what the medical community calls 'daily activities of living,' doctors often sit up and take notice. ... Above all, it may help to change the way you think about your doctor's visit. It's not a social call; it's a business meeting. Keep your goals top of mind and stay focused."

Rumblings about a public health crisis are growing in the United States. There are reportedly shortages in the primary care field. As a result, patient loads are increasing. If you can get an appointment with a doctor, it's on you as the patient to make the most of limited time with them.

"So, how can you lay a solid foundation for this all-important chat? Start by being prepared," stresses Wellness Wave HQ. "It's about arming yourself with knowledge and getting ready to describe your pain accurately. This isn't just about telling your doctor you're in pain; it's about painting a clear picture of how pain is affecting your life. ... You're the expert on your pain, but your doctor is the expert on medical care. The goal is to merge that expertise for the best outcome." Also be mindful that when it comes to sharing your pain, your doctor can't experience what you're feeling.

Keeping a "detailed pain diary" is often suggested by support organizations. And when appropriate, have a family member or friend join you during your visit. "They can provide another perspective on how your pain affects your life and can help remember details you might forget," according to Wellness Wave HQ.

Follow Chuck Norris through his official social media sites, on Twitter @chucknorris and Facebook's "Official Chuck Norris Page." He blogs at http://chucknorrisnews.blogspot.com. To find out more about Chuck Norris and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate webpage at www.creators.com.

----