The Pain Scale

The very BEST way to get any nurse or doctor to dismiss your migraine episode pain is to describe it as a 10 or even an 11 on a 10 point scale. A "10" in the USA medical field means "Pain so severe that immediate long term hospitalization is absolutely necessary as the pain is so very high as to be life threatening in and of itself." Like being in a car accident and going through the windshield head first, falling under the wheels and having a leg amputated, plus simultaneously being the victim of a stabbing. THAT kind of pain, Pain so bad you will faint, pass out.

So if you are sitting there in an office, ER, or other medical establishment and are able to speak and say your pain is a "10" - your pain will likely be dismissed as false. Instead, say 8 or 9. You WILL get better pain relief treatment.

I read about this on medical blogs and on the Net often. Really folks, if you are able to type or speak, your pain is NOT 10. And NEVER say 11 or 12 on a 10 point scale.

Just some unsolicited advice from the migraine-war-zone. (MWZ - I like that phrase! LOL)

Richard,

You are absolutely correct.

Even when I have one of my bad ones when my bp goes really high and I am very nauseated, I always say it is a 7.

Used to be when I went to the ER, they never wanted to give me what my doctor does and sometimes they would even offer me Torodol!

During one of my doctors visits I was complaining about this and my doctor reminded me never to say my pain level is a 10.

He said they may not take your pain seriously if you do.

Speaking of the ER, I have been getting very good treatment there lately.

They take what they consider non-emergencies to a seperate part of the ER and have the PA's see you.

Now they just ask what my doctor uses for my pain and they give me exactly that.

They used to say that they were uncomfortable giving me such a high dose of narcotics, but not anymore.

My MD told me that they are taking patient comments much more seriously at the Er now.

It really makes it much less stressful when I have to go there now.

Thanks for bringing this subject up Richard because there are probably folks who don't know this.

Hope you are feeling well.

Take care,

Cindy

I don't think I've ever described one as being higher than an 8. Not because I thought that was that the Dr's wanted to hear, but because I experienced a level 10 when I had a ovarian cyst and it caused tortion in my fallopian tube. That in turn twisted around my ovary and strangled it.

I have never experienced pain like that in my life before or since. I couldn't stand, I couldn't walk, couldn't talk and no amount of morphine would stop it. After spending the night in our small local hospital I was transferred to the "Big City". It was the most miserable 1 hour ride in an ambulance I've ever had. It was such a relief to be knocked out for the emergency surgery.

I have always felt that gave me a realistic view of the pain scale. But, for people who have never had that type of pain, I'm sure it must be difficult to rate it. How do you know what a 10 is, if you've never had it?

And boy, oh boy, I hope what I had was a 10, because if that was only an 8, I don't even want to think what a 10 would be!!!!

Cindy, I'm so happy your ER is treating you with respect. How refreshing to hear!

Charlotte

My doctor and the hospital here use a different system. they use the 0-10 system, but their version of 10 is "the worst pain you've ever felt." Even at that, I won't use #10. My worst migraines I consider 8-9. The kidney stone I had was a 7.

Thank you Charlotte for the kind words.

It sure makes my life easier when I know I can actually get some help at the Er that will get rid of my pain.

Now if they would just bring the price down!

Take care all,

Cindy

Brenda,
Kidney stone pain really doesn't feel good by any means but I think migraines are worse because they effect your head! I agree with you, although I passed my kidney stone without any medication at all so I'd rate mine an 8. I'd take abdominal pain over head pain any day.

I'd have to say that tooth pain is a killer for me. Dry socket in particular. Never in my life have I seen myself so pale and disoriented from pain before. It was worse than childbirth. I'd probably give the dry socket a 10 for worst pain in my life but a 9 on the worst pain ever because I'm not sure if that is the max it can be. Dry sockets are soooo painful, especially when left untreated for days like mine was. IV Morphine didn't help.

I put my head and hands through the windshield of my car after hitting a concrete median going way too fast (about 85-90mph and breaking) That pain wasn't so bad. It was a 5. I'm happy I was wearing my seatbelt and I still have my legs and arms though. Oh the not so funny things you do when your drunk.

Thanks for informing us Richard. I will surely put this information to use when I keep my headache journals from now on. I do occasionally mark my lay down in bed for days migraines as "10's". I won't do that anymore, instead I will mark them as 8-9's. It makes loads of sense.

The only time I ever had pain of ten is when I twisted my back (slipping on some ice in my driveway) and the throbbing put me flat on my back in bed unable to move. I stayed there for about 20 minutes until it settled down. I'd get these reoccurring dings (going through the same routine) for about a week until my Chiropractor fixed it for me. That sports fans, was a ten!

Even though my migraines have put me in bed with throbbing headaches, I would describe them no higher than a seven.

I have never experienced level 10 pain. I consider the worst pain that I can imagine to be level 10. I imagine that some of the POWs in Viet Nam experienced level 10 pain during their "interrogations".

The worst pain that I have ever had, I call level 9; and I have only been at that level fewer than a half dozen times in my entire life of more than 55 years. Level 9 pain causes my knees to buckle, making standing extremely difficult. The first time I reached that level of pain it caused me to writhe on the floor. None of my nines have been from headache.

The worst headaches have been level 8.

That's interesting and I understand exactly what you're saying. I guess childbirth wasn't even 10/10, although sometimes when I've got a migraine I think I'd rather be giving birth. I'm sure if I was giving birth though, I'd think the opposite!

If I'm speaking about the pain scale to my GP, I make it clear that it's my own personal migraine pain scale, not relating to any other pain. 10/10 (on my scale) is not very often fortunately, when I am prone, can't move my head/body/open my eyes at all and the nausea is like I'm about to throw up. People probably have worse pain than this during their migraines but that is my worst - so far.

Which brings me to another thing which is how do you guys make it to ER when you're feeling like this. It's at this point I'd want intervention but am unable to move. It's been puzzling me

Liz

DH and I are both migrainers (our house is a triptan's play zone) and on occasion we are each other's drivers for the doc/er visit to finally go the injectable route. I know I've done the naughty and described dh's current episode as an 11 for one of his migraines. What I meant about that was that for what his 'normal' migraine is pain wise, this is off the chart for his migraine pain.

Since we've been seeing the same pcp for almost 10 years now the doc knows what I mean by the statement, and that I'm using a specific 'migraine only' 1-10 scale. I know I shouldn't use a personal scale, but when dh's pulling his own hair out, cause it distracts him from the migraine pain, he's at an 11. Thankfully our doc really knows the 2 of us, and understands that if we're coming in for the tordol/compazine injections, we're at our oral medication limit and still in severe pain (or dh's too nauseous to go the oral med route)

Helpful info Richard. I always think those scales are so lame...with the smiley face pics by the numbers....so when they ask me out of 10 where is my pain I say 20.

I will have to shift that, though I must comment I have never NOT been taken seriousely.....(Though I have only gone to ER in SERIOUSLY scary episodes, where it was apparent in many other ways that I was in no way in ok shape!!)

Good point Richard

I have passed out with migraine pain a few times and for me this is a 10 (as Brenda says, most of the scales used here a 10 is the worst pain you've ever felt, but I can't see it being worse than the point of passing out!)

My average migraine pain I say is a 5-6. This has changed over the years as I would have described this as a 7-8 a few years ago. By 'normalising' my average pain I have more leeway to describe the worse days, which is helpful, plus pschologically I think it makes me feel better. I'm in no competition with myself or anyone else to have the very worst pain around by toting numbers. When talking to drs about my pain I explain this approach, that I am using MY pain scale (what else can it be really, it's very subjective).

Amy

I think one of the problems with the pain scale is that if you have built up a certain tolerance due to chronic pain, then how can one tell what number is their pain. That`s the problem that I have.

Liz,

Hubby usually drives me in. He helps me to the car. I'm usually bundled in my 275 pound son's big hoody sweatshirt to shield my eyes, and it also helps dull the noise. Then a ball cap and my huge migraine sunglasses.

Oh how I hate going there. There's always a child screaming, brights lights and a TV on.

I have driven myself in and called a relative for a ride home. I called my best friend at 4:00 am to come and get me once. He did. Co-workers have driven me from work.

By the time I decide to cave in and go to the ER though my vision is usually so funky I can't drive.

Charlotte

Oh the not so funny things you do when your drunk.

I'm amazed that I made it through my 20's. After I had my first son though I decided I was NOT going to raise my children the same way I was raised, and I put down the bottle.

Charlotte

Charlotte

Thanks, it does sound grim. I know my husband would drive me if he was here but I couldn't stand the thought of moving. Here I think it's a case of calling out the duty doctor for a huge shot of morphine. I haven't done it but know others who have.

I know you've had a bad time lately. I hope things are a bit better now

Liz

Thank you, Lizzie

I'm having a great day today, and man, is it WONDERFUL! I've got my back brace on and am about to tackle cleaning out the guest room. It has turned in to a catch all for other junk. As soon as the Daytona 500 is over, hubby is going to start moving out furniture.

I'm sure I will regret this tomorrow, but it's has MONTHS since I've had the energy to even think about doing something like this.

In my old house I had lovely gardens, I would repaint about every three years and redecorate. I've been in the new house now for four years and don't have any flowers, my living room has a couch and a table...no area rugs, no cohesiveness.

Oh, I just got invited out to dinner. Boy, that even sounds like a social life! Yay! Gotta run.

Thank you for your good wishes. Hoping for another good day tomorrow.

Charlotte

I think the lesson here is never ever exaggerate your pain to get meds. Most ER MD's have heard it all and their BS detectors are on high. Always assume the moment you walk in to an emergency room you are being observed. My wife has worked in ER and has seen it first hand.

Charlotte, I feel exhausted just listening to you! No, that sounds great and so positive. I hope tomorrow's as good too.

I hope everyone had a good day, is having a good day, is about to have a good day and thoughts to those with bad heads.

Liz

10 is described as

"Pain so intense you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain and not blood loss, have experienced level 10."

I think I felt this once for a few seconds when a car hit me. I mean the car contacted my body directly. I came to on the ground and stayed conscious after that. I think I went to a 9 which is described as

"Pain so intense you cannot tolerate it and demand pain killers or surgery, no matter what the side effects or risk. If this doesn't work, suicide is frequent since there is no more joy in life whatsoever. Comparable to throat cancer."

I was, in fact, demanding surgery and pain killers.

Fortunately, I guess, for me, I had no trouble convincing the ER of my pain. You think it had anything to do with my extremely swollen, bruised, distorted looking leg?

Chris

I've never really understood the standard 10-point scale, so I normally define my pain scale to doctors when they ask.

mine is:
0 - no pain or just a tiny bit in the background
1 - annoying but can ignore and do whatever I want
2 - starting to distract me, might make my sleep very restless
3 - can barely focus on a task, will keep me up at night
4- unable to focus at all due to pain
5 - totally engrossing my attention

#5 occurred for a few minutes when I was making tea and accidentally poured about a cup of boiling water on my hand, getting a second degree burn and a giant blister that covered the entire back of my hand. This was at what I call a #5 for maybe a minute or two, then faded to a #4 for about 10 minutes before fading to a #3 for a few hours or so.

#4 was right after I broke my arm, which then quickly faded to a #2

#3 is the typical pain I get from flare-ups of my radiculopathy or when my back goes into spasm.

I'm sure there is much greater pain than my #5, but I've been lucky not to experience it.


ANYWAY - I explain my pain scale, multiply it by 2 if they want a 0-10 scale, and that seems to work.

I've never been denied pain treatment. In fact, most of the time I'm fending it off. During the day I'd rather suffer #3 pain that get the wooziness and constipation pain meds give me. But I'm rather adverse to all meds.

A real issue to me is the duration of the pain. I can suffer #4 pain for an hour or so, but if it went on for much longer I would be begging for pain medication or for someone to cut off the offending part of me. #5 reaches that level almost instantly - it's so intense that it's actually more a "shock" than pain.

what an excellent point. I've often described my pain at a ten when it is completely engrossing and I can't do anything but lay in bed and try to pull out my hair. I will start calling that an 8-9.

I have felt a 10 after my shoulder surgery. After the nerve block wore off I was sick to my stomach with pain and was in absolute agony for several hours until the pain medication finally kicked in. Again after a bunionectomy. That was one of the most awful experiences. It was so much worse than childbirth and pain meds didn't even touch the pain for a couple of days. And once again after my hysterectomy... morphine didn't even touch it and if it did, I don't even want to think about it.

My worst pain has been after surgery. So that is what I gauge my pain scale with. I've had migraines that are as bad as that but most are more like a 7-8.

If I end up in the emergency room again and am upright, that will be an 8 or so.
Alli

Begin whine: I'm suffering from a migraine with #3 ( my scale pain). I'm convinced it's due to the contrast agent from the MRI I had this morning for breakfast, although, objectively, I think it's just the stress of the MRI setting off a migraine. End whine. I have to whine here because my wife has heard enough of it ...

But it's been moving back and forth from #2 to #3 for the last three hours. I'm actually home from work because I can barely focus.

If it was to stay at #3 for many hours, even though I find that level of pain tolerable it DOES start to grind me down, making me fatigued and lowering my focus even more. So just because a certain level of pain is tolerable for a while doesn't mean it is tolerable for hours or days on end. And I'll eventually take something if this doesn't let up soon, partly so I can get back to work and partly to just get rid of it.

I've given birth 5 times (never any medication given), dislocated a tail bone, have had glass in my eye and broken my back. All could have been considered close to a 10. I don't care, I still tell them it is at a 10 in the ER because I do not go in unless I am vomiting, ready to pass out and can barely talk. I have always been wisked away immediately and never had to wait. Maybe I am just lucky. One thing I can say is that head pain seems more unbearable than other pain even if the other pain is worse.

In addition to my comment above, when then ask me on a scale of 1-10 what the pain is like, the 10 is a 10 as far as a migraine goes. I don't try to compare it to other pain. A lot of people may have never had any other pain that bad. They should take a "10" seriously.