Many people, even “normal” people who don’t have a roster of medical specialists have seen pain scales. The most commonly used (posted all over ER exam rooms around the world) is the Wong-Baker FACES® Pain Rating Scale. It was a tool initially design to helpassess pain in pediatric patients but it is now widely used for patients 3-years-old into adulthood. More in-depth scales have been created based on this principal of rating pain from 0 to 10, with 10 being the worst pain that one can imagine. This “Universal Pain Assessment Tool” (below) is seen a lot too. Based on the Wong-Baker scale, it adds more detail.
I am not the first patient to feel frustrated by such scales. Yes, they are useful for medical professionals to get a quick idea of pain levels but they are also lacking, particularly when it comes to people who deal with chronic pain or who have a high pain tolerance. Such scales also can fall short because a person’s “worst pain possible” is variable. To illustrate, when I first started dealing with chronic pain, I spent a lot of time in bed or resting. I spent a lot of time with “Moderate Pain” (blue and purple faces). Now, despite pain levels increasing, I spend most of my time with the “No Pain” green happy face. Additionally, some people have gone through extreme pain experiences. I know a few people who have had hollow organ ruptures (appendix, ureter etc.)…. whereas someone else may have experiences a sprained ankle as their worst pain so far. These past experiences would change someone’s pain scale perception drastically. In my search I came across one scale that rates “comparative pain” (something I wrote about in a previous blog which you may be interested in reading here). I have seen numerous blog posts and memes (like the one to the left) that approach this issue of chronic pain often being invisible.
The scales I have found most useful for myself so far have been those based on functionality. Instead of assessing pain, it assesses the person’s ability to function. In the pain management world, functionality is the focus of pain management specialists anyway with the focus being taken away from quantifying a person’s pain. An example would be the Functional Ability Scale or the Work and Social Adjustment Scale (WSAS) – Serenity Programme.
Though this is all very complex, when I doctor asks you to rate your pain from 1 to 10 with 10 being the worst pain you can imagine, you can’t delve into a five minute discussion raising all the relevant points. The key is to be skillful. I often quickly state what my 10 is and what my 5 is so that there is perspective setting. I also often mention how pain and suffering are not the same thing… which I don’t dig deep into in a specialist’s office but I will elaborate on here.
In the first months of my chronic pain condition, I took a mindfulness for chronic pain course series at the Ottawa Mindfulness Clinic. One of the most poignant pieces of information I took from the course was: SUFFERING = PAIN x RESISTANCE. If I were to be completely and utter (body and soul) non-resistant to the pain my mind tallies, I would have absolutely no suffering. Now, though I practice informal mindfulness every day, I do not expect to get anywhere near Enlightenment in this lifetime! The message is still valid though.
I believe a good compliment to the Pain Scale would be a “Suffering Scale”. Here is one I created base on my own experiences. It is not rigorously research or thought-upon by any means.
SUFFERING SCALE FOR PAIN
0 – EVERY experience is truth and wonder. I register all my pains and discomforts with the same perspective and curiosity that I register my joys and see them as they are. I am the opposite of numb.
1 – I live a life of full of joy and wonder but I have to be vigilant in my mindfulness. When I experience suffering, I do not hide from it but I may not identify it truthfully at first.
2 – The perspective or stance I take on my life means I spend quite a bit of time and energy dwelling in places that can easily lead to suffering.
3 – My negative emotions and physical pain cause me enough suffering that it is leaking into the lives of those around me and adding to their suffering.
4 – I can no longer process thoughts effectively about suffering, pain, or anything. My suffering is physically and emotionally blinding.
5 – Disassociation from self. I do not register pain or joy. My body and mind are detached and numb.
This is a quick version I jotted down. What do you think? What would you change or add? This does give you a bit of a idea of what I mean though. Someone could be at Level 5 out of 10 on the Pain Scale but 1 out of 5 on the above Suffering Scale. Level of suffering compared to that of pain makes a HUGE difference. When someone expresses sadness or pity toward me, I often respond with, “I am happy. My life is full of joy. I may experience chronic pain but I believe I am suffering much less than a lot of people who experience no bodily pain.”
Chronic pain has changed my life. The trick is to keep seeing it as a different life and not a worse life. Working at it every day! 🙂