PAIN

Have you heard the phrase, “Live and learn?”  I’m 70 years old and can personally verify that not only is “Live and learn” true but that another common phrase, “You are never too old to learn” is true, as well.  A few weeks ago, I experienced one of life’s lessons that I wish I could have skipped.

I tore a muscle/tendon in my groin. I spent 35 years asking people to rate their pain on a 1 to 10 scale. I have had multiple docs ask me the same question.  I thought I knew what a 10 was.  I didn’t!  I was getting out of my car when I felt a burning, searing rip in my groin that almost knocked me off my feet.

When my patients complained of pain, I asked them to describe it.  I then offered them some common descriptions of pain by asking, “Is it burning, stabbing, crushing, throbbing, aching, dull, sharp, etc.?”  Once the type of pain was determined, I asked them whether it was continuous or intermittent, what made it better and what made it worse. Patients were usually quick to answer these questions and their answers made sense anatomically.

It’s when I asked them to score their pain on a 1 to 10 scale or some other scale that things got difficult. The problem with scoring your pain is that whatever scale you use, the answer is going to be highly subjective and individualized.  It is also going to be unreliable.  Scoring on a 1 to 10 scale helps the physician gage the success of his/her therapy from visit to visit.

Let me explain. Patient “A” has lower back pain.  He injured his back at work and has been out of work for        a week. He walks hunched over and rates his pain at 11 on a 10 scale. His face showed no signs of pain or distress.  His pulse and BP are normal. When my pain hit 10, my pulse shot up, I started sweating, and I screamed, “F.ck, f.ck, f.ck.”  I certainly was not calm.

So, what is a doctor to do with this patient’s 11 or 10?  Some people exaggerate (I’ve been accused of that).  If he is one who exaggerates, then his 11 will serve as his baseline and will be compared to future values. The patients 1 to 11 scale will be personalized.

Perhaps he has a low pain tolerance.  Often, I would ask the patient to imagine that he was putting up a picture and hit his thumb with the hammer rather than the nail.  I would tell him that the pain from smashing his finger should be a 10 and ask him, given that information, what his number would be.  In this case, he said 11 of 10.  He also asked for Norco.

He didn’t get his Norco and stomped out of the office.  It was interesting to note that his hunched stance disappeared as he left.  I watched him slide into the seat of his Camaro and drive off.

The point is that grading your pain based on a 1 to 10 scale is difficult and of limited value.  Categorizing pain based on the type of pain and what makes it worse or better is much more helpful.  Faking or exaggerating pain to get narcotics is not only hard to do but turns physicians into skeptics and adversely affects the care of other patients.  Abuse and overuse of narcotics has led to the current restrictions on pain management.  Many of my colleagues will no longer prescribe narcotics and many of my chronic pain patients are suffering due to these restrictions.

If you suffer from pain, before seeing your doc, assess your pain, paying attention to location, type of pain, and what improves or worsens it.  In using these descriptors, you are trying to paint a picture of your pain so that your doc can make the correct diagnosis and formulate an appropriate treatment plan.

Here’s your joke for today:

A young woman has been taking golf lessons. She has just started playing her first round of golf when she suffers a bee sting. The pain is so intense she decides to return to the clubhouse.

Her golf pro sees her come into the clubhouse and asks, “Why are you back so early? What’s wrong?”

“I was stung by a bee.”

“Where?” he asks.

“Between the first and second hole,” she replies.

He nods knowingly and says, “Apparently your stance is too wide.”

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