My brother and I were talking about the pain scale as we discussed his imminent knee replacement surgery.

The pain scale is childish, and can’t be very helpful.

Joe Rogen often says, “the hardest thing a person has ever done, is the hardest thing that person has ever done.”

That statement isn’t as trivial as it seems.  Getting over the pain of being dumped by his sweetheart, may be the hardest thing a high school kid has ever done.  It may be trivial compared to going through a contentious divorce, but he’s never gone through a contentious divorce.

That is true of pain, and the pain scale.  It’s possible to live a relatively pain-free life.  If a person has good teeth and is not a competitive athlete, most pain can be avoided with a cautious attitude. 

The pain scale is entirely subjective without some context.  Doctors should, but often don’t, provide context or discussion.  I suggest defining the categories along this line:

  1. Hardly noticeable. I can get used to it.
  2. I don’t think about it if I’m doing something, like watching TV or driving.
  3. I know it’s there and kind of irritating, but I can get on with my day.
  4. Pain is always there, but others wouldn’t notice. May cut out a few optional activities.
  5. I can function, but am distracted when doing everything. Do only mandatory tasks.
  6. Can think, talk and move, but it’s all very difficult. Limited ability to drive.
  7. Dominating. Complicated thinking or talking aren’t possible. Simple movement is possible.
  8. Consuming. I can’t think or talk beyond one word answers. Might vomit.
  9. Unbearable. If there was button to kill myself, I might push it.
  10. Kill me.

Imagine sticking your finger in boiling water for a second, or other first degree burn.  For an hour or so, that might be a 5.  After that, it’s a 4, and it might be hard to get to sleep.  The next day, it’s a 3.

The pain scale is important because a doctor makes decisions on treatment and medication based on a vague, self-reported number.  If the medical issue can’t be verified with diagnostic equipment, the pain scale may be all the doctor has to work with.  Sciatica is like that.  Nerve pain down the back or leg is a common ailment that will afflict about a third of us. 

A stoic person may try to tough it out, giving a lower number on the scale, resulting in needless suffering and ineffective treatment.  A cream puff may give an inflated number, resulting in serious medication and unnecessary treatment.

I usually only think about the pain scale when something has gone very wrong and I’m sitting in the room waiting for the doctor.  Having had a kidney stone that put me in the 9 range, most pain only warrants attention if it indicates a condition that won’t resolve on it’s own.