Oi weh! – A new pain index

George Rebane

Due to my bride’s unfortunate fall that shattered her elbow and required urgent and complex orthopedic surgery to put the pieces back together, there has been a lot of talk about pain with the attending surgeon, medical techs, and physical therapists.  Everyone one was interested in the magnitude or intensity of the pain.  And today the only way to extract that from a patient is to ask them to assess their pain level on a scale of one to ten, a scale which no one knows how to anchor, calibrate, or even claim whether it is normative.  In clinical lingo something is normative if a large cohort of people in a ‘similar’ situation agree, here in assigning the same pain number to the same intensity of pain.  As you would expect, no one knows; yet they still keep asking and dutifully writing down that number from one to ten.

After noodling on the problem that I’ve had an opportunity to witness numerous times recently, I have come up with an alternative scale that should at least be more normative and therefore useful to the attending medicos.  My approach is based on behaviorism and requires the patient to relate the level of pain to either ongoing (chronic), planned, or executed behaviors.  Here is a first cut at it.

Level 0 – No pain, or that the former episodes of pain have ceased.

Level 1 – Chronic pain or pain episodes continue, but are inconsequential in that the patient does not think about the pain before acting, during/after which act only a mild discomfort is noticed that is not intense enough to make it memorable.

Level 2 – Pain that causes patient to become conscious of it or anticipate it before the act, but at an intensity that induces no hesitation to act and suffer the resulting pain.  The episode remains memorable.

Level 3 – Chronic or anticipated pain at intensity that causes patient to consider delaying the pain-causing act.  The episode remains memorable.

Level 4 – Chronic or anticipated pain at intensity that causes patient to contemplate how to entirely avoid the pain-causing act.  After the act, the episode definitely remains memorable.

Level 5 – Pain at an intensity that causes patient to consider changing after-act plans, but most likely will not actually bring about such a plan change.  The act creates/reinforces a very memorable episode.

Level 6 - Pain at an intensity that causes patient to either avoid act or definitely change after-act plans.  Previous completion of the act created/reinforced a very memorable episode, that made it unlikely that the act would be repeated without some mediation to reduce the pain’s intensity.

Level 7 – Chronic or anticipated pain at intensity such the contemplated act will definitely not be undertaken without some known mediating effect or agent to reduce the pain to an acceptable intensity.  At this level, such prophylaxes and their former absence are vividly remembered during the next precursor to the act.

Level 8 – Chronic or anticipated pain that is/was suffered with attempted analgesics which are/were ineffective.  The sensation/memory of this pain summarily prevents the patient taking/repeating the action since there is no known way to reduce the pain to a level at which the act may again be contemplated.  Suffering is intense and ongoing, causing the patient to essentially avoid all activities.

Thoughts?

Comments

[fish]

My best to your dear bride and hope for a rapid recovery!

[Gregory]

I demand a scale that goes to 11! (Hat tip to Nigel Tufnel)

George, not a bad swag but I think the clinical use is mostly to get a handle on if you're getting better or worse. The junkies looking for a fix can and do put on an act and will go to 11.

Best wishes to JoAnn. Ouch.

[George Rebane]

Jo Ann thanks you for the good wishes, and reports that she is currently at L1 and looking forward to L0.

Gregory - Good points, but when I questioned two separate people at two separate facilities about the 1-10 index, they both reported that not only were the patients' reported numbers taken normatively, they actually had established response policies afo the reported pain number - e.g. a number above 5 was required before analgesics would be considered or prescribed. Go figger.

[scenes]

The important value is the one that gets you the decent drugs. Sometimes a nurse will telegraph that number.

[scenes]

Seeing as how all people are identical, regardless of ethnicity, it's interesting that there's a measurable difference in pain response.

The one that should shock no one is that redheads are more difficult to sedate and have high pain tolerance.

[Scott O]

Very sorry to hear of her fall and fracture. Not fun. Caroline and I wish her a speedy recovery. We know her home care will be top notch.
My wife has unfortunately been in situations where the med staff would ask her about the pain on the '1 to 10' scale and it always struck me as being a bit arbitrary, but as was noted - it's at least some kind of baseline to establish better or worse as the treatment commences.
My favorite line of all time from the cinema:
"The trick...is not minding it"
https://www.youtube.com/watch?v=TvQViPBAvPk
Ah - there's the rub!
Most of us do mind it.

[Barry Pruett]

Oh no. Prayers to Jo Ann. We hope that she gets better soon!