Where do you rate your migraine, back pain, abdominal pain? A two, a five, a ten?

A few weeks ago I went to see my physical therapist for hip pain. “On a scale of zero to ten, ten sending you to the emergency room, how bad is your pain?” she asked. Pain is universal, and, like most of us, I’ve been asked to choose a number from the pain scale time and again: in the weeks and months after my pelvis, foot, ribs, and lower back fractured in a car accident, when my bowel got all tied up in a knot, and when a cyst on my ovary ruptured.

In 1999, the Veterans Administration established pain as the fifth vital sign, requiring medical professionals to assess pain using the pain scale, a practice introduced by hospice in the 1970s. But how accurate is that scale? While one’s heart rate, blood pressure, and temperature can be objectively measured, pain is subjective. It’s based on perception, which is influenced by a whole host of factors: attitude, stress, culture, upbringing, age, gender, and more. One’s five may be another’s eight. And what about all the fractions in between two whole numbers? Couldn’t one’s pain be a five and two-thirds? What about chronic pain? Doesn’t that change our perception of overall pain? Are you more apt to assign an eight to, say, your recent foot pain because you’re sick and tired of the pain? Or are you more likely to give that toe, say, a three because you’ve become used to pain and can no longer decipher a three from a four or an eight?

I’ve never met anyone who said they’ve never felt physical pain. There are too many opportunities: paper cuts, stubbed toes, headaches, toothaches, back and neck aches. Why is there a zero on the pain scale anyway? It seems useless. As Eula Biss says in her essay “The Pain Scale,”  “Zero doesn’t behave like other numbers.” When we count, we don’t start with zero: “Zero, one, two, three.” Zero is merely a placeholder, a midway point between one and minus one, for instance.

Because I’m not good at making decisions, I’m not partial to the pain scale.

I think pain is best described with real life descriptors: throbbing, stabbing, crushing, needling, nauseating, a quadruple knot in the gut, the hottest part of a fire, a butcher knife to the toe. I want to tear apart my skin and crawl out of my body. I want to scream, scream, scream.

If you were asked to describe your pain, past or present, what would you say?

Are you in need of a service dog?

It is well known that people with physical disabilities benefit from service dogs, but emotional support dogs have yet to be scientifically proven to help those with post-traumatic stress disorder. Service dogs are trained to carry out specific tasks like guiding people with vision difficulties across the street, or picking up dropped items. Emotional support dogs provide companionship for those with mental health conditions. They are pets and not trained to do the tasks that service dogs are trained to do.

After previous studies were suspended, due to inadequately trained dogs, this past April the Human Animal Bond Research Initiative (HABRI) granted funds to Purdue University to measure the outcomes of utilizing service dogs for post 9/11 war veterans suffering from PTSD. Researchers will be working with K9’s for Warriors, a non-profit that follows a “Gold Standard” when training rescue animals to be service dogs. The study will assess for changes in stress level, medication, and relationships among veterans.

Though some private organizations provide service-dog training for individuals with mental health conditions such as PTSD, the Veterans Administration currently does not; they offer information on how to contact places that provide service animals. But they do offer veterinarian services. If the Purdue research proves that service dogs can help those with PTSD, the VA will also provide veterinarian care to those dogs.

The study will take several years to complete, but, who knows, maybe it will lead to more studies, ones involving service dogs for those with PTSD in the civilian community. Though such dogs are not to be relied on as a panacea for PTSD, if they are recognized as a legitimate adjunct to traditional treatments, thousands of people may benefit. In the United States alone, more than 24 million people are estimated to have PTSD at any given time.

Are you among the 24 million?

In 2012, nearly half a million premature births occurred in the United States. An infant born before 37 weeks gestation is considered premature. Risk factors include: race, smoking, alcohol use, having delivered a previous pre-term infant, carrying multiple infants (twins, triplets), problems with the uterus or cervix, and chronic illnesses such as diabetes, asthma and kidney disease. www.cdc.gov/PrematureBirth

If you don’t already know, post-traumatic stress disorder is also considered a risk factor for premature births. In the largest study ever conducted, researchers at Stanford University Medical Center followed more than 16,000 infants delivered by female veterans. More than 3,000 premature births were delivered by mothers diagnosed with PTSD. Those diagnosed with PTSD in the year prior to delivery were found to be at thirty-five percent greater risk. The researchers factored in other issues, such as race, age, medical conditions, and alcohol and drug use. It’s worth noting that fifty percent of the women studied never went into combat, proving that the link between PTSD and delivering a premature infant is not exclusive to veterans. Civilian women are affected too. www.sciencedaily.com/2014/11/14

But how does PTSD contribute to premature births? Stress. Though the exact mechanism is not completely understood, higher than normal levels of stress hormones are released in those suffering from PTSD symptoms. The immune system then becomes suppressed, increasing the risk for infection, which increases the risk for premature birth. www.marchofdimes.org/pregnancy/stress

The good news: those who do not experience PTSD symptoms in the year before delivery are at the same risk for giving birth to a premature infant as those who do not have PTSD. For those who do suffer symptoms in the year prior to delivery, treatment is available. The Veterans Administration is using the results of the study in the care of pregnant women with PTSD. For pregnant civilians with PTSD, the good news is that you now know you are at risk, and can inform your obstetrician. There are some risk factors you might not be able to control – age and race for instance – but you can gain control over your PTSD. www.sciencedaily.com/2014/11/14

For a list of therapists, go to The National Board of Certified Counselors at: www.nbcc.org/counselorFind