The Pain Scale

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?