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From: Sancin
Date: 08-12-2005, 12:36 AM (1 of 13)
After the discussion on Migraines in Home and Hearth and the chronic pain / PMR discussion here I have had several pm. Pain seems to be a big part of our life at times and may be chronic. I am therefore going to post the following information for general interest. I used to teach a course on pain and one of the discussions that always came up was what is suffering and tolerance in relation to pain. What will people put up with and for how long. I would be interested in what this group think of suffering and tolerance.  We are often asked for our pain levels on a scale of 0-10, with 0 being absolutely no pain, and 10 being the worst pain you have ever experienced in your life. It's all very subjective, and depends upon a person's previous experience or expectations in relation to pain, but, over the years, the 0-10 scale has remained a mainstay. Several sufferers and health professionals have developed some scales to help patients communicate their pain. There is great agreement between the scales The following is amalgam of some of these scales PAIN SCALE Very Important: This is the subjective pain level that is experienced AFTER taking the daily medication prescribed by your doctor. * Levels 1-3 are tolerable and don't affect everyday functioning, 2 and 3 are uncomfortable but one may not seek professional assistance. People with chronic pain usually experience level 4 most of the time, except some cancer or trauma pain which may be greater. 0-Pain free - no further medication needed 1-Very minor annoyance -mild aches to some parts of the body. No pain medication needed. 2-Minor annoyance- dull aches to some parts of the body. Occasional strong twinges depending on what one is doing. No pain medication needed. 3-Annoying enough to be distracting. Over-the-Counter pain relievers (such as Asprin, Naproxen Sodium, Acetamonophen (Tylenol), Ibuprofen or topical treatments such as Absorbine or Arthritis Pain relieving rubs or application of heat or cold take care of it. Taking medications at this level may prevent pain from getting worse and harder to control. 4-Can be ignored if you are really involved in your work, but still distracting and causes some stress. Over-the-Counter pain relievers remove pain for 3-4 hours. 5-Can't be ignored for more than 30 minutes and is stressful. Over-the-Counter pain relievers help somewhat (bring pain level from 5 to a 3 or 4) with pain for 3-4 hours. Not smiling. 6-Can't be ignored for any length of time, but you can still go to work and participate in social activities. May be becoming irritable.Stronger painkillers (such as Codeine, Tylenol 3, Vicodin, Ultram) relieve pain for 3-4 hours. At this level pain must be treated or will be harder to get under control as it escalates. 7-Makes it difficult to concentrate, interferes with sleep. Pain is difficult to tolerate. You can still function with effort. Stronger painkillers (such as Oxycontin, Ultram) are only partially effective. (Stronger pain killers bring pain from a 7 to 4-6.) 8-Physical activity severely limited. You can read and converse with effort. Stronger pain killers (such as Ultram) are not effective. (Narcotic pain killers do bring this pain down to a level 3 or lower.) Nausea and dizziness set in as factors of pain. May cry and moan. 9-Non functional for all practical purposes. Unable to speak. Cannot concentrate. Physical activity halted. Strongest painkillers are only partially effective. Panic sets in. (Narcotic Pain killers bring the pain level from 9 to the 4-6 level.) 10-Totally non-functional. Unable to speak. Crying our or moaning uncontrollably - near delirium. Strongest painkillers are only partially effective. *~*~*~* Nancy*~*~*~* " I try to take one day at a time - but sometimes several days attack me at once."
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User: Sancin
Member since: 02-13-2005 Total posts: 895 
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From: gb1
Date: 08-12-2005, 08:19 AM (2 of 13)
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I don't think the pain scales are all that accurate. Not only are they totally subjective, but people have a wide degree of pain tolerance. My husband who lived with severe chronic pain for years got to the point where he could "block" the pain so he was not consciously aware of it -- that was the only way he could even get out of bed. His blood pressure was sky high and uncontrolable. The doctors kept saying the pain would not raise his blood pressure and when I would talk to nurses I couldn't get them to believe he had pain because they would always pull out that pain scale -- so I'm not a big fan. IMHO most doctors focus only on treating the pain itself without looking for what is causing it. Pain is a only a symptom -- the body's way of telling you something is wrong. Hubby was taking Celebrex which was the only drug that would even touch the pain, but when the FDA started pulling the other Cox 2 drugs off the market we started looking for other solutions. I insisted we not wait till Celebrex was gone. He is totally off the Celebrex now and feeling better than he has in years -- his blood pressure is also fine. We made some dietary changes and added MSM to our Glucosamine/Chondrointin formula and also started taking the full reccommended dose -- we had been trying to save money. His doctor was astounded -- but he did take notes, because he has a lot of patients that took Cox 2 drugs. This is an area where I believe everyone has to find their own way. But at least for us the hard part was getting doctors to believe there was a problem and that darned pain scale really got in the way. |
User: gb1
Member since: 08-08-2005 Total posts: 6 |
From: Dede
Date: 08-12-2005, 09:11 AM (3 of 13)
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Pain has to be evaluated on a case to case basis, even then ... I am extremely pain tolerant, the opposite of a friend of mine who thinks she's going to die when going for a waxing session. Having said that, I personally think it would be difficult for any professional to make any kind of assessment or decision for that matter, on a patient or should I say a perfect stranger. That's just my opinion. |
User: Dede
Member since: 03-23-2001 Total posts: 469 |
From: LeapFrog Libby
Date: 08-12-2005, 12:28 PM (4 of 13)
I guess I am one of the luckiest people on this earth, because the worst pain I ever had was a migrane.. I had 2 children (labor and delivery-- not C-section) and I had menstrual cramps that were worse than any labor pains I had.. 3 surgeries, but other than that been fairly healthy all my life.. Oh yes, 1 broken bone in my foot.. I don't know if I had ever had a 5 on a scale of 1-10.. I am not bragging, just saying I am lucky to reach age 71 in this shape.  .
Sew With Love
Libby |
User: LeapFrog Libby
Member since: 05-01-2002 Total posts: 2022 
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From: Sancin
Date: 08-12-2005, 02:10 PM (5 of 13)
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GBI - You are right on about pain being personal and individual. My reason for posting this is so people understand when a professional asks a person if their pain is 0-10 this is what they mean. I think the best way to describe pain is not just the discomfort, but what it prevents you from doing or what you can do with pain, what works to decrease it and how long is goes on - is most concrete information from assessors point of view. Another bit of useful information is what degree of pain are you willing to put up with because it may not be possible to totally remove pain (tho technology is getting closer). This type of questioning tends to be very poorly done by most health professionals. Your husband being to 'block' his pain is an excellent coping mechanism, tho no doubt it seemed time consuming. Congratulations on finding ways to improve your husbands health. Read my previous message in PMR about difference between acute and chronic pain. Fatique and stress (and yes stress caused by elevated blood pressure!) can make the pain seem worse or not copable. That stress at any level can actually become panic - "I can't stand this" which then becomes spiral as stress cuts down circulation. Old studies used to show that the worse ACUTE pains were migraines, labor and delivery and kidney stones. We now know that all of those lead to lack of oxygen to organs and muscles and anything that causes oxygen to be blocked will cause Pain. The other thing that can affect the pain one feels is the meaning of the pain. The pain of cancer may seem worse as it may predict death while surgical pain may mean one knows it will end soon. People with chronic pain usually know the pain is going to continue. Many thanks for your opinions. *~*~*~* Nancy*~*~*~* " I try to take one day at a time - but sometimes several days attack me at once."
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User: Sancin
Member since: 02-13-2005 Total posts: 895
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From: gb1
Date: 08-13-2005, 02:18 PM (6 of 13)
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[QUOTE=Sancin] Your husband being to 'block' his pain is an excellent coping mechanism, tho no doubt it seemed time consuming.QUOTE] No, it really wasn't. In fact it almost killed him. Pain is only a symptom. A warning sign that something else is wrong. Doctors who ignore that and only treat the symptom (the pain) are putting their patients lives at risk. Guess we're just going to disagree on this one. Sorry, but I just couldn't leave people thinking blocking pain is a good thing. I've said all I'm going to say to on this topic. |
User: gb1
Member since: 08-08-2005 Total posts: 6 |
From: sewingrandma
Date: 08-13-2005, 03:24 PM (7 of 13)
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My doc told me that because I was taking NSAIDs for my arthritis pain it was causing my blood pressure to rise. Once my pain was under better control the bp went down, even though I was still taking the NSAIDs. Sancin, I like your explaination of the pain scale. A lot of nurses ask you for your pain level but can't explain the difference. Hospitals should have your explanation posted instead of just the number/face scale.
Brockie
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User: sewingrandma
Member since: 03-06-2003 Total posts: 432 |
From: Longblades
Date: 08-16-2005, 01:22 PM (8 of 13)
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Sancin, I like your chart, I'm going to print it and keep it in my Health file. I have been told, by medical people, that I have a high pain tolerance (dental procedures, broken leg in car accident). The referencing to how the pain impacts your life was suggested to me by my Doctor and helped resolve some problems. I also see the point about coping measures and blocking pain not always being a good thing. I walked around for a week on the broken leg. The leg ached but not too badly. I also had huge abscesses, with no pain at all, in my two front teeth, that should have been root canalled long before my dentist noticed them. Isn't there some kind of dangerous condition some people have where they feel no pain at all, from anything? I think I saw a TV show years ago about a child with such a disease/condition/syndrome and the parents were in constant fear that he would engage in normal childhood activities but fall and do damage to himself and not have the pain to tell anyone where the damage was. |
User: Longblades
Member since: 07-14-2005 Total posts: 182 |
From: Magot
Date: 09-05-2005, 02:22 PM (9 of 13)
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Pain is an indicator that something is not right with your body. The weirdest thing I found is you become accustomed to chronic pain (I was about a 5-6 with a bad shoulder) and learn to live with/cope with it. Your expectations of a pain free life reduce. I then had an operation to repair the tendon (hurray -18 months waiting list) and am now pain free. I was amazed at how the cessation of pain affected my mod. I was unaware of how crabby and intolerant I had become because of the pain. A point always to conider when dealng with folks with chronic pain, they may not really be that short tempered by there is only so much they can take before overload sets in. By the by, I have recently been waking up at night with hip pain - spoken to doctor and he lovingly tells me I am wearing out. Presribed stonger painkiller and warned me of side effects. I decided not to take them and am now taking the glucosamine and chondritin supplements - fantastic - no more hip pain! love and kisses, Jan
Guts-R-Us Cells a Speciality DNA to order. |
User: Magot
Member since: 12-22-2002 Total posts: 3626 
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From: Jayde877
Date: 09-06-2005, 05:52 PM (10 of 13)
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7-Makes it difficult to concentrate, interferes with sleep. Pain is difficult to tolerate. You can still function with effort. Stronger painkillers (such as Oxycontin, Ultram) are only partially effective. (Stronger pain killers bring pain from a 7 to 4-6.) 8-Physical activity severely limited. You can read and converse with effort. Stronger pain killers (such as Ultram) are not effective. (Narcotic pain killers do bring this pain down to a level 3 or lower.) Nausea and dizziness set in as factors of pain. May cry and moan. I hope no one minds me adding my two cents here, because I am not "Middle Aged" (28) but I just came back from the doctor and found this thread interesting. I listed two of the numbers on the 1-10 pain scale for a reason. My visit to the doctor today was for chronic muscle-tension headaches. I began having them after the anesthesiologist tried (and failed) 5 times to give me an epidural when having my son (9 years ago come November). I have seen a neurologist in the past and she found no 'cause' of them, but that's beside the point. Most of the time I could take a couple Excedrin (asprin-free cause I can't take asprin) and be fine, but the past couple of weeks I have been getting headaches every day and the Exedrin just wasn't helping. I would never have listed my pain on a scale as a 7 or 8, but looking at the descriptions they are closer to that than a 4 or 5 which I would have said. The only difference is, it doesn't take much effort for me to function even though I'm nauseous or dizzy, and even though I have difficulty sleeping. I have had joint problems all my life and had surgery (when I was 10) on my feet. I have lived with pain all my life so I guess I have learned to deal with it. I don't have high blood pressure, actually it usually on the low side if anything, and I function normally ( with some whining and griping when it's really bad  ) Anyway, I have to agree with the person who said each person should be dealt with on an individual level, as with anything, all people do not fit into one single mold. I think the descriptions that were listed are really quite helpful and using those descriptions along with the number scale a person can better define their level of pain. Anyway, good luck to everyone with dealing with their own pain.Charity |
User: Jayde877
Member since: 07-27-2005 Total posts: 106 
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From: Sancin
Date: 09-07-2005, 02:58 AM (11 of 13)
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Jayde/ Charity - we hope you do add your 2 cents or more. You have chronic pain, which is different than acute pain. Check out the discussion called PMR (also in this forum) where I posted some differences between chronic and acute pain and some different approaches. My interest is professional as I was/am a nurse educator, but also because I also suffer chronic pain d/t several conditions. Today I am incredibly irritable, weepy and trying everything I can think of for back pain. I finally went outside and leaned hard against my fence in frustration.... and the pain stopped! I think it goes without saying that everyone is different. As individuals we are all different and we have all experienced life differently - even identical twins. At times I think it is a miracle we can communicate at all! And, of course, you function with pain. You are a mother! Headaches after epidurals are not uncommon and sometimes are caused by slow leakage of fluid but it should seal itself after a relatively sort period of time (weeks). There are some alternate therapies that work. A physio may be able to help as may a massage therapist. I wish I could remember the name of the technique "... release", - it involves pulling one's hair until it hurts all over one's head - sort of like hitting your head against a wall because it feels so good when you stop!!!  Not really, but actually does release muscle tension on skull - like counterpressure on back during labor. A massage therapist taught my students the technique. There is also a technique that Healing Touch practioners use that is very effective. Good luck with your pain - there is an answer somewhere - but I appreciate it is trying and tiring finding an answer.
*~*~*~* Nancy*~*~*~* " I try to take one day at a time - but sometimes several days attack me at once."
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User: Sancin
Member since: 02-13-2005 Total posts: 895
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From: Catalina
Date: 09-07-2005, 06:37 AM (12 of 13)
| I've been having pain for some time. Herniated disc in neck and low back pain and spasms and stiffness from MS. I just recently started with tmj pain. I've been reading Healing Back Pain - the mind body connection by John Sarno MD- I'm not sure I agree with everything in the book but its helped me look at pain in a different way. I am going to PT now to stretch and stregthen my back and am seeing a tmj dentist. I also take a pill for my spasms. Being in pain is no fun, it can make someone ornery and depressed. I wish all our pain would just go away. |
User: Catalina
Member since: 01-06-2005 Total posts: 119 |
From: Jayde877
Date: 09-07-2005, 01:18 PM (13 of 13)
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Right after having my son I was having headaches so bad that I couldn't do ANYTHING. I couldn't feed my son, I couldn't walk, move or anything they hurt so bad. I went to the ER and was told to take something stronger than tylenol (was so used to only being able to take tylenol during pregnancy that something stronger just didn't enter my mind lol) and to drink lots of caffine. After a few weeks the headaches did lessen but they never went completely away. I don't know why. I can only assume it had something to do with that messed up epidural, I was leaking spinal fluid from 5 holes. Usually there is only one. I haven't had any doctor confirm it, but I just know it's because of that. When I had my daughter I told my Nurse Practitioner that I was in NO way having anything stuck in my back. She was dumbfounded and asked what I wanted for pain. I explained to her what happened with my son and she swore that wouldn't happen again. So I agreed to have an epidural but if it didn't work they could not stick me more than once. I had my son with almost no pain meds (one shot of Demerol (sp?) about 6 hours before I actually pushed him out) so I figured I could live through it a second time as well. Turned out there wasn't time to give me an epidural with my daughter. She took less than 4 hours to be born once labor started. Anyway, I'm going off track here. I would like to have an MRI or something done to check my lower back or something to find out for sure if that was the cause, but alas, my insurance will not cover that. Dealing with pain is difficult, and I do my best, the every day meds my Dr prescribed for me yesterday didn't get rid of my headache, just dulled it a bit then it came back full force when the meds stopped working, so I took the stronger one before bed, even it didn't make it go away completely. (The stronger med is called Cephadyn which I looked up on Yahoo Health and discovered it's a barbituate!! WOW) So now, I will go back to him again and let him know what's going on and see what he suggests next. Thanks for all the support here. You guys are great!! Charity |
User: Jayde877
Member since: 07-27-2005 Total posts: 106
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