Monday, September 22, 2008

The Pain Scale

Everyone I know who deals with pain and doctors hates the "pain scale."

You are asked "How is your pain on a scale of 1 to 10 with 10 being the worst pain you have ever felt?"

First of all, this makes the scale completely subjective. What if the worst pain someone has felt is a hangnail, and another person's is a Csection with no anesthesia?

I was asked this question 3 times last week. First, by an orthopedic surgeon. Next, by a neuropsychologist and lastly, but a neurologist. All were part of a team of "agreed upon medical examiners" for my workers comp insurance and also for my attorney.

[I want to mention here, without segue, that I have experienced such horrific pain. The worst, I suppose, was when I broke my neck. I had natural childbirth without any anesthetics, and my son was born "face up" and it was a difficult birth. I've fallen off of a lot of horses (I'm not accident prone, it's just that my livelihood of training unbroke horses for 35 years just sort of lends itself to an "e-harmony" relationship between one's face and the hard, rocky surface of the ground).

I suffered a dislocated and fractured ankle up in the wilderness while moving cows up into the high country. I just went through a very painful surgery with my tethered cord operation. That was almost 11 months ago and the pain is worsening.

I've had some wicked dental issues with one time being, I had an upper molar and a lower molar abscess the same weekend, our dentist in our little town was away for the weekend and I had no pain meds. I wished for death, as a sweet release, until Monday when the dentist immediately took me in and gave me a big ol' needle and I thought maybe life was worth living again.

One of the worst pains I've ever experienced was food poisoning last year. Also, stupid as it sounds, a particularly bad bout with constipation a few months ago made me longing for fusion surgery and a halo, things I've dreaded.

I woke up from anesthesia sooner than I should have when I had "invasive cervical traction" done last November. I remember feeling the pain, the kind of pain where "pain" is just not sufficient a word, from where they were tightening the screws of the halo into my head and now that I'm writing about it, perhaps that was the worst amount of pain I've known. Later on, I likened how I felt for those moments to what it surely must feel like in Saddaam's torture camps, pure pain, the kind that allows for no words, only utterances.

So, I do know what #10 on a pain scale feels like. And this morning, once more I got up in agony. At 3:45 am, I finally succumbed and arose from bed and hobbled with hurting feet to the kitchen and to decide if I should risk taking a Perocet or not (I did risk).

So, Mr. Doctor, or Dr. Doctor? Ask me to answer the rate of my pain 1 to 10 with a 10 being the worst pain I've ever felt. What do I say? when I woke up a half hour ago, I sat at the computer screen to divert myself, monitor screened darkened to almost black, holding my glasses up with my left fingers so that I can look through my bifocals at the right angle in order to focus (I do this all the time since cranking my chin up to focus thru the bottom part of the bifocals is something a bit insulting to someone with a broken the mornings when I first look at a computer, my eyes are so painful! I'm sure it's because the retinas are not closing very well and I end up each night with eyes that feel like I've just had those drops from the opthamologist to widen the retinas (you know the kind and the pain you feel from any sort of light).

So, I'm sitting here in a lot of pain but thinking, hey, compared to when I broke my neck; when they screwed a halo into my skull and I was awake; when my teeth abscessed, the pain today is more like a "4." But, how misleading is that.

Everyone, most likely, reading here knows what I mean. Pain Scales suck and are useless. And here they are, an incredibly caveman-type (sorry Geico guys) of technology, being used by neurologists, neurosurgeons, brain surgeons, neuropsychologists.

What do I answer? Does it make a difference? I've chosen to just answer 9, by eliminating the worst pain I've ever felt from the equation, and the least pain I've ever felt, like they do in scoring ice skaters. Thus, I envision a judge from the old days, pre-computers, holding up a white sign with a rounded number sketched in with black, heavy markers: 9.5! The crowd goes wild, I jump up and down in the "kiss and cry" booth, hug my coach, knowing if I practice really hard next time, I might get the elusive "10!"

Right now, I'm on morphine 3x a day with Percocet to be taken for breakthrough pain, which means I'm taking it every 4 hours.

Then, someone calls me up and says, "How are you feeling today?"

I can't blame them, I call people and ask the same thing. Are they like me and say "fine" out of weariness and out of "not really wanting to talk about it?" Imagining the white placards with bold numbers handed out by a neuro-judge? Does the friend really want to know? Won't I just sort of ruin their day?

Perhaps I'm placing too much significance on my score.

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