Wednesday, November 7, 2007

An Excellent Pain Scale

This pain scaled was devised by Dr. J.S. Hochman MD, the founder of the National Foundation for the Treatment of Pain (NFTP). It is far better than the counterintuitive "1 to 10" pain scale as it uses descriptions of the patient's pain and functionality at various levels as well as the predicted efficacy of various meds at those levels. This is important, as perceived pain level is really a function of the physical sensation of pain, its impairment on your functionality, and the relative efficacy of various medications at relieving that pain, as few modalities work as quickly as meds to get pain under control and improve functionality. It overcomes the severe deficiencies of the numeric scale, particularly the bit about 10 pain being "the worst pain you can imagine," as no matter how bad your pain is, you can always imagine it being worse so in theory level 10 pain doesn't exist. This is a loophole that I've seen some doctors cite in ridiculing patients who claim level 10 pain, so being able to say your pain is level 10 because it is unbearable, and not "the worst you can imagine" seems more reasonable and defensible. Studies show that 65 percent of people with chronic pain will not go to a doctor until their pain becomes "unbearable," so defining pain like this also helps to explain the large number of people presenting to the ER claiming level 10 pain, because "unbearable" is how we intuitively think of level 10 pain, and why people will claim levels of 12 or 15 for pain that goes way beyond merely "unbearable," like that of CRPS, for example. I have taken the liberty of creating a PDF of this file so you can print it out and bring it to your doctor if you feel it accurately reflects the realities of your condition. Anyway, enough of my yapping, here's the scale, which I found at Our Chronic Pain Mission:

The NFTP Pain Scale

Pain Scale
J.S.Hochman MD

0 No pain

1. Occasional pain effectively managed by Aspirin, Tylenol, Ibuprofen, one tablet, three times a day or less - or by opioids with no limitations on activities of daily living.

2. Frequent pain, managed only by 1 or more tablets of ASA, acetamenophen, ibuprofen, every four hours - or by opioids with slight impairments of actitivities of daily living.

3. Frequent pain, not effectively managed by NSAIDs, requiring an opioid medication, but not restricting daily activities of living

4. Frequent pain, moderately affecting activities of daily living, but still controlled by opioids medications

5. Frequent or almost constant pain. Contained by opioids, but still causing significant limitations on activities of daily living and occasionally causing the patient to be house or bed confined

6. Constant pain, moderately contained by opioids, but with frequent limitations of activities of daily living. Frequently causes confinement to bed or the house.

7. Constant pain, only partially contained by opioids at the doses prescribed, with continuous limitation of activities of daily living

8. Constant pain, frequently disabling, making most activities of daily living difficult if at all possible

9. Constant pain, uncontained by prescribed medications and doses, completely disabling of activities of daily living, requiring interventions or assistance by others, preventing any form of employment and fully qualifying the patient for Social Security Disability

10. Intolerable pain requiring emergency room treatment, generally with opioids injections.


Anonymous said...

It is indeed an excellent pain scale, especially useful for chronic pain. I would love to see this scale implemented, the ones out there now are crap.
Thanks for posting this!

Sunny D said...

I agree, every-time I go in to see my doctor the nurse asks each time what is my pain level....Now...hmmmm
If I've taken my dose of prescribed meds before I go, my pain is at level of 5. Now they think oh-well her pain is good and they tell me on the road to no pain soon. NO, DOC...I just took my meds a hour ago and I know in two hours if this scale to 1 to 10 is actuate, my pain is going to be a level of 10.

The scale always confuses me in the one you showed here maybe makes since, thank you.

It's nice to see a REAL blog about pain and read the truth about health care these days.

BTW-I'm Deena, we already met, i thoughgt I would leave a comment...

I did get through the night and waiting for 8AM to call my doctor about my pain meds dosage.

Payne Hertz said...

Thanks for your comment. I hope everything works out when you speak to your doctor and you can get the dosage sorted out.

Twilight said...

thanks for posting this, I have never seen anything like this before, I just stumbled on this website looking up ways to treat chronic pain. its so nice to have support when you are really suffering. have a good night and hopefully everyone here has a pain free day.

feminizedwesternmale said...

How about a description for eleven?

Probodywork said...

Thank you for posting this useful scale. I can see that it will help patients communicate more accurately their subjective experience.

Anonymous said...

Looks like Scalpel won. :( This was a great blog with a great cause.

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orville shwartz said...

A Day in the Life
"Grooooaaaaann" (he is waking up after another sleep disturbed night)

"ouch, ouch, ouch ouch, ouch ouch ouch ouch ouch ouch" (walks the ten steps to the bathroom sink)

"Another hot day" he thinks, "How will I make it through?" (although the voice on the radio declares a beautiful day is in store, it cannot know that anything above 68 F is an invitation to hellfire.)

He has a thought to write a letter explaining this to a few, select friends, those of whom he has lost contact with these last years, however, the slight exertion of handwriting triggers a hot flare of pain in his hands. “I’ll get to it another time”, he thinks to himself.

Instead, he takes down a book of poems and reads from it:

"PAIN has an element of blank;
it cannot recollect when it began,
or if there ever were a day
when it was not.

It has no future but itself --
its infinity contains its past,
and the promise
of new periods of pain. " – E.D.

He puts down the book, forgetting what he was supposed to do this morning, wondering if his brain would still function if the pain ever decides to let up. But that thought, too, is crowded out by the constant activity of nociception, nerve pain pulses that burst across the brain and occupy the field of thought. This man, who once had faith that could shake the world, no longer has even a small ambition. The word itself has no meaning to him. In his shadowy existence there is no hope, no fear, no word, no whisper nor even a cry; there is only the stiff grip of pain and some unspoken, distant longing; a longing for release from the marching orders that fall down on his head each day like a pile of bricks. He tries to take things one step at a time, but what does one do when each step is its own little ordeal? Where does it lead, and for what purpose? The answer is it doesn't. It is this treadmill of torture that makes up his life. Still, he does not curse it. He cannot. To condemn his own lot in such a way would only add new sadness to his suffering. While it can always be said that there exist others who “have it worse”, it is small solace to one who is preoccupied in battle; and it is this battle with pain that is now his life's work. It will take courage. So much has been lost – estate, career and family -- he mustn't lose himself as well. Each day he wakes with the resolve that the pain will not become him. Steep as the cost of pain is, it must not consume him. He will not allow the cost to be that high.

His affliction is unseen. You wouldn’t know he is unwell to look at him, at least on those good days when he has not become soaked in sweat and dropped from fatigue. In his student days, and for a long time afterward, he was well equipped to work alone, and often, in fact, preferred solitude. But this lone-wolf creativity too has fallen away. Now he needs assistance with most things, and if left to himself will only use the time to convalesce, propping his legs up to alleviate the pain in the lower extremities. What is now missing in him is that certain exaltation of spirit that the French call joie de vivre; that quiet joy found in being oneself, something the saints have in abundance. This attitude of mind manifested itself in a spontaneous acceptance and relaxed enjoyment with the circumstance of life. Every action he took, however small, had the aura of some world changing subversion. Washing dishes was no longer a disagreeable and mundane task, but an ablution, a requisite cleansing of self as a prelude to the greater work of cleaning up the political process; mind numbing academic editing was just practice for cracking the code of the secret government. The most ordinary moments of everyday life became extraordinary; playful even, but if play it was, and I do not know what else to call it, it was as if to be invited into a game that allowed one access to the true self. It is to this lost place he seeks to return. His pain, however, has other ideas, and it stubbornly blocks the door.