Sunday, August 26, 2012

Pain Scales - Useful Tools or just Tools? Needs to be updated.

I always chuckle when i meet with a new Doctor and they ask me what my pain level is today on a scale of 1 - 10.  Seriously?

Ok, Which Pain? CRPS pain? Fibro pain? Back pain? Eye pain?

And you don't mean ALL the symptoms correct? Not the individual symptoms like exhaustion, fatigue (very different things, ask anyone with fibromyalgia or CFIDS), burning pain, allodynia, crushing, aching, squeezing, insomnia, etc. right?

Oh, and which pain scale? The pain scale for 1- the "normals", 2 - the people in acute pain, or 3 - the people in chronic pain?

And compared to who? You haven't seen me before. How do you know what my 7 is like, or my 8?

Is my 7 the same as Diane's? Or is Karen's 9 the same as Maxwell's 10 perhaps? They say that women can handle pain better than men. Is my 9 today of more importance than it might be three weeks from now after you started me on a new medication? But what if in three weeks the weather is different, or there is construction outside of my house all week, or a neighbor moved in with a barking dog, or I stubbed my toe the night before and am in a flare?

Herein lie the many problems associated with pain scales and yet you see them peppered throughout all sorts of medical studies, especially ones having to do with pain.

Simple pain scales, the 1-10 deals are archaic. They need to be updated, adjusted, modified for today's patient and for today's medical professional. It would help not only your pain management physician but also your physical therapist, psychiatrist, and pretty much anyone dealing with your pain; attorney, WC, SSD, etc. Especially if there was a single, across the board Chronic Pain Scale that everyone agreed on that addressed all aspects of a patients pain and not just a simple number.

I understand that there would still be some variations based on Drs and patients individual perceptions and possibly even some regional variations but it would be a huge improvement on what we have now.

There are Pain Conferences that occur usually ever year where pain management physicians gather and perhaps this issue could be addressed there?

What would you like to see included on a new Chronic Pain Scale? What things should your Dr ask you when inquiring about your pain? A typical chronic pain patient?

You will have to do your part as well. That may mean keeping better track of your symptoms and pain levels in between visits.

Average Pain over the last month?
Worst level during that time? Best level during that time?
What symptoms should be included? Aching? Crushing? Throbbing? Spasms? Shooting? Electrical feeling? Difficulty walking/standing/  Difficulty falling/staying asleep?

What about a picture?

One of the best Drs I ever had, had a wonderful pain chart and part of it had a series of faces. Picture a smiley face gradually changing to a very sad, painful face. Just as you filled in each of the other items; 1-10 rating of burning, aching, crushing, etc. you circled which of the five faces best fit your pain today. He also had on there two drawings of the human body; one facing front and one facing back. You had to fill in where you pain was, and if you liked you could use symbols. For instance I used x's for my CRPS pain and -- for my fibro pain, and then where my pain was worse I made it the darkest.

I am not saying this has to be the template, just an idea I am throwing out there as a possibility and to say that you can think outside the box.

So what do ya'll think?

Send your suggestions to me and I will put them in a future post here!

Peace, Keith
American RSDHope

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