Pain is one of the most important symptoms of Rheumatoid Arthritis and many other conditions. Pain is the most obviously significant signal that something is wrong. However, pain is also the most difficult symptom to measure.
Need for a pain scale
Since pain is such an important indicator that something is “wrong,” we ought to find better ways to measure pain and more meaningful ways to relate pain to disease activity. Obviously, pain is mostly invisible. I say mostly because pain can be seen on the face with a furrowed brow or winced eyes, especially in people who strive to be quiet about their pain.
The two challenges to creating a suitable pain scale:
- Helping people to quantify their pain in a way that is as objective as possible so that it’s meaningful to care-givers (personal and professional).
- Having a trusted scale that allows care-givers to take patients at their word.
Looking over the inadequate pain scale examples from the NIH Pain Consortium is discouraging; something better is obviously needed.
Meaningfulness of a pain scale
For healthcare professionals, the ultimate challenge is to determine the meaningfulness of pain. The pain scale is only a means to this understanding. A good doctor or nurse needs to know how a patient’s pain is associated with disease activity. The pain scale can only help the provider to discern disease activity as he appreciates what a patient’s pain is like and deduces what the origin of it may be.
“Pain follows the same pattern of development as other parameters of disease activity in groups of patients with RA,” Assessment of Pain in Rheumatic Diseases.
Pain scale relatability
The provider has another difficulty that has nothing to do with a particular patient or pain scale used: His own experience or lack of experience with pain is the only means that he has to relate to pain. His ability to comprehend various levels of pain is helped or hindered by his experiences.
According to Callahan et al, “Pain is a most important indicator of clinical status in rheumatoid arthritis (RA). Inquiry about pain is included in every encounter of RA patients with a health professional; however, the patient’s response to such inquiry is generally regarded as ‘subjective.’”
I’ve seen pain scales on the wall at doctors’ offices, but I’ve never been asked to use a pain scale. Does that mean the doctors I’ve seen haven’t experienced much pain?
The problem of pain tolerance
Another difficulty with measuring pain is that people who live with severe pain such as Rheumatoid Arthritis tend to adapt to it. They increase their tolerance to pain out of necessity. This is the reason that people living with RA often complain that pain scales “don’t work because they don’t go high enough.” RA pain is often starts out as the most severe pain a person has ever experienced, so they might rate it with a high number. But, then, if pain worsens or occurs in numerous joints at a time, they wish for a bigger number. Consequently, they adapt their personal pain threshold and now rate the pain which was previously a “9” as a “7” in order to be sure to fit all of their pain onto the scale. RA patients tend to continually increase their pain tolerance in this way.
Can we make pain scales make sense?
What would be your model pain scale? Please post about it in the comments or on your own blog. Let’s make this our next great blog carnival!
Just send me an email at Kelly @ rawarrior.com with the link to your blog post about pain scales and I’ll post them all here in two weeks (December 28th). Let’s see what our imaginations can create! Please put “CARNIVAL” in the subject of your email.
Read the awesome entries of this pain scale blog carnival – click here.
Pain scale articles worth a look:
- Stanford Pain Visual Numeric scale from 1-10.
- The Comparative Pain Scale has detailed categories, but this is not specific to rheumatology.
- MIT’s Technology Review published An Objective Way to Measure Pain complete with brain images.
Further reading on measuring pain
- Does Rheumatoid Arthritis Pain Really Hurt That Much?
- Some Rheumatologists Don’t Understand How Much It Hurts
- Do Rheumatoid Arthritis Patients Have a Low Pain Threshold?
- IOM Pain Report Relieving Pain in America Gets Mixed Reviews
- The Hypochondria of RA Pain: Do I Smell an Elephant?
- “Fine Thanks, and You?” and 5 More Stupid Things I Say