Each time I go a doctor, even if it is unrelated to the conditions that are causing me pain, I’m asked “do you have any pain today?”
I often chuckle at this question. They’re well-meaning, I know, and I’m not laughing at the nurse. My chuckle is more of a shaking-my-head-in-resignation reflex. Because I’m always in pain. It’s similar to the “does a bear…” question.
I answer “yes” and then am asked “How long have you had it?”
This question again makes me laugh to myself again, this time at what has become to me a massive amount of time with no comfort, as I answer “um, coming up on three years.”
The third question in this series is “On a scale of 1 to 10 with 10 being the worst pain you could ever imagine, what would you rate your pain?”
This is the question that always gets me. “The worst pain you could ever imagine.” As soon as they say that phrase I immediately down-grade the number I probably would have said had that phrase not been included in the question. It instantly makes me think “surely this is no where near the worst pain I could imagine.” There’s a couple reason for this pain-scale-downgrade process that I always seem to experience.
First of all, I am fully aware that there are always people in the world worse off than I am. I don’t want to seem ungrateful, I don’t want to seem like I’m saying I’m as bad as the people dealing with things far worse than myself. Even if that thought never crosses the nurse’s mind, I don’t want to seem to MYSELF (in my own mind) that I’m equating my issues with those that are struggling with more. Intellectually I know that this is a ridiculous reason to downgrade my pain scale rating, but it’s the reality of what’s happening within me.
Second, some days are better than others. The pain is never gone, but some days are better than others. If I rate my current pain as higher on the scale and then days, weeks, or months later it gets worse that I imagined it would…I’ll have no place to go on the scale. If I “top out” or even “overrate” then how will I communicate when it’s getting even worse? Again, intellectually I know this is a strange way to think about it, but it’s my reality.
So I go through the process of thinking to myself “what’s a reasonable number for my issues?” What’s a reasonable number for pain in my hands, wrists and feet compared to someone that was crushed in a car accident or burned over most of their body (apparently, those are the types of pain that would be the worst I could imagine)? Surely those must be “10” type pains. And if that’s what a 10 is then mine must be only a 3! After all, there’s a big difference between my situation and those!
But if I rate it too low will the doctors take it seriously? Will they realize that I am truly in constant pain and work to understand or relieve it?
So then I do the strange thing of giving a range: “3 to 4, I guess.” Really? I can’t just pick a number? I’m a mess!
Then, as if this simple process of rating my pain on a scale of 1-10 could get any more unnecessarily complicated, sometimes the office will have a poster that not only contains the 1-10 scale with the smiley faces but they also have descriptors about how the pain is affecting your day.
On these posters, the phrase “can be ignored” appears under the “1-3” range. Well, mine definitely cannot be ignored.
So then I look at the next range “interferes with tasks” is shown under the “3-5” range. OK, well my pain definitely interferes with tasks (not to mention my mood). OK, so maybe that’s a better place for me – but I’d better check the next level up to see if I fit in that one.
“Interferes with concentration” is below the “5-7” range. Oh. Well, yeah, my pain does that. Maybe I should rate it higher. I’d better check the next level…
“Interferes with basic needs” and “bed rest required” are the top to categories. OK, I’m not there yet.
So it seems that most of the time I’m in the “5-7” range. But I bet if I went through my medical records of all my various appointments, “3-4” is probably my most common response. So why do I have such a hard time expressing a number in the “5-7” range to my doctors? Does everyone have this issue?
My 8 year-old daughter certainly doesn’t seem to have these issues – she has no problem pointing to the dark red frowny face under the number 6 or even the orange deeper-frowny-face under the 8 when she has a sore throat or pink eye? Why is she so able to express how she really feels while I am not? Is it my age/experience and realization that there are much worse things in the world going on than what I’m dealing with? Or is it something about me, my personality or the way I think?
Or is it because her pain and discomfort is acute – it wasn’t there the day (or couple of days) before and it won’t be there (hopefully) within a day or two after. She knows what she feels like when she’s feeling good and she knows how she feels right at that moment isn’t good. She can easily compare the “before” with the “after.” She knows how she’s feeling now isn’t normal.
I’ve been in daily pain since January 2011. Unfortunately this has become my “new normal.” I truly don’t remember what it is like to not have pain. I have some vague understanding of “it’s better than this,” but beyond that I really don’t know. Has the chronic nature of my discomfort somehow shifted my ability to communicate to others the severity of my pain?