Pain Scale

I am Autistic, and deal with something called Alexithymia as a result. On my regular tumblr, I have posted a description and example of how Alexithymia effects me. 

Another way it effects me is that I have difficulty judging my pain. Judging things, like making choices, is an area of executive functioning that can be effected by Alexithymia. 

The typical pain scale is useless to me. It typically depicts a series of line drawing faces, which supposedly depict the different levels of pain. The other descriptors included are typically the numbers (0-10) and the words “mild” “moderate” and “severe.” 

A sample of the typical pain scale. a line with tics in it is draw, and numbered zero to ten. Above 0 is "no pain", above 5 is "Moderate Pain," and above ten is "worst pain." Below, a series of line cartoon faces which are numbered evenly from zero to ten. 0 has a big smile. 2 has an "okay" smile. 4 has a straight line mouth. 6 has a down turned mouth. 8 has a very down turned mouth and pressed down eyebrows. 10 looks like 8 but with lots of tears.

These are all subjective measurements with no solid, tangible, non-emotional descriptions to them. There are no examples of what they mean. And while some people might be helped by the images of faces, they don’t help me at all. In fact, the faces usually used are outright confusing, as they tend to have a neutral expression for 4-5, when 4-5 is supposed to be moderate pain.

Instead, I prefer a Functional Pain scale. Interestingly, when I did an image search this type was more often hosted by places specializing in chronic pain than any other sort of place. 

The one I’m using, below, gives a number range, a description that includes both how it would effect functioning and how often it occurs, and a comparison to weather. While I do not attach emotional significance to the Weather (other than finding rain soothing), I do understand how it effects people’s ability to engage in certain activities, so it is the perfect way of illustrating functional levels to me. 

At the top of the image, it is titled, "What is your Weather today in Blue. Below that, there are 6 rows. Each row contains 4 collumns, with the following in each: 1 = an image of weather; 2 = the name of said weather; 3 = a number range; 4 = a functional description of that number range. The weather Phenomena are sunny, partly cloudy, overcast, showers, sleet, and snow. They correspond to the following. 0-1 "no pain or only minor annoyance at times"; 2-3 "Pain beginning to interfere with life but manageable most of the time"; 4-5 "Pain is constant but low intensity"; 6-7 "Pain intermittent but interferes with most activities of life. Keeps you entirely from a few activities."; 8-9 "Many activities difficult due to pain. Sometimes function at lower levels."; and 10 "almost all activity difficult due to pain. You are 'snowed in' and most activities are cancelled for the day."

As you can see, this particular one is designed for Chronic pain users, not for ER style pain. However, the one scale I found that was both a functional pain scale and was appropriate to ER style pain was minimizing to people with chronic pain, told the reader that there was little chance that they ever got beyond an 8, and said- contrary to any doctor I’ve had describe it- that natural childbirth was an 8. So, obviously, I would very much avoid that one. 

So, while I think that the “What is Your Weather Today?” chart is not entirely accurate when it gets to the 8-9 and especially the 10 range, It is better than other available options. (Also, weather.) If I were to correct it, I would say 10 is “ALL activities difficult or impossible due to pain” and I’d remove the “sometimes” from 8-9. Once you hit that level of pain, you *are* functioning at a lower level. That’s the nature of that sort of pain. 

For reference, I spend most of my days hovering around a 6 or 7, and in December 2010 more like an 8, with some pain spikes hitting 9 and even 10. That month I spent mostly in bed. My good days are when I can place it at 4-5, and even on those days I usually wake up with pain at 6 if I’m lucky. Very rarely do I wake up not in pain.