My Favorite Pain Scale!

For the longest time, I was lost when someone would ask me where my pain was on a scale of 0-10. A typical pain scale looks like this:

All of this is very, very subjective.

For example, I had someone tell me that natural labor was the worst pain I’d ever experience in my life. For me, it wasn’t. My worst pain has caused me to pass out. Natural labor didn’t come close. So for that person, natural labor would have been a 10 on a scale like this. For me, the very worst of it was an 8 to a low 9… and I had a long second degree tear (a second degree tear involves muscle). I would put most of my labor in the 5-7 range.

This one is a little better, but the whole “facial grimace” thing doesn’t work for me, either. I will be laughing and cracking jokes all the way up through level 7-8 pain. Until I get to the point of not being able to think straight, I’ll be finding something to laugh about. Humor is my favorite coping mechanism!

You know what else doesn’t work with this one?

Look at level 4-6. “…may interfere with your ability to do certain normal activities such as reading, watching TV, having a phone conversation, etc.” I showed this pain scale to my RA support group and they cracked up laughing. “Level 4-6? Oh you mean Monday – Thursday?” Level 4-6 pain is just normal everyday pain for a lot of us. We are watching TV, on our phones, and reading specifically to distract us from the pain. So this pain scale doesn’t work for chronic pain patients, either.

Of course there’s always this pain scale…

Slightly dramatic. But sometimes very tempting to use!

So if those three don’t work… which pain scale do I prefer? I have two!

This is the pain scale that helped me figure out how to rate my pain. Noting how much the pain is affecting my activity level and my ability to think or talk was incredibly helpful!

Even better… I found out this looks like it is a variation of the Mankoski pain scale:

As someone who deals with chronic pain of varying intensities, I feel like this is very accurate. When my pain gets to the level that it’s hard to concentrate well enough to hold a conversation, mid level painkillers are only mildly effective. The Mankoski pain scale puts both of those at an 8.

If you have a chronic pain patient, they may present in a couple of ways.

  1. They may have become sensitized to pain. They might be aware of their pain all the time. Sometimes what happens is something called central sensitization. The pain nerves become more active and the body just starts feeling more pain all the time.

  2. They may have become desensitized to pain. We see this happen ALL the time in my rheumatoid arthritis support group. People miss broken feet and fractured ankles for days to even weeks. They’re so used to their RA pain that walking around on a fracture was nothing to them.

I know for me, I have become desensitized to pain. This has actually caused some issues for me because I don’t present like a typical patient during an injury assessment examination when the assessment requires looking for tenderness. We’ve had torn ligaments and muscles show up on MRIs and I hadn’t flinched when it was palpated during the exam. It doesn’t really faze me compared to the pain I deal with on a daily basis. I’ll know when something feels injured and likely needs to be checked. I just don’t present normally during the assessment. For me, I need providers who trust me when I simply say, “Yes, that’s tender,” and believe that I’m not being melodramatic when I give them examples of how an injury is impacting my functionality.

Thankfully, my regular doctors know how I am and are fantastic about this. Know your patients!

Chronic pain friends: I am working on getting a printable pain scale ready for the site! Once it’s ready, I’ll link it back to here.

Love and gentle hugs ❤