I Figured Out What The 1-10 Pain Scale Is Actually About

Pain scale chart, with facial expressions. Image source.

[content note: mentions of physically painful situations and speculation about how bad they are compared to each other. No graphic details though.]

Okay, you guys, big revelation here. You know how when you go to a doctor for some pain problem, and they always ask you "how would you rate your pain on a scale of 1 to 10"? And this is always super confusing to me, because how am I even supposed to know how this scale is calibrated? 

Like, the obvious questions that I want to ask are, what are the endpoints of this scale? What do 1 and 10 mean? Also, is this a linear scale, or...? (And, can you believe, many doctors have thought it was kind of funny that I asked these questions? What??? Funny? Why would this be funny- these are the key pieces of information that are needed in order to answer this question correctly. Like, "don't overthink it, just answer the question"- like how am I supposed to answer it if you haven't even told me the parameters of this scale???)

And if I ask for clarification on it, the doctor always says, "1 is only a little pain, 10 is the worst pain you can imagine." Oh gosh, the worst pain I can imagine? Uhhh, okay... well let's see, giving birth without anesthesia is apparently painful. Breaking a femur. Root canal. Let's see, what else? Stab wound? Water boarding? Foot binding? Crucifixion? Getting eaten by piranhas? Getting lost in the wilderness and you need to amputate your own hand without anesthesia? Giving yourself a C-section?

Like, geez, I just want to see the doctor to get some help with whatever little problem I have, and when I walk in the door I'm immediately expected to have a good understanding of how painful crucifixion is compared to a root canal. As if there is one standard scale for these things, and everyone knows what it is so it can be easily used as a reference when you want to describe your problem to your doctor.

This is why it wouldn't make sense for this pain scale to be a linear scale, actually. Suppose that crucifixion is 5 times more painful than giving birth without anesthesia. Okay, so, we have to put crucifixion at 10, and giving birth without anesthesia at 2. Yes, I know people who have given birth with no anesthesia/ no epidural/ nothing- this is a thing that some women do. So, the 2 on the scale will be experienced by some women/ people who give birth, but the majority of people will never experience anything at all in the 2 to 10 range of the scale. Most of the scale is unusable, if it's calibrated like this. Most people's entire life experience would have to be squeezed into the 0-2 range (yeah I put 0 on it because if we're talking about something being 5 times worse than something else, it makes sense to start at 0 rather than 1). 

Basically the issue with the linear scale is, there are a lot of painful experiences that some humans throughout history have had- painful experiences which the overwhelming majority of people will never ever experience, thank goodness, but which are very different from each other, and some are very much worse than others. So if the scale is really linear, then most of the scale ends up being used to differentiate between these extreme rare excruciatingly painful experiences that the overwhelming majority of people will never ever have to go through, thank goodness. So the scale's not very usable then.

What would make more sense, is to calibrate the 1-10 (or 0-10?) pain scale so that 9 is the worst pain that most people in our current society will experience in their lifetime. From 1-9 (0-9?) the scale can be linear, and then 10 can be used for anything beyond that. If something is greater than 9, it's not really important to know exactly how bad it is compared to a 9. It's already really really bad and should be taken as seriously as you possibly can take it- it doesn't matter whether it's as bad as crucifixion or whatever.

ANYWAY, years ago I was having some health problems, and every time I went to the doctor they asked me about my pain on a scale of 1 to 10, and usually I said something around 3. You know, out of respect for my ancestors who were mauled by saber-toothed tigers or whatever- I wouldn't want to act like my pain is anywhere close to that.

It just always felt very weird to me, that in order to get the doctor to help me, I needed to have an understanding of how much pain a human being has ever experienced. And an understanding of what 50% of that amount of pain would feel like. And 10%, and 20%, and so on.

Like, what does that have to do with anything???

This is already such a difficult question, but doctors treat it like it's very simple, like everyone understands where their pain fits on the scale of all pain ever felt throughout human history- so simple and easy to understand, in fact, that this is the primary way that we can communicate to each other about how bad our own personal pain is, and everyone will clearly understand it.

Like, what? This makes no sense.

Well, guess what. I finally figured out what this 1-10 pain scale is actually about. It is NOT about "the worst pain you can imagine." It is NOT about objectively comparing your pain to some standard. It is actually not about measuring your pain at all.

Here's what the "scale of 1 to 10" question is actually asking: What is your opinion of how bad your pain is? In the context of your own life, how much of a big deal is it? What do you want to communicate to the doctor about how seriously they should take it?

WOW.

I KNOW! This makes so much more sense as a question that a doctor should ask, right? Because really, does it matter that my health problem is, for example, 25% as painful as foot-binding? I mean, that doesn't seem like useful information at all! What would you even do with that? But if what they're actually asking is, how much of a problem is it for me, well that actually makes sense!

So really it has nothing to do with measuring pain at all. It's more about, what are my feelings about how much of a problem the pain is. So 1 doesn't mean "10% as bad as getting crucified" (??? why would you even have a scale for that, how would this ever be useful information???); instead, 1 means something like "it kind of bothers me but not really a big deal."

And 5 means something like "yeah it's pretty bad" and 10 is like "OH HOLY CRAP THIS IS SO BAD I CANNOT EVEN THINK ABOUT ANYTHING ELSE RIGHT NOW, HELP." You can be at that point even if it's not "the worst pain you can imagine." Even if your own situation is very obviously not as bad as some torture victim from medieval history, or whatever.

(And back then, when I said my pain was a 3, now I'm realizing I should have said 8. Now that I have figured out what this scale was actually supposed to be measuring. And, I should note, I actually have seen some versions of the 1-10 pain scale which defined each number in terms of how much the pain interferes with your life- which makes sense and is a lot more useful than measuring your pain as a proportion of "the worst pain you can imagine.")

So, I mean, wow. This isn't about measuring your pain against some objective standard, or anything like that. It's asking what your opinion is about how much of a problem your pain is. It's a way to communicate to the doctor how seriously they should take it. That makes so much more sense, because that's something that you can actually easily know about yourself, and is useful information for your medical treatment.

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