Most of us have used the above idiom, usually with a smirk of self-satisfaction on our faces, or have had it said to us, wincing at that same self-satisfying expression on the face of the person enjoying themselves just a little too much. These words are sometimes uttered as a “warning,” which means you alert someone that something is going to happen, and they say: “Yeah, right,” and then it happens just as you said it would, and you respond… Or someone disagrees with something you’ve said, and then it turns out that you were right. What follows is along these lines, with a slight twist.
When I began this Daily Musings page of this blog in 2022, my very first post (Jan.21, 2022) was titled: The Pain Index and had the same photo as you see above. It was a very short (352 word) rant about how I hate being asked by any doctor I happen to be seeing at the time the following question: “On a scale from zero to ten, zero being the least and ten being the most, what is your pain level?” In my mind, it is the dumbest question one could ask, because everyone’s pain threshold is different; you might consider a slight ankle twist the most painful experience you’ve ever had, while I, on the other hand, would simply wrap it and continue skiing. Put another way, if you told your doctor that the ankle sprain feels like a “nine,” your doctor might say: “Oh no, here are some painkillers, go home a put your foot up,” whereas I tell my doctor the ankle sprain feels like a one, and he says: “Okay, wrap it up and you’ll be fine.”
The reason for this brief trip down writing memory lane is because of an article I just read in The Atlantic (June 24, 2024) titled: “Pain Doesn’t Belong on a Scale of Zero to 10.” The subtitle is even more revealing: “A popular scale for measuring pain doesn’t work, but medicine still has no better alternative.” So, I will cut right to the chase: I TOLD YOU SO! My vindication was further bolstered by the fact that the article was written by a former E.R. doctor turned journalist, Elisabeth Rosenthal, not just someone else like me with an axe to grind, but no medical background. And the article is quite revealing.
The pain index concept, “reducing [the] shades of pain to a single number,” dates back to the 1970s, but as Rosenthal states: “…the zero-10 scale is ubiquitous today because of what was called a ‘pain revolution’ in the ‘90s, when intense new attention to addressing pain – primarily with opioids – was framed as progress.” And we all know how that turned out. I recently had back surgery to repair some bulging discs, and at my initial appointment with the surgeon, I was asked the same question: “What is you pain level 0-10?” Really? Are we still asking that question? What was more disturbing, though, was when I was discharged after my surgery, I wasn’t even asked that question, just given a prescription for opioids, which I choose not to take. The reason for being given the prescription, as Rosenthal explains, is because 30 years ago “physicians who championed the use of opioids gave robust new life to what had been a niche specialty: pain management.” What this means is that they were pushing the idea that “pain should be measured at every appointment as a ‘fifth vital sign.’” Of course, the problem with this is that the other vital signs like blood pressure, temperature, heart rate, etc. have “objective” scales measured by instruments designed for doing so. Your “subjective” response of: “Oh god, it hurts like hell, it must be a ten,” might be a sign, but it is not a vital one! Can you see my ear-to-ear smirk?
Los Angeles 2024
Ouch!
I recently suffered with a bout of sciatica that lasted about three weeks. I’d had it a couple of times in the past, though the pain was not nearly as severe as it was with my latest bout. As with my previous cases, I went to a chiropractor (a new one this time), and he did indeed ask me to identify my pain level on the infamous zero to 10 scale. Without hesitation, I answered “10”, as at its most severe, the pain I’d experienced was in all seriousness the worst I’d ever felt in all my 69 years. It was as if someone was repeatedly stabbing my left lower back and left calf with a butcher knife. The only relief I found was from my old opioid pills left over from my knee replacement surgery in 2020, which wasn’t anywhere near as painful as this latest bout of sciatica. Nerve pain is one of the worst!
Sorry to hear that. My sciatica was also acting up because of the severely bulging discs (the two lower ones), but the pain I was experiencing was all down my right leg, and yes, nerve pain sucks big time. I had to suffer through three weeks of that after the surgery, not fun to be sure! You have to promise me that if we ever do meet in person, wer talk about anything else but our aches and pains. :-)!
It’s a deal! And I hope we will meet in person one day.
Of course you told us soI Agreed – the 1-10 scale is so subjective. It’s like asking someone about the spice level of a hot dish (Scoville scale aside, which can actually measure heat). Everyone’s tolerance levels for pain, and spiciness (heat) is infinitely variable. But if I went to my doctor with a sprained leg that felt like an 8 to me (while you’d be back on the slopes), I’d want something to relieve my pain. MY pain. Just not an opioid, thank you.