[10-09-08] The Austin Pain Scale

[10:40pm]
     I've been spending the day cataloging my video game collection. What is the average rating? What is the genre? Is it multiplayer? I am preparing. Like a squirrel gathering acorns, I am saving my games for the winter ahead of me.

     Then, I think back to how Barbara said how I liked to "quantify the subjective." It's true; I do. In fact, I've been doing it since I was like 5 or so. I've always annoyed people by incessantly asking for a "favorite," "which would win", or a "top five." Kinda like that guy on High-Fidelity.

     Maybe I'll post a few of my neurotic lists, sometime. :P

     Anyhow, back to the conversation with Barbara... We began discussing this after a nurse looked at me skeptically when I described my status on the pain scale (due to Neupogen back pain). Yes, the pain scale, again.
     I obsess, I know. But it's such a perfect example: level of pain seems like such a subjective experience! There's no pain indicators attached to our heads or pain meters that we can attach to our brain stem. In addition, the nurses and doctors place such importance on the number that you give them. Naturally, I can't resist the challenge to quantify this.
     Back to the nurse. So I told her that I had a pain rating of 5 and she looked at me like I just picked my nose. How *dare* she question my objectivity! I then commented to Barbara, "If only she realized how much thought I put into accurately providing my pain rating."

     I then thought about actually writing it out. So, here it is:

     The pain scale is on an integer scale of 0-10, with nothing more than faces to assist in the self assessment.


     Although there are many different scales, this is the one I see the most in California hospitals. So, here's the criteria I use:

Pain 0: No Pain.
Pain 1: Detectable Pain. However, it is not sufficient enough to do anything about it. It is neither annoying or distracting. If a Tylenol and a glass of water was 2 feet away, you wouldn't take it.
Pain 2: Annoying Pain. You would take the Tylenol, but would have no problem watching TV or browsing the web. Not sufficient to distract you from your at-rest activities.
Pain 3: Distracting Pain. You would really like some medication at this point. If the Tylenol isn't near, this is where you'd start digging through your bathroom cabinet. Why not? You can't really enjoy watching TV, and reading a book is out of the question... This pain needs to be solved. Sleep would be possible at this level, but difficult.
Pain 4: Sleepless Pain. Medication is needed. Over-the-counter medications may dull the pain a little, but they wouldn't really help -- Vicodin would be nice. Sleep is very, very difficult at this level. Imagine not falling to sleep for at least three hours, then waking up every 30 minutes due to pain. At this level, I'd say getting 2.5 hours total of scattered sleep in a period of 8 hours is likely. (The pain scale, to me is a bit like the Richter scale: moving from 2 to 3 is a bigger step than moving from 1 to 2, and so on.)
Pain 5: Fidgety Pain. Narcotic medication is mandatory. If a doctor recommends Tylenol, then you should request a new doctor. If you are at home, without narcotic pain meds, then you'd probably start pondering the pain relief given by getting incredibly drunk or repeatedly banging your head against the wall. We're not in ER territory, but the pain is severe enough to cause you to constantly reposition yourself in an effort to reduce the pain -- fidgeting. Sleep is downright impossible.
Pain 6: Frantic Pain. Narcotics would help; Morphine would probably be best. If I were at home, then I'd consider going to the ER. It is a bit difficult to speak properly, due to abrupt spikes/stabs/pulses in the pain. You cannot stay still; you need relief.
Pain 7: Physiological Pain 1. Morphine is mandatory; go to ER at this level. This is where the pain is painfully obvious to doctors on a physiological level. Breathing and speaking become erratic, due to abrupt spikes/stabs/pulses in the pain. Envision grunting. Your pulse is way up.
Pain 8: Physiological Pain 2. Morphine may help slightly; something stronger may be best. All the previous physiological symptoms, but more so. Visibly trembling/shaking.
Pain 9: Physiological Pain 3. Something stronger than morphine is mandatory. All the previous physiological symptoms, but more so.
Pain 10: Fantasy Pain. The most pain you've ever experienced, or could fathom experiencing.


     Ah, I love to quantify.