Understanding the 1-10 Pain Scale and Pain Related Disability

In my line of work, I read a lot of medical records and one thing is consistently troublesome for me; the reported 10 out of 10 pain. Most often, this is simply because doctors and their staff do not properly explain what they are asking. So here are some tips on how to explain your pain so your doctor understands what you mean.

First, let me say, I understand chronic pain intimately. I wholeheartedly believe chronic pain can be a severely debilitating symptom of a huge host of conditions. However, you should never have a constant 10 of 10 pain level. If your records repeatedly state you are at a 10 of 10, even with pain medication, it is very clear to me you are either (a) severely exaggerating your pain for some other purpose, or (b) really don’t understand what the pain scale is all about or how doctors (and Social Security) use this information. I prefer to think (b) is the most common cause.

A 10 on a pain scale of 1-10 is that horrific, intense type of pain that happens the instant you severely hurt yourself. That moment where a migraine pushes you to think you would rather be dead than to continue to deal with that pain. If you are in severe pain and there is anything you can do that causes your pain to get worse, then that severe pain is not a 10, the higher pain is a 10.

If people are living with a pain level of 10, they are probably suicidal and have been in and out of the hospital searching for any type of help, even if it is just to knock them unconscious. A 10 is where you cannot form a single other thought except OUCH, DEAR GOD PLEASE HELP ME OR LET ME DIE!

Almost everyone has had a moment or two of pain at a level 10. But the human body is an incredible thing, it immediately releases a ton of chemicals to help your body and brain deal with that pain. So much like a hard beat of a drum, the sound diminishes the further you get from that initial intense pain. How far down the pain goes, is really where the patient needs to explain to their doctor.

Typically a 0 means no pain. But most of us over the age of 25 or 30 have at least some mild ache, joints that hurt when you sit or stand too long, hands that don’t like using the computer or holding a phone, a crick in your neck or headache that is just always there in the background. If you can ignore it and still function normally, your pain is at a 3 or less.

When your pain starts to limit what you are doing and you feel you need to take some medication to help you tolerate pain, that is in the 4-6 range. This type of pain still lets you do your job, and most of your activities, but the pain is there like the background noise of your body. The brain may have a bit more trouble focusing and multitasking, but overall people wouldn’t know you are in pain if you didn’t tell them. If you take something for the pain, it will hopefully go down to a 4 or less.

When we get into the 7-8 pain category, it means pain is always present, and generally you cannot focus on a task and have significantly limited your activities. Your pain sits on your shoulder (or knee, back, neck, ankle, head, etc.) and talks to you like Gilbert Gottfried in a never ending monologue. You can’t ignore the pain, and other people will notice something is most definitely wrong. Often people with very severe, chronic pain live in this range even with medications. This pain is debilitating.

So, what is a 9? Well, a nine is that narrow strip between talking Gilbert Gottfried and screaming Gilbert Gottfried. That moment just after you stepped on a nail and you’re hobbling to the chair. The pain is super intense often because of an acute event, but the initial horrific pain has passed. Because of the body’s natural defense mechanisms against pain, a 9 is fairly rare unless someone is moving a certain way, or had to pick up something. It is a pain you would not wish on your worst enemy, but you don’t want to kill yourself.

When I’m reading records and I see someone referring to 10 of 10 pain even with taking narcotic pain medications, this raises a huge red flag not only for the individual, but also for the doctor’s office. If the medication is not helping to reduce your pain, there is no reason whatsoever to continue prescribing it. If you are staying at a 10, then it isn’t helping. With all the crazy regulations out there on pain clinics and primary care doctors who administer pain medications, this is a big problem. In the context of any litigation, if the medication is not lowering the pain then the treatment cannot be reasonable and necessary (meaning it cannot be included in a lawsuit). In the context of Social Security, this calls into question the claimant’s credibility, which is a crucial component for all claims of disability resulting from chronic pain.

So now that you know, what can you do to fix your records. First, start by writing out a detailed statement to your medical providers who have asked this question. Explain to them what your understanding was previously. Explain that you now understand the pain scale in greater detail and would like to supplement your medical file. Give them more objective information about how you are really doing. And from that moment forward, always give a more thoughtful answer with this information in mind.

The best answers to these types of questions from doctors is to give them a complete answer. Everyone who suffers from pain has a range throughout the day/week depending on their level of activity. It is very common to see people say “At my best I was at a 4, at my worst, an 8. On average I stay between a 5-6, and I am currently at a 6.” This is the best kind of answer as it gives the broader picture of functioning with pain, and over time the averages will help a doctor know if the treatment is working or if there are new test to run. With a lot of patience, treatment, and a bit of luck, those numbers will go down and your quality of life will go up.