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Objective Pain evaluation devise
An_246419 posted:
Just like many other chronic pain suffers the doctor usually asks me to rate my pain on a scale of 1 to 10 or 1 to 5 and that is it. Now their is a group trying to restrict opioids use to 90 days except for cancer patients. They are concerned about those who get adicted to pain medicine and so forth.
My question is why not spend more money on developing a devise that could be used to measure pain objectivily in stead of a pain scale? If there were such a devise that could objectively measure an individuals pain over a period of time, then a doctor would know if they had real pain or not. This would solve the problem of prescribing pain medicine for someone who did not need it. Also as a patients condition changed, the medical professionals could adjust the amount of pain medicine needed accurately.
From what I can find out there is very little research funding available to develop such a devise.
I know that the amount of pain an individual feels can vary greatly from individual to individual. I am a red head and I suffer from pain greatly or at least more than others seem. I know of a guy who had bone cancer, but did not know he had it until 3 weeks before he died from it. I understand that bone cancer is very painful, yet it did not bother him much until just before he died. There are stories of others who feel pain way before anything shows up on any medical detection equipment.
In my own experience I lost my leg from a land mine in a war and they were giving me heavy pain medicine and sleeping pills, but nothing worked and I got very little sleep for months. Later the doctors though we, others like me, were faking since some other amputees had no pain or just minor problems while some of us were in extreme pain. After over 40 years I still have a lot of phantom pain as well as nerve pain from my back, arthritis, fibromylgia, and a variety of other conditions that have developed since my first injury. So I pose two questions.
1. Why not spend more money to develop a devise that can objectivily measure pain?
2. What is the reason so little research time and money is being spent on developing such a measuring devise?

In todays environment one thing occurs to me and that is that many people are making a lot of money from pain patients and therefore they have no desire to have such a devise. Greed seems to be running a lot of things today and my guess is that there are a lot of people making big money from the pain industry. Such as drug companies, alcohol sales, insurance companies, organized crime, politicans and many more including the medical industry itself. If there were a devise that could accurately measure how much pain an individual was experiencing it might lead to a large reduction in the need for so many medical prescriptions for pain. Another use would be in surgery to alert surgeons if a patient could feel pain during an operation. There are a lot of pain suffers who can not get treated legally so they use alcohol and they buy pain drugs on the streets because no one will believe them.
In addition, unfortunately, I know of a few who have died due to the pain they had and could no longer tolerate. This is a great loss to society as some of those that I knew personally had a lot to offer, but the pain and lack of treatment for it destroyed them and their families.

Take the Poll

How many of you believe more should be done in terms of research and research funding to invent a devise or machine that could accuractely measure how much pain an individual is experiencing? Vote yes if you believe more should be done to develop an objective measuring devise.
  • Yes more needs to be done for an objective measure of pain.
  • No, nothing more needs to be done.
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finn2 responded:
I have a pain management doctor too and always had trouble rating my pain. It's constant, and varying and changes from day to day and some is consistant. I thought a 10, being high, wasn't me, I pictured that as writhing on the floor screaming in unbearable agony, if it was the highest you could be. Since I can move and I'm not screaming, I'd put a 5 or 6, but worried someone would think that wasn't enough to warrant help. I read everything I can find about pain and in a pain management site one day (forget which one) it had a scale to rate pain and explained how it was to be used. The 10 rating indicated pain that effected every aspect of your life, had an impact on everything, instead of being the strength or level of pain felt. Well my pain does effect every movement I make and what I do either hurts and I do as much as I can in pain or I don't do a lot of things anymore due to pain. I'm talking about just living from moving to get out of bed (even being in bed hurts, the pain wakes me up), walk, clean the house, up to leaving the house to do necessary shopping and errands plus activites that most people enjoy, eating out, going to a park, etc. I can't do anything without pain and with no pain medication, there were so many things I simply no longer did, (gardening, walking a dog) not to mention never wanting to go anywhere. I even avoided larger stores as there was more walking required. At home I sat on the couch which also hurt, my hand and wrist hurt holding a book to read. My house was a mess, I never wanted to stand long enough to cook a decent meal. Sex hurts, I enjoy it but not when it hurts and so our sex life (mine and hubbie's) was impacted to a large extent. So my pain effected and had an impact on every facet of my life and so I now measure mine as a 10 with no medication and 4 to 6 with medication, as every chronic pain patient knows, you never are pain free even with meds I have a good pain management doc now and enjoy life again, have a decent looking house, had a large garden this year, I'm living again and liking it, just rescued a shelter dog a few days ago too. Without pain medication, my life isn't worth living. I'm 64.
davedsel57 responded:

You bring up a very interesting concept. The flaw that I see is that pain is fully subjective. I think it is pretty difficult if not impossible to objective measure pain. Each person is unique and responds to and tolerates pain uniquely. What I call a '5' on a level of 1-10, you may only consider a '3'. Some people do things despite feeling pain, where others stop at the slightest twinge.

There is something called a Functional Capacity Evaluation that many pain management doctors perform or send patients to a rehab center to have performed. My wife sustained a back injury at work last year that has caused permanent spinal damage and a certain percentage of disability. She did this test (FCE for short) a few weeks ago and will receive the official findings soon. The test took 4 hours and she was asked to do various tasks (walking, climbing ladders, lifting, twisting, bending, etc.) and rate her level of pain during and after each one. The results will be used to document what her work restrictions need to be and if she should even be working.

As far as any type of device to measure pain, I'm not sure it is feasible. If medical technology eventually leads to that result, that would be great.


annette030 responded:
Yes, it would make life easier for the doctors, but why not just trust what the patient says, and use whatever $$$ there is for treatment?

If there were unlimited funds to spend on medical stuff, I would have more energy for this kind of thing. I worked in the ER as an RN and such a device would be very helpful, it would quickly weed out the addicts from the pain sufferers. But, there are not unlimited funds for medical research, and as a patient I would prefer they spend the $$$ on treatment issues.

Take care, Annette
Pattiecake replied to finn2's response:
It was meant for me to read your comment today. I am also 64 years old and have had to give up things I want so badly to do because it hurt. I went to a Sports Medicine doctor yesterday after talking to my Primary Care Physician about my various ailments for years and getting muscle relaxers that made me loose connection with life until they wore off. I don't want ANY day to be taken from me, whether for pain or the pain reliever. I was given a prescription dose of an OTC pain reliever and set up to begin Physical Therapy next week. I am excited to try to take my life back and live more pain free. Thank you for being candid. p.s. dr. asked me my pain level and I, like you, had a hard time coming up with an answer. I wish I had read your comment before I was asked. My concept of 10 was writhing on the floor also.
Gram23 responded:
That would indeed be a handy device (maybe a brain scan that shows which areas are firing up?), but probably wouldn't be practical for frequent or routine visits. I'm 70 years old and I too have difficulty deciding on a number from 1 to 10 after being told 1 is no pain at all and 10 is the worst pain I can imagine. I've gone through childbirth twice, the first time losing consciousness several times from the intensity of the contractions. A couple of years ago I suffered a compression fracture in my thoracic spine which was diagnosed in the emergency room as a muscle spasm (no x-ray). I was given a prescription for a muscle relaxant and sent home. A few days later I was back in the emergency room with pain that made me want to scream, but I couldn't because at its most intense my back and chest muscles all spasmed together and I couldn't breath or make a sound. I would try to scream "Help" as I curled up in agony, but nothing would come out. By the time they did an x-ray I also had a cracked rib, Was that experience a 10? I have NO idea what 5 through 8 would be, so my estimates tend to be pretty random. I go to an Advanced Pain Management Center every few weeks for monitoring and occasional prescription renewal, and the younger of the two women who record the information gets very frustrated/annoyed when percentage improvement estimates and pain level number estimates don't match up as well as she thinks they should. She appears to be in her late twenties. The other woman is probably about 50 and is much more understanding about the difficulty of estimating pain levels.

As I tried to explain to the younger one, at tolerable levels constant pain becomes like background noise, like the appliances and electronics in your home. You know the sound is there but you don't really notice it until one of them makes a very unusual noise, or the electricity goes off and the sudden silence gets your attention. A slightly louder noise (or slightly stronger pain) for a brief period is initially noticed, then forgotten unless it keeps happening.

No, Ma'am, sorry I can't tell you what my pain level was yesterday or the day before, or last week. I have enough trouble figuring out what it is right now. And by the way, do you mean now while I'm sitting here in this chair, or earlier when I tried to climb the stairs, or in the car on the way over when my husband hit that pothole, or early this morning while trying to sleep in a regular bed at a relative's house with my knees hurting and repeatedly waking me up? Average pain? Yeah, right, I'll get right on that!
ctbeth replied to finn2's response:
Comparative Pain Scale
0 No pain. Feeling perfectly normal. Minor
Does not interfere with most activities. Able to adapt to pain psychologically and with medication or devices such as cushions.
Very Mild
Very light barely noticable pain, like a mosquito bite or a poison ivy itch. Most of the time you never think about the pain. 2
Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails. Note that people react differently to this self-test. 3
Very noticable pain, like an accidental cut, a blow to the nose causing a bloody nose, or a doctor giving you an injection. The pain is not so strong that you cannot get used to it. Eventually, most of the time you don't notice the pain. You have adapted to it. Moderate
Interferes with many activities. Requires lifestyle changes but patient remains independent. Unable to adapt to pain.
Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma to part of the body, such as stubbing your toe real hard. So strong you notice the pain all the time and cannot completely adapt. This pain level can be simulated by pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails, and squeezing real hard. Note how the simulated pain is initially piercing but becomes dull after that. 5
Strong, deep, piercing pain, such as a sprained ankle, or mild back pain. Not only do you notice the pain all the time, you are now so preoccupied with managing it, your normal lifestyle is curtailed.
ctbeth replied to ctbeth's response:
Strong, deep, piercing pain so strong it seems to partially dominate your senses, causing you to think somewhat unclearly. At this point you begin to have trouble holding a job or maintaining normal social relationships. Comparable to a bad non-migriane headache combined with several bee stings, or a bad back pain. Severe
Unable to engage in normal activities. Patient is disabled and unable to function independently.
Same as 6 except the pain completely dominates your senses, causing you to think unclearly about half the time. At this point you are effectively disabled and frequently cannot live alone. Comparable to an average migraine headache.
Pain so intense you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time. Suicide is frequently contemplated and sometimes tried. Comparable to childbirth or a real bad migraine headache. 9
Pain so intense you cannot tolerate it and demand pain killers or surgery, no matter what the side effects or risk. If this doesn't work, suicide is frequent since there is no more joy in life whatsoever. Comparable to throat cancer. 10
Pain so intense you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain and not blood loss, have experienced level 10.
ctbeth replied to ctbeth's response:
I have heard many people, when asked, reply that their pain, on a 0-10 scale, is a "12".

If our MDs could show us an objective pain scale such as this one (author/source unknown), our subjective self-assessment may be more accurate.

In reality, other than after the direct impact of my auto accident, I have probably never experienced a "10", yet I have told my MD, upon many occasions, that my pain is a "10"....and I've had five children and experienced natural childbirth. It was a "9" at worst.

We are asked to rate our subjective pain without being given the objective information to accurately do so.

With an objective scale, such as the one I posted, but DID NOT AUTHOR ( I have it saved in my documents, but did not save the source- sorry), long as the MD and the PATIENT have the same scale, I think the 0-10 scale can pretty-accurately tell our MDs what we are experiencing.

I have shared the above with my MD, which is why I have saved it. This way, I feel more secure that when I say that I'm a "6", he and I KNOW what a "6" means to me.

With the scale above, I would, indeed, call my bad pain days a "6".
Without the thoughts and behaviours explained, I would have called my bad pain days an "8" or "9".

To give our MDs accurate ratings, we MUST be in agreement what a "6" vs an "8" or "9" , or even "10" really feels and appears.

I would encourage everyone to ask his/her MD for a written explanation of what each pain number means to the MD. We can then more- accurately give and objective finding of a subjective event.

Any thoughts?

Thanks fro a great discussion!

annette030 replied to ctbeth's response:
Hi Beth,

Your explanation is interesting, but does not seem to work with my pain levels.

I was well known for my ability as a nurse to give a painless injection. It is all about how the person gives it. I must have learned right. it would be an insult for someone to label the pain from an injection from me at a 3.

I have had migraines for many years, and they also do not fit with the pain scale you mentioned. They can be anything from a 1 to a 9. I personally think the nausea is worse than the pain, I hate throwing up.

Someone cannot live alone at a 7 according to your scale, many of us have no choice and function fairly well at a 6 or a 7. You do have to remember that chronic pain is not always a 6-7, it varies. Chronic pain is very different from acute pain. Perhaps on a day when our score is lower we will do that load of laundry, and when we have a bad day we won't.

For me, I like the scale that shows a smiley face at the 0, and tears and crying on the 10. Although that would not work for people who are stoic. My husband had AVN of the hip and had a crushed femoral head, he claimed a 2 on the pain scale, even though he was walking with a cane at the time. He really believes that if you do not say you are in pain, you will experience less pain, I do not know if he is right or not.

I think using the scale for a trend is the best thing to do. Once your doctor gets to know you better, he will know what you consider okay and what you don"t. If you go through life at a 0-2 on whatever scale is used, and all of a sudden your score is a 6-7 or even higher, then it would be nice for someone to notice.

Take care, Annette
ctbeth replied to annette030's response:
Hello Annette <3,

I understand exactly what you're saying.

The scale, as I said, is NOT of my authorship.

My point is merely that the same scale needs to be understood by both the MD and patient.

If my "7" is that I am bed-bound and need total care and my MD's "7" is that I'm too uncomfortable to go grocery shopping, then getting we're, basically, speaking two different languages.

It's not that THAT particular narrative scale is the best or right one, but rather that if there were a universally-recognised (in the medical community) description of what each pain number means, in regard to subjective and objective findings (what I feel being subjective and what activities I can and cannot perform being somewhat-objective), it could assist in communication between MD and patient.

Trending is certainly a valuable assessment tool that tends to be under utilised, imho~

I hope all is well with you and your family,

ctbeth replied to annette030's response:
I just re-read your comment.

I think you are quite right- the scale I copied and printed yesterday does seem more appropriate to an acute, rather than a chronic pain.

Ok, not the best scale, but the idea of a widely-accepted scale so that the patient and MD both know what each number really means (to both) would foster better communication, which is a key to better management.
annette030 replied to ctbeth's response:
The med. asst. at my doctor's office simply holds up the card with the numbers and the faces on it and you pick the one that most nearly reflects what you feel now. She does it along with your vital signs. Anything more than that about your pain, and you need to discuss it with the doctor.

You are right, it always works best if you and your doctor are on the same page as far as any communication goes.

We are both fine, as is my son and his family. I hope you and your daughter are doing well too.

Take care, Annette
finn2 replied to ctbeth's response:
This is very interesting, I'd really like a copy of it to discuss with my doc so we can see the importance of he and I agreeing what the numbers indicate. According to this scale, I've never been at a 10. I woder what he thinks of my 10 every month on the form. I'm not unaware of anything but pain and sobbing and screaming, yet he's never asked why I think I'm a 10. (as on the scale I read about, 10 indicated effected everything you do, but there are also degrees of that, as in are you effected enough that you can't do it or does it just hurt while you do it?) This subject could warrant a real lengthy discussion, and I'm so glad it was brought up. Do you a neat copy you can easily send to my email address or should I hand copy this one? Thanks.
davedsel57 replied to finn2's response:
Hello, Finn2.

On the left hand side of the screen you will see an option for "My Email Digests". Click on that and then click on the option to sign up. You will get discussion in the Community sent to your email. Now, I don't know if it is just new or there is an option to select a specific date range or discussion. I also had heard people were not getting them regularly after signing up but hopefully that has been resolved.

You may have to resort to the manual copy and paste method. Paste what you want into a word processing document and save it to the hard drive on your PC.

Hope this helps.



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