Moving Past the Pain Scale

Dr. Rebecca Cherry
August 2, 2022 / 5 mins read

Most people who have been to a doctor's office or emergency room are familiar with the questions: “Are you having any pain? How severe is it, on a scale of 1 to 10, with 10 being the worst pain you can imagine?”

Many providers and organizations consider the pain score to be one of the "vital signs" which is checked regularly in a medical setting. It helps to determine things like a patient's treatment regimen and readiness to go home from the hospital.

But when it comes to chronic pain, assigning those numbers becomes less helpful. One of the issues with the pain scale is that each time a person uses it, their attention is drawn back to the exact thing they are hoping to avoid.

Even if they were already finding an effective way to use distraction as a coping tool, answering a question about their pain may pull their focus right back to it. (Many people think of distraction as a bad thing, as they are concerned that it will take away the motivation to address any underlying cause of a health problem. I disagree. Distraction can be an excellent technique for improving quality of life in the short term, and does not get in the way of finding other solutions.)

So, when a child is acting like their usual self, and a well-meaning adult asks, "How bad is your pain?" the child may go from having essentially no discomfort to identifying something like a 4 out of 10 pain intensity.

In the doctor's office, we do a similar thing. We ask, “Where exactly is the pain? What does the pain feel like? What makes it worse?” Those questions, like the pain scale, can be very helpful during the process of diagnosis. However, once the pain has taken on a life of its own, as it has in so many kids with chronic pain, I prefer to ask a different set of questions:

  • "What time of day do you tend to feel best?"

  • "What have you found you can do to feel better, even if it is just a little bit better?"

  • And, for those who are frequent users of the pain scale, "What is the lowest number you can get to on a typical day?"

Once we have identified when a child feels their best, we can focus on figuring out which lifestyle factors or treatments are most helpful in getting there. We can also start to set specific goals, which provide more direction.

For instance, if a child tends to feel best for the two hours after lunch, with a pain score of 3, I might ask: “What would be better to change first -- to feel that well for three or four hours at a time, or to get the score down to a 2 for those two hours?” Part of the benefit of these questions is that they increase the range of ways that a person can feel better. This approach also gives positive reinforcement for even small increments of improvement.

The pain scale has its place in the medical system, but it can trap us in an unending focus on what is still wrong. Let's neutralize some of its power by focusing instead on what is going right.