How to Measure Pain: Going Beyond the Smiley Face
You’ve probably seen the smiley face pain scale in your doctor’s office. When asked to rate your pain, you do your best to figure out which face fits best. But have you ever wondered if everyone pinpoints their pain at the same point on the scale? Translating your pain to a scale isn’t easy, says Dr. Kishan Yalavarthi, a Neuroradiologist at CDI:
“It’s very subjective. I’m standing in my shoes and they’re in their shoes. You really have to assess how the patient is feeling. Everyone’s pain level is going to be different. Even when I’m looking at the same disc herniation in two different people – the pain response and feelings are going to be different.”
At CDI, we understand that pain is complicated because it is so subjective. Knowing you are in pain (or else you wouldn’t be here), we go beyond the smiley face in assessing your pain and finding a way to help relieve it.
How do you Accurately Rate Your Pain?
When patients come to Dr. Yalavarthi for relief, he relies on a two-step approach for assessing pain. He already knows his patient is experiencing pain and has been asked a lot of questions by their referring physician. The first step is to find out more and that means asking for his patient’s story. How long have you been in pain? What makes it better? Are there specific movements that make it worse? How is it affecting your quality of life? This approach follows the McGill Pain Questionnaire (MPQ), which helps physicians to assess pain by measuring three dimensions of a person’s pain experience:
- The emotional impact of the pain such as fear, anxiety or depression
- The sensory impact of the pain, the location, intensity, temperature, pressure and pattern
- The intensity of the overall experience, including actions that increase or decrease pain
After you share your story, and are ready for a procedure, there’s a second step – the quick scale. “What we want to understand, in that moment, is how effective the pain injection is for that individual,” explains Dr. Yalavarthi. “That is why we measure their pain on a quick scale of 1-10.” Doing the quick scale test before and then after the injection allows your radiologist to gauge how well the injection works.
Click here to find out more about treating pain with injections vs. medication
Assessing patients both on a quick scale of 1-10 as well as getting your personal pain story, allows you doctor to see how you are responding to treatments and to see any patterns of progression or remission. Pain management is a complicated field. “It’s a very tough one to get 100% success,” says Dr. Yalavarthi. “It’s not like an appendectomy – an easy cut and dry procedure where you know you are doing one thing and relieving the pain. Pain is multi-factorial -- it’s everything from perception to physical to emotional and even environmental. All these factors play into what pain is, so diagnosing and treating pain is probably one of the toughest fields in medicine.”
Two Ways to Help your Physician Understand your Pain
First, be honest with your physician. If you feel sensations of ants crawling on the top of your foot or a feeling of water running along your leg – make sure to put that into words. What you may think is an odd description, can actually tell your doctor a lot about your pain and, more importantly, the reason for the pain. For example, the sensation of ants crawling on the top of the foot can be caused by a disc herniation in the lumbar spine. Don’t feel embarrassed because what you say can hold the answer to managing your pain.
And then, try to understand your perception of pain. Some people believe that pain is just a normal part of what they are going through, for example a chemotherapy patient may think pain is just part of the process. Others may just feel that they don’t want to be a bother to their doctor or family. It is important to take a look at how you perceive pain. When you do not communicate because you just don’t want to be a bother – your doctor may miss something vital to your diagnosis.
Go beyond the smiley face pain scale and share your story with your physician. Don’t let pain interfere with the quality of your life.
About Dr. Yalavarthi
Kishan D. Yalavarthi, M.D. is a board certified diagnostic and neuroradiologist at ProSight Radiology Group who reads for St. Luke's Center for Diagnostic Imaging in Missouri. He specializes in neuroradiology and musculoskeletal imaging, and performs diagnostic and therapeutic injection procedures to help patients manage joint and back pain. Read his full bio here.
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