Skeptics Guide to the Universe Forums

General Discussions => Health, Fitness, Nutrition, and Medicine => Topic started by: brilligtove on August 24, 2019, 07:19:33 PM

Title: Pain Scales
Post by: brilligtove on August 24, 2019, 07:19:33 PM
I think we may be able to calibrate pain scales using ice cream headaches as a standard candle.
Title: Re: Pain Scales
Post by: John Albert on August 24, 2019, 07:33:29 PM
Does this include psychological pain?
Title: Re: Pain Scales
Post by: brilligtove on August 25, 2019, 08:45:03 AM
It is this kind of headache I'm talking about:
(https://i.imgur.com/IH1PMal.gif)
https://i.imgur.com/IH1PMal.gifv
Title: Re: Pain Scales
Post by: The Latinist on August 25, 2019, 12:32:40 PM
The problem with this is that there are many factors that affect the severity of pain beyond its intensity: duration, quality, location, etc. While an ice cream headache can indeed be extremely painful, it is a pain which is short in duration and which I know will not persist.  It is therefore significantly more endurable even than moderate chronic pain.
Title: Re: Pain Scales
Post by: brilligtove on August 25, 2019, 04:47:43 PM
All fair points. I was looking for intensity only, however.
Title: Re: Pain Scales
Post by: The Latinist on August 25, 2019, 05:37:52 PM
But my point is that I do not think that I can reliably separate intensity from the other factors I mentioned in assigning a subjective number to pain.

An ice cream headache is certainly not the worst pain I have ever felt; I have never felt, for instance, that I might vomit if faint due to the pain of an ice cream headache.  Nor do I think it is even the worst headache that I’ve had, though I’m not sure I am able to separate the quality and duration of the pain from its intensity, especially in this case.

The worst pain I have ever felt was slipping on stairs and landing with all of my weight on my coccyx. While I did not quite faint, I nearly did so. For what it’s worth, no ice cream headache has approached that pain.
Title: Re: Pain Scales
Post by: amysrevenge on August 26, 2019, 11:03:25 AM
Post-gout my pain scale is all fucked up.  I didn't know there was that much pain in the world.  A couple years ago when I was having (ultimately not serious) nutsack issues, I was flummoxed by the pain scale.  Pre-gout I probably would have categorized the nutsack pain as like 7 or 8, but post-gout it was maybe 4.
Title: Re: Pain Scales
Post by: DevoutCatalyst on August 26, 2019, 11:07:30 AM
Post-gout my pain scale is all fucked up.  I didn't know there was that much pain in the world.  A couple years ago when I was having (ultimately not serious) nutsack issues, I was flummoxed by the pain scale.  Pre-gout I probably would have categorized the nutsack pain as like 7 or 8, but post-gout it was maybe 4.

Let's see acupuncturists claim to treat gout.

May I ask what your solution for gout turned out to be? There are different approaches, just curious.
Title: Re: Pain Scales
Post by: Noisy Rhysling on August 26, 2019, 11:38:36 AM
At one point the doctors were telling me "it's okay to pass out!" I had no intention of doing so. One of the nurses ran out of the room.
Title: Re: Pain Scales
Post by: Calinthalus on August 26, 2019, 12:15:00 PM
When I was in the ER with my heart attack, the doctor asked me to rate my pain.  I told him it was about a 4.  He looked me in the eye and said, "Mr. Jones, I know you are trying to put on a brave face for your family, but we really need to know what your pain level is so we can accurately treat you".  I said, "You just popped me with morphine like ten minutes ago.  I'm good."
Title: Re: Pain Scales
Post by: amysrevenge on August 26, 2019, 12:15:46 PM
Post-gout my pain scale is all fucked up.  I didn't know there was that much pain in the world.  A couple years ago when I was having (ultimately not serious) nutsack issues, I was flummoxed by the pain scale.  Pre-gout I probably would have categorized the nutsack pain as like 7 or 8, but post-gout it was maybe 4.

Let's see acupuncturists claim to treat gout.

May I ask what your solution for gout turned out to be? There are different approaches, just curious.

Allopurninol, colchicine, and eliminating fish from my diet, all for the rest of my life.
Title: Re: Pain Scales
Post by: Rai on August 26, 2019, 12:27:03 PM
I'd like it more if it had evocative descriptions like the Schmidt Sting Pain Index. I can place ""Pure, intense, brilliant pain. Like walking over flaming charcoal with a three inch nail embedded in your heel" much better than a simple "8".
Title: Re: Pain Scales
Post by: DevoutCatalyst on August 26, 2019, 02:46:59 PM
Post-gout my pain scale is all fucked up.  I didn't know there was that much pain in the world.  A couple years ago when I was having (ultimately not serious) nutsack issues, I was flummoxed by the pain scale.  Pre-gout I probably would have categorized the nutsack pain as like 7 or 8, but post-gout it was maybe 4.

Let's see acupuncturists claim to treat gout.

May I ask what your solution for gout turned out to be? There are different approaches, just curious.

Allopurninol, colchicine, and eliminating fish from my diet, all for the rest of my life.

I got lucky, just need the colchicine prn and a dietary elimination which I dare not violate. Haven't had to take colchicine for a few years now. The pain in my big toe was incredible, wanted to shoot the toe clean off.
Title: Re: Pain Scales
Post by: brilligtove on August 26, 2019, 03:40:19 PM
I'd like it more if it had evocative descriptions like the Schmidt Sting Pain Index. I can place ""Pure, intense, brilliant pain. Like walking over flaming charcoal with a three inch nail embedded in your heel" much better than a simple "8".

Sure. In this case I was looking for an intensity rating on a single, specific, commonly experienced pain.
Title: Re: Pain Scales
Post by: daniel1948 on August 26, 2019, 06:30:35 PM
I'd like it more if it had evocative descriptions like the Schmidt Sting Pain Index. I can place ""Pure, intense, brilliant pain. Like walking over flaming charcoal with a three inch nail embedded in your heel" much better than a simple "8".

If that's your idea of an 8, I think I'd pass out just reading your description of what would constitute a 10. (This board needs more emojis. Please imagine I put an EEK! emoji here.)
Title: Re: Pain Scales
Post by: daniel1948 on August 26, 2019, 06:32:24 PM
I'd like it more if it had evocative descriptions like the Schmidt Sting Pain Index. I can place ""Pure, intense, brilliant pain. Like walking over flaming charcoal with a three inch nail embedded in your heel" much better than a simple "8".

Sure. In this case I was looking for an intensity rating on a single, specific, commonly experienced pain.

I think the problem is that ice cream headaches come in different intensities.
Title: Re: Pain Scales
Post by: amysrevenge on August 26, 2019, 06:38:20 PM
Post-gout my pain scale is all fucked up.  I didn't know there was that much pain in the world.  A couple years ago when I was having (ultimately not serious) nutsack issues, I was flummoxed by the pain scale.  Pre-gout I probably would have categorized the nutsack pain as like 7 or 8, but post-gout it was maybe 4.

Let's see acupuncturists claim to treat gout.

May I ask what your solution for gout turned out to be? There are different approaches, just curious.

Allopurninol, colchicine, and eliminating fish from my diet, all for the rest of my life.

I got lucky, just need the colchicine prn and a dietary elimination which I dare not violate. Haven't had to take colchicine for a few years now. The pain in my big toe was incredible, wanted to shoot the toe clean off.

 I had what they call "polyarticulate" gout.  Bad like that in the one toe, but also bad (at a much lower level) at knuckles, wrists, elbows, knees, ankles.  I remember crying out from feeling the wind from my wife opening the door to the bedroom.

I get daily allopurinol, 1 per 3 days colchicine.  I hear colchicine is pricey in the USA.  It is also used in veterinary medicine, so my wife hears about the costs down there.  Something like $5 per pill.
Title: Re: Pain Scales
Post by: DevoutCatalyst on August 26, 2019, 06:46:45 PM
Quote from: amysrevenge
I had what they call "polyarticulate" gout.  Bad like that in the one toe, but also bad (at a much lower level) at knuckles, wrists, elbows, knees, ankles.  I remember crying out from feeling the wind from my wife opening the door to the bedroom.
I get daily allopurinol, 1 per 3 days colchicine.  I hear colchicine is pricey in the USA.  It is also used in veterinary medicine, so my wife hears about the costs down there.  Something like $5 per pill.

Glad you have that torture managed.

The price of colchicine was dirt cheap my first prescription. Then a turn of events gave a monopoly to one maker and the price shot up maliciously. Stupid USA.
Title: Re: Pain Scales
Post by: arthwollipot on August 26, 2019, 07:56:52 PM
Worst pain I've ever had was a perianal abscess.

At one point while I was waiting for surgery a nurse walked in, and we had this brief dialogue:

How's it going?

Hurts like hell.

Want some morphine?

...Yeah, okay.
Title: Re: Pain Scales
Post by: Noisy Rhysling on August 27, 2019, 06:07:45 AM
. (This board needs more emojis. Please imagine I put an EEK! emoji here.)
http://rationalia.com/z/index.html (http://rationalia.com/z/cheers2.gif)
Title: Re: Pain Scales
Post by: brilligtove on August 27, 2019, 09:04:12 AM
I'd like it more if it had evocative descriptions like the Schmidt Sting Pain Index. I can place ""Pure, intense, brilliant pain. Like walking over flaming charcoal with a three inch nail embedded in your heel" much better than a simple "8".

Sure. In this case I was looking for an intensity rating on a single, specific, commonly experienced pain.

I think the problem is that ice cream headaches come in different intensities.

Do they? In my experience they are very consistent, which is why I started with them.
Title: Re: Pain Scales
Post by: brilligtove on August 27, 2019, 09:11:35 AM
My worst pain was having a trache tube replaced when my new blow hole was infected. 10/10 was all-consuming  writhing agony. There was nothing else: only pain. If I had the capacity to scream I would have been screaming. If it had been a little more intense I think I would have blacked out.

When doctors and nurses ask how bad the pain is, the scale is subjective. I thought if there is a pain that everyone experiences at a similar level, it might give us a way to compare my 6 to your 4.
Title: Re: Pain Scales
Post by: stands2reason on August 27, 2019, 09:23:55 AM
https://www.youtube.com/watch?v=1ydGv5XId4g
Title: Re: Pain Scales
Post by: daniel1948 on August 27, 2019, 10:18:37 AM
I'd like it more if it had evocative descriptions like the Schmidt Sting Pain Index. I can place ""Pure, intense, brilliant pain. Like walking over flaming charcoal with a three inch nail embedded in your heel" much better than a simple "8".

Sure. In this case I was looking for an intensity rating on a single, specific, commonly experienced pain.

I think the problem is that ice cream headaches come in different intensities.

Do they? In my experience they are very consistent, which is why I started with them.

I really think this only means that your ice cream headaches are consistent for you. And pain in general is very subjective. The same actual damage will cause different people to experience very different levels of pain. One person will keep on going through an injury that would cause another to collapse in agony. Whether this is a learned skill or the result of repeated injuries or genetic variation or a combination, I don't know. But it's clear that we experience pain differently.

The one-to-ten scale is just a way of gauging how close you are to finding your pain intolerable.
Title: Re: Pain Scales
Post by: brilligtove on August 27, 2019, 12:58:38 PM
Yes, the fact that my ice-cream headaches have a consistent intensity for me was part of the inspiration for this poll. I thought that most individuals would rate their ICH with a consistent intensity - not a 3 this time but an 8 the other time, for example. I don't have that consistency with any other commonly experienced pain. Normal headaches, gas cramps, stubbed toes, whatever - they all have a wide range of intensity.

If my hypothesis was accurate, ICH could represent a standard candle to calibrate your pain against my pain. If I rated ICH at 4 and you rate it at 7, we can both have an intuitive, consistent, and useful understanding of how much pain you are in when you say "it's an 8" or "it's a 3". It would also give medical practitioners a sense of my pain tolerance - something that is not well expressed in the current scales.

If there is no 'standard candle' for pain, there is no standard candle for pain. Fair enough. It was worth a shot.
Title: Re: Pain Scales
Post by: The Latinist on August 27, 2019, 01:04:41 PM
But even if your hypothesis about consistency were true, we would have no way of knowing that my subjective experience of the pain is the same as yours.  You may rate it a 4 and I might rate it a 7 for numerous reasons: perhaps I have less pain tolerance than you; perhaps I have never experienced worse pain and therefore have nothing to compare it to; perhaps my ice cream headaches, while consistent, are actually significantly more painful than yours; or perhaps I am more sensitive to the particular quality of pain created by an ice cream headache than you are. We have no way of knowing which of these or the numerous other causes one could think of it might be.
Title: Re: Pain Scales
Post by: brilligtove on August 27, 2019, 01:25:01 PM
All true, but I think only one point is relevant to calibrating your pain against my pain. You're right though: if you and I compare ICH intensity to a bunch of other pains and you consistently rate ICH as much more painful than I do, it would not qualify as a useful standard candle. I don't thing the other specifics of the subjective experience are necessarily dealbreakers.
Title: Re: Pain Scales
Post by: The Latinist on August 27, 2019, 02:10:33 PM
Your understanding (or perhaps your experience) of pain intensity is fundamentally different from mine.  I do not think that it is possible to separate intensity from quality, duration, individual sensitivity, past experience of pain, and numerous other factors. Indeed, I think that pain intensity is as fundamentally subjective as any other aspect of pain. You are insistent that you are able to separate pain intensity from other aspects of pain, and I have no reason to reject your claim; I request the same respect for my own insistence that I am not able to do so and that, for me, intensity of pain is, in fact, inextricably linked to its other characteristics. Your insistence that all other aspects of the pain are irrelevant to my rating of the pain is, therefore, unjustified and, in my opinion, offensive.
Title: Re: Pain Scales
Post by: Noisy Rhysling on August 27, 2019, 04:39:47 PM
When my appendix went bad I went to sick call dressed for work. (At that time it was a suit with optional shoulder holster.) When the doc saw me he said "You know, when you feel this bad you could go straight to the ER." I replied, "I'm still standing, so I don't consider it an emergency."

It's the hard-headed Oirish in me.
Title: Re: Pain Scales
Post by: DevoutCatalyst on August 27, 2019, 04:46:00 PM
When my appendix went bad I went to sick call dressed for work. (At that time it was a suit with optional shoulder holster.) When the doc saw me he said "You know, when you feel this bad you could go straight to the ER." I replied, "I'm still standing, so I don't consider it an emergency."

It's the hard-headed Oirish in me.

You could have done your own surgery, tough guy.
Title: Re: Pain Scales
Post by: daniel1948 on August 27, 2019, 04:50:05 PM
The normal 1 to 10 scale is useful because no matter who you are, a 1 means "I hardly notice it" and 10 means "It's so intolerable I cannot stand it and I cannot imagine anything worse." Since pain is inherently subjective, there can be no absolute scale. This lets the medical professional get an idea of your state of mind.
Title: Re: Pain Scales
Post by: daniel1948 on August 27, 2019, 04:50:49 PM
When my appendix went bad I went to sick call dressed for work. (At that time it was a suit with optional shoulder holster.) When the doc saw me he said "You know, when you feel this bad you could go straight to the ER." I replied, "I'm still standing, so I don't consider it an emergency."

It's the hard-headed Oirish in me.

You could have done your own surgery, tough guy.

But probably not while standing up.
Title: Re: Pain Scales
Post by: Noisy Rhysling on August 27, 2019, 05:01:17 PM
When my appendix went bad I went to sick call dressed for work. (At that time it was a suit with optional shoulder holster.) When the doc saw me he said "You know, when you feel this bad you could go straight to the ER." I replied, "I'm still standing, so I don't consider it an emergency."

It's the hard-headed Oirish in me.

You could have done your own surgery, tough guy.
Could've, yes, but the Navy frowns on that.
Title: Re: Pain Scales
Post by: brilligtove on August 27, 2019, 05:57:48 PM
Your understanding (or perhaps your experience) of pain intensity is fundamentally different from mine.  I do not think that it is possible to separate intensity from quality, duration, individual sensitivity, past experience of pain, and numerous other factors. Indeed, I think that pain intensity is as fundamentally subjective as any other aspect of pain. You are insistent that you are able to separate pain intensity from other aspects of pain, and I have no reason to reject your claim; I request the same respect for my own insistence that I am not able to do so and that, for me, intensity of pain is, in fact, inextricably linked to its other characteristics. Your insistence that all other aspects of the pain are irrelevant to my rating of the pain is, therefore, unjustified and, in my opinion, offensive.

At no point have I denied your experience, or even disagreed with your points. My hypothesis was that there is a kind of pain that individuals could consistently rate for intensity. That does not appear to be the case.

I did not intend any offence.


Title: Re: Pain Scales
Post by: brilligtove on August 27, 2019, 06:08:26 PM
When my appendix went bad I went to sick call dressed for work. (At that time it was a suit with optional shoulder holster.) When the doc saw me he said "You know, when you feel this bad you could go straight to the ER." I replied, "I'm still standing, so I don't consider it an emergency."

It's the hard-headed Oirish in me.

This is why I think some sort of calibration - subjective though it would be - would be useful. It seems such a thing is not real however. Too bad.

I'll stick to this in the future:
(https://i.imgur.com/UHIfbmG.jpg) (https://imgur.com/gallery/BvVJBgX)
Title: Re: Pain Scales
Post by: Noisy Rhysling on August 27, 2019, 06:49:45 PM
Is a "10" holding your hand in a candle flame or having an ice pick stuck in your eye?
Title: Re: Pain Scales
Post by: brilligtove on August 27, 2019, 07:03:42 PM
I'd probably go with 8 on the flame and 9 on the pick.
Title: Re: Pain Scales
Post by: Noisy Rhysling on August 27, 2019, 07:08:59 PM
I'd probably go with 8 on the flame and 9 on the pick.
Galileo, when scolded for recanting his thesis on the solar system, said "how long would you have your hand held in a candle flame before changing your mind about anything?"
Title: Re: Pain Scales
Post by: daniel1948 on August 27, 2019, 07:28:35 PM
Since we're talking about self-reported pain, "unconscious" falls nowhere on the scale since you cannot report it. The ice pick in the eye sounds like a 20 to me. On a scale of 1 to 10.

Galileo, when scolded for recanting his thesis on the solar system, said "how long would you have your hand held in a candle flame before changing your mind about anything?"

I doubt Galileo ever said that. But it's an excellent point. Threatened with the Inquisition I'd have adopted any position they wanted. Note that Galileo was never tortured. He was shown the instruments of torture. That's all it would have taken for me.
Title: Re: Pain Scales
Post by: arthwollipot on August 27, 2019, 07:32:15 PM
The phrase "shown the instruments of torture" sounds like a euphemism.
Title: Re: Pain Scales
Post by: Noisy Rhysling on August 27, 2019, 08:10:17 PM

I doubt Galileo ever said that.
Why?
Title: Re: Pain Scales
Post by: Noisy Rhysling on August 27, 2019, 08:12:07 PM
The phrase "shown the instruments of torture" sounds like a euphemism.
The Inquisition made sure people knew what was waiting for them if they stepped out of line. The Malleus Maleficarum was a fun read back then.
Title: Re: Pain Scales
Post by: The Latinist on August 28, 2019, 01:41:13 AM
At no point have I denied your experience

But you have.  You have repeatedly told me that things (such as pain duration, quality, etc) which I have said in my experience are inextricably linked to pain intensity are irrelevant to a discussion of it. In doing so, you are dismissing my experience of pain and insisting that yours is correct.

Quote
I did not intend any offense

I do not think that you intended offense; I am trying to explain that you have it, regardless of your intentions.
Title: Re: Pain Scales
Post by: daniel1948 on August 28, 2019, 11:13:19 AM

I doubt Galileo ever said that.
Why?

It just sounds to me like a made-up quote. Further, Galileo would not have been criticized by anybody for caving in to the Inquisition. Everybody knew how bad it was to fall into their clutches.
Title: Re: Pain Scales
Post by: seamas on August 28, 2019, 11:32:13 AM

I doubt Galileo ever said that.
Why?

It just sounds to me like a made-up quote. Further, Galileo would not have been criticized by anybody for caving in to the Inquisition. Everybody knew how bad it was to fall into their clutches.

Well everyone may have known what it would be like if they did fall into their clutches, but no one ever expects that.
With one good reason.

Fear and surprise.

Title: Re: Pain Scales
Post by: Calinthalus on August 28, 2019, 11:33:48 AM
I wish I could like that more than once.
Title: Re: Pain Scales
Post by: lonely moa on August 29, 2019, 02:13:59 AM
A pathologist's needle in a neuroma in the neck is 11/10.
Title: Re: Pain Scales
Post by: jt512 on August 29, 2019, 02:20:21 AM
Your insistence that all other aspects of the pain are irrelevant to my rating of the pain is, therefore, unjustified and, in my opinion, offensive.

Lately, Latinist, one cannot help but notice, everything in your opinion is offensive.
Title: Re: Pain Scales
Post by: brilligtove on September 13, 2019, 10:03:22 PM
(https://i.imgur.com/Fh14t0w.png)