Pain Scales (1-10): How To Explain Your Pain

The pain scale: “1-10, describe your pain with numbers,” like it’s that fucking easy.

Ten means the worst pain you’ve ever experienced. Or else ten means the worst pain imaginable. Unless it means “bad enough to go to the ER.” Or just “very severe.”  My new favorite pain scale description is “Unspeakable / unimaginable. Bedridden and possibly delirious.” That seems closest to the gist of it.   There’s even a visual scale for kids with faces called the Wong-Baker FACES Scale! 

The Wong-Baker FACES Pain Scale, even numbers with cartoon faces whose expressions supposedly reflect pain levels
Pick a face, any face

Pain scale–1-10– and its inescapable fuckery

All those things are completely different, of course. I mean… go look at that sentence again and think about how far apart some of those are. I’ve never given birth, had a kidney stone, or had my arm cut off without anesthesia, but I can imagine how badly those would hurt. If I truly went by ‘the worst pain ever felt,’ my entire scale would have changed after my L5-S1 disc herniated. Does that mean that what was my 7 was now a 5 because the scale was stretched? What about everything else: how do I compare a migraine to a laminectomy?

“There are lots of problems that come with trying to measure pain,” Professor Stephen McMahon of the London Pain Consortium told The Independent in 2018. “I think the obsession with numbers is an oversimplification. Pain is not unidimensional. It doesn’t just come with scale […] it comes with other baggage. How threatening it is, how emotionally disturbing, how it affects your ability to concentrate.”

On a reddish background of purple and teal flowers, text reads "chronic pain is no joke. And it's every day waking up not knowing how you're going to feel. Lady Gaga,"
Click here for more of the best quotes about chronic pain, disability and mental health

What does ‘the most pain you’ve ever been in’ really mean?

I’ve been thinking a lot about this since I saw a post by someone new to chronic pain. They said that they couldn’t understand the arbitrary value of a 1-10 scale of pain:

“Especially when they say ‘10 being the most pain you’ve ever been in’ because yes, the pain that I’m in all the time is the most pain I’ve ever been in but I always doubt that it’s a 10.” 

My response was: 

“Your instincts are right, you should lowball it.

Don’t ever say 10, because they will dismiss you. If you’re not literally on your back screaming in pain, or flat-out unconscious, it’s not a ten.

Don’t ever, ever, ever say your pain is an 11.  Unless you’re Spinal Tap. Only Hyperbole and a Half is allowed to go past 10. And even HER 10 is “being actively mauled by a bear.”

– Janet Jay

I say that not to be mean, but because I have been through this. Your normal everyday ‘worst pain’ is an 8. At MOST. That’s how you get a doctor to take you seriously. Especially if you have an invisible illness or disability without an obvious cause.”

And don’t ever, ever, ever say it’s an 11. Unless you’re Spinal Tap.

Pain Scale 6-12 from Hyperbole and a Half featuring comedic faces exhibiting exaggerated pain
Only Hyperbole and a Half is allowed to go past 10. And even HER 10 is “being actively mauled by a bear.”

Turns Out Doctors Care About The Pain Scale Numbers, Not The Words

Here’s what drives me up the wall: the doctors who make us do this don’t know or care about the technicalities. A ten is a ten is a ten, I’ve discovered, no matter what the ‘definition’ happens to be. But as a very literal-minded person who uses words for a living, that realization took me faaaaaar too long. 

The original McGill Pain Scale / Index Questionnaire, 1975
The original McGill Pain Scale / Index Questionnaire, 1975

Pain Scales: Choosing The Best Version For You (Sorry, They All Suck)

Some people like to write their own pain scales. There are also a whole bunch of other all-slightly-different scales that focus on one thing or another.  For instance, the McGill Pain Index, created in 1975, asks patients to select from among a list of sensory, affective, and evaluative descriptors for their pain, and assign a number describing their intensity. I’ve filled out this form so many damn times, even in my own medical journey over the last 20+ years (good lord, it’s really been that long hasn’t it).  But it’s still a subjective measurement that’s treated as objective and forced onto a numerical scale that truly doesn’t describe the situation.  

Things I Wish I’d Known About 1-10 Pain Scales

I wish someone had told me at the start that my affect was being judged and noted every time I came in. “Affect” in this case means the visible reaction a person displays toward events (often described by such terms as “constricted,” normal range, appropriate to context,” “flat,” or “shallow”).

A ten is a ten is a ten, I’ve discovered, no matter what the ‘definition’ happens to be. But as a very literal-minded person who uses words for a living, that realization took me faaaaaar too long. 

I wish I’d known that the numbers on the scale matter more than the definitions that go along with them. Even if a poorly-worded definition traps you at a 6, if your pain feels more like 7 out of 10, you should go with 7.   

Pain Scale 1-10 by Famous Artists
So why not use art! I’m feeling a bit Picasso today, how about you?

Describe your pain (seriously, actually describe it)

But honestly it’s better to just get the number over with so you can move on to actual description. And that’s the right word, too: don’t just say your pain is worse. Explain how it’s worse. Elaborate on the effect it has on your job, your relationships, your day-to-day activities. (Then describe the actual pain as best you can: not just “my back hurts” but “it burns, it stabs, it clenches, it aches, it throbs.”)

Don’t just say your pain is bad. Explain how it’s bad. Elaborate on the effect it has on your day-to-day activities. Describe the actual pain as best you can: not just “it hurts” but “it burns, it stabs, it clenches, it aches, it throbs.”

Finding the words to describe your pain… especially when you’re young

My chronic pain started when I was fifteen. Back then, I wish that I had had the words to describe just how different my pain was. How I felt at night was worlds away from what it was at 10 AM when I might have a doctor’s appointment. My affect at 10 AM and my affect at 10 PM are, well, like night and day. But just saying “it gets worse as the day goes on” doesn’t really communicate that. Turns out most pain gets worse as the day goes on! But not to the extent mine did, and it took time to figure out how to get that across.

An Updated Pain Scale using Roadkill by Holly Scott
My new favorite pain scale right here, using roadkill. By Holly Scott, @curseofmen

Pain Scales: An Imperfect, Objective Measurement of a Variable, Subjective Experience

And that’s the crux of it: all these things are trying to objectively classify something that resists that categorization. There are so many types of pain, but even if you only have one (“only”), pain isn’t neat and tidy. So as you answer pain scale questions, keep the bigger picture in mind. Stress out less about the technical wording of the scale you’re using and more about how you’re going to get across the information you need to get across. Think of pain scales as an intro to a conversation that might really be useful to both you and your doctor, rather than as the be-all-end-all.

Or just scream “BEES!!!” and hope they get the joke. 

"Improved pain scale" 1-10 meme: 1. might be an itch 2 just need a bandaid 3 it's kind of annoying 4 this is concerning bu ti can still work 5 bees? 6 BEES! 7 i can't stop crying 8 i can't move it hurts so bad 9 mauled by a bear or ninjas 10 unconscious

What do you do when asked to rate your pain on a scale of 1-10? Are there any pro tips that I completely neglected to mention? Leave me a comment or shout at me on social media and let me know!

Pin this bad boy so you remember where all the sweet sweet 1-10 pain scale memes are! Then check out some other pieces that might interest you below.

on a purple background, text reads "how to use pain scales to explain your pain even though it sucks," with "sucks" in rainbow, one color for each letter
On a torn piece of teal paper held on by tape, text box reads "chronic-pain-weight-getting-through-the-damn-day, janetjaycom"
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4 responses to “Pain Scales (1-10): How To Explain Your Pain”

  1. Tom vVukovich Avatar
    Tom vVukovich

    Amen sister! I have MERSA in my ankle and I rated my pain an 8. I have had 14 surgeries in my life,so I know about pain.I have been disrespect and dismissed by my pain doctor who says the pain didn’t warrant strong pain meds.

    1. Janet Avatar

      I am sorry, that absolutely blows. It’s horrible how we have to fight to have our pain even taken seriously, much less adequately treated!!! I hope you find some relief soon.

  2. Linda Avatar

    I recently suffered a broken vertebrae forbrhe thirst time!
    They asked how did I know it was broken? I explained the stabbing knife through Mt chest and back, said my pain had gone well over 10! Only to be given 1 tablet and told that is strong pain relief. It was like taking paracetamol! Did absolutely nothing.
    When the pain meds kicked in after complaining of how much pain I’m
    In, I managed to get it down to a 5/10.
    And to take regular paracetamol!!
    Finally the emergency department contacted my precious neurosurgeon and said he needed a particular C T scan, and whm it flowed bright pink (although radiographers said there was no break) my surgeon took my work for it and operates to cement the vertebrae. I had 80% relief the day after surgery which tells me it was definitely broken! My surgeon was glad I listened to my body and pushed for immediate surgery.
    Thank goodness for this surgeon who finally listened, and it was all due to a sneeze that broke the thirst vertebrae!
    I say, listen to your body and stick with it.
    From Tasmania, Australia!

  3. ufaland Avatar

    This was beautiful Admin. Thank you for your reflections.

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Hopefully this site will help you avoid some of the BS I’ve experienced over the last 20 years seeking treatment for my chronic pain, invisible illnesses & mental health challenges. Maybe it’ll even help you think about disability in a new way! But at the very least, I hope you learn something, and I hope it helps you feel less alone.

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