Getting a patient to use the numerical pain scale should be easy, right? Pick a number from one to ten with one being just a little bothersome and ten being the worst pain you have ever felt or imagined. Seems pretty straighforward to me.
But my patients sometimes look at me as if I've asked them to add the square roots of their children's birth dates and round to the nearest hundredth.
They stare at me and scrunch up their faces as if this is a scary pop quiz and they don't want to get it wrong. After a ten or fifteen seconds of agonizing, I get answers like, "Not quite a four and a half," or, "sort of a six," or, "somewhere between a two and a seven."
We all know about the 10/10 folks who want every prn measure available the second they can have it. But this other group seems really cowed by the complexity of the question. I've seen the same expression on people who have just been told they have to do a dozen algebra story problems. I feel for them. I really do. Sometimes I have even said, "Don't put yourself into a tizzy over this," and reassured them that they aren't being graded. Not even on a curve.
When I offer the pain faces as an alternative, I'm not sure if the face they pick matches their actual medical discomfort or if they are expressing the psychological intimidation they feel about having to choose the exactly appropriate not-so-smiley face.
It's not a big deal. We work it out and they get the meds they need. I'm just periodically amazed/amused at the overwhelming burden picking a pain face or number seems to put on some patients. Makes me wish I could offer them some light sedation before putting them through the ordeal.
