Tuesday, February 24, 2009

The Pain Scale

I went to a chiropractor yesterday to see if he could help with my persistent backache. Yes, it turns out; the doc at Mass Ave Chiropractic is very good at what he does. I'm wishing I would've done this two months ago, instead of waiting to see if it got better on its own. If you're looking for a good chiropractor downtown, I would highly recommend Dr. Keilur.

As all doctors do, he asked me the strange question: on a scale from one to ten, how much does it hurt? This always bothers me, because it's such a relative scale. A few years ago, I had a roto-tiller accident. Not the serious kind -- I hit a drainpipe underground, and the machine kicked sideways and mashed my hand into a wall. I lost a fingernail, and the doc at MedCheck picked debris off of the raw nail bed, then spent thirty seconds scrubbing it with a brush. This was probably the longest half-minute of my life; I wouldn't have thought it was possible for anything to be as urgently painful as this disinterested doctor scrubbing at the raw flesh where my fingernail used to be. I didn't realize until he was done that I was clenching my jaw, and I was clenching so hard that my jaw muscles had cramped. On the one-to-ten scale, this was probably only a nine; I could see it being worse. And, relative to that, I had a third-degree burn that was only a seven. I've had fifty or so stitches in my life, and none of the injuries that caused the wounds was more than a five. So describing back pain as a two or three is accurate, but probably doesn't convey how much my back is bothering me.

I also think there's another factor with back pain that's not covered by the pain scale. I'll call it the Annoyance Factor. Think about allergies and chronic tinnitus (ringing in the ears). Both rank a dead zero on the pain scale; they don't hurt. But they can keep you awake, distract you, and ruin your concentration, and both can seriously interfere with your daily life. They've got a high Annoyance Factor without pain. Back injuries are much the same. It doesn't need to hurt a lot to have a high Annoyance Factor, if it hurts every time you turn your head, or if it keeps you from sleeping, or if you can't reach over your head without wincing and groaning. I once needed twelve stitches on my leg from a machete injury (this is much less cool and macho than it sounds, trust me), but it had a relatively low annoyance factor. I also once needed two stitches on the tip of the thumb on my dominant hand from a frozen pot-pie injury (this one is exactly as stupid as it sounds), and this had a very high annoyance factor; it affected everything from writing to driving to brushing my teeth. There needs to be a separate scale for the Annoyance Factor. Maybe the doctor can add the two together and use the aggregate to determine treatment, instead of relying strictly on a very subjective measurement of physical pain. Then again, just as some people have a high tolerance for pain, I'm sure some people have much more tolerance for lifestyle-altering constant irritation. It's still all subjective.

And, I want to be clear that that this wasn't an issue with Dr. Keilur; I'm not complaining about him at all. His concern was much more with the limitations my back was placing on my activities, than with the arbitrary number on the pain chart. I recommend him highly.

1 comment:

Ted said...

Pot-pie injury? I need to hear this story.