What is the most physically painful event you've ever experienced?  Childbirth without the pleasure of an epidural?  Kidney stone, perhaps?  Table saw to the hand?  Or have you been lucky enough to experience no worse than a really horrible hangnail?  Or pink eye?  Maybe a splinter?  Whatever your most horrific experience has been, rate it on a scale of 0-10.

Our society has come to expect complete pain relief.  Pain is present for a reason, and that reason is to alert you that something is (or remains) wrong with you.  Actually, it's sometimes dangerous to have total pain relief.  

Pain is subjective.  Two different women of equal size and stature can give birth to equally sized babies without epidurals and have different reactions to their pain.  Two separate equally sized men can have comparable kidney stones and display completely different signs of pain.  Many circumstances change how individuals react to pain.  Things like culture, stress, traumatic childhoods, abuse, neglect, age, fear, and actual injury or illness change how one reacts to pain.  Despite all these varying circumstances, pain is subjective.  It cannot be measured.

You may be asking about the common 0-10 scale from which nurses ask you to rate your pain...to measure it.  Do not confuse actual measurements using tools such as rulers, weight scales, sphygmomanometers, seismographs, or basic counting with your rating of pain on a subjective scale.  Your rating does not equal a measurement simply because it has been given a title of "measurement on a scale."  

There are five vital signs which are measured when you go into a hospital, clinic, urgent care, or other healthcare facility.  They are:

  1. Blood pressure
  2. Heart rate
  3. Respiratory rate
  4. Temperature
  5. Oxygen saturation

These vitals signs are all obtained with tools which do not allow for subjective information.  The tools provide a reading, and professionals then interpret the readings.  

Healthcare facilities have now started making pain (a subjective matter) a sixth vital sign ("sign" indicates objective data).  Controversy surrounds this issue of pain.  As misleading as people's perceptions of pain may be, health professionals are now forced to document whatever a patient states is their pain level, even if the trained professional is witnessing things that may indicate otherwise.  For instance, if a woman says her pink eye is a 10 but flirts with her boyfriend, texts on her phone, laughs and jokes, and seems in no apparent distress, these behaviors are clearly (and objectively) documented.  However, this places healthcare professionals in a precarious position.

We as a society have created a monster, a vast entitled community who have unrealistic expectations.  Hospitals are now openly advertising things such as "pain-free needles," "total pain relief," and "best pain control."  Is it fair for the public to expect these things from healthcare personnel who very well may not be able to live up to these expectations?  These unrealistic expectations have been created partly due to the search for high customer service ratings in order to receive government reimbursement.  

When a nurse asks a patient who presents with pink eye how bad his pain is on a scale of 0-10, some health professionals are starting to add a caveat to this question.  It may sound something like this:  "If you were to rate your pain 0-10, where 0 is absolutely NO pain and 10 is the worst pain you actually experienced in your life, what number would you give this pain you're having right now?"  Instead of simply asking how bad his pain is, he is now being asked to use a point of reference (his worst pain ever actually experienced) and gauge this current pain from that point of reference.  Patients will often change their answers.  Sometimes they do not, so a 10 must be documented for minor health complaints such as pink eye, torn fingernail, acne, or a contact stuck in an eye.  If a doctor or a nurse notices behavior that indicates a patient is not having the worst pain in her life, despite her having reported a 10, they clearly document what behaviors they are witnessing.  

Maybe those problems are actually the worst pain those patients have ever experienced in their lives.  Maybe not.  It's all subjective, and health professionals now have to document this subjective information in a seemingly objective manner of filling in a blank for 'pain level' with the rest of the vital signs.  That comprehensive information is supposed to compose an overall objective picture of that particular patient.

How does this affect me? you might be asking.  Healthcare is a complicated system, and unfortunately it is quite abused.  You might go to an emergency room or clinic someday with a legitimate illness or injury, having significant pain.  Know that many people go to that same emergency room or clinic every day lying about their pain for a multitude of reasons.  Those reasons include addiction, narcotic re-sale, or attention seeking.  The professionals from whom you seek care have to weed their ways through the nonsense to see the legitimate needs.  

So do you control your pain relief?  When you're a patient needing pain medication and treatment, do you really have a say?  Does the documentation by the nurse and doctor make a difference?  Does your behavior make a difference?  Does your injury make a difference?  Do government regulations have a say?  The answer to all of these questions is 'yes.'  

The term 'pain tolerance' is a misnomer.  Maybe the phenomenon of reacting to pain should be called, well, pain reactivity.  Should healthcare professionals be allowed to rate a patient's pain on that 0-10 based on how the patient is objectively reacting to their pain?  Maybe, but then the patient wouldn't own that pain anymore.  He would be stripped of his right to call it his own.  But then what about the patients who are either lying or exaggerating their pain level in order to obtain more drugs or the unreachable goal of total pain relief?  Then it turns into the systemic problem of abusive drugseekers controlling your pain.  How's that fair?  What if you're a stoic person who dislikes showing pain?  You may actually be experiencing your 10 but displaying little evidence of a high pain level.  Now the doctors' and nurses' documentation may indicate you're not displaying signs of high levels of distress.  And then you don't get adequate pain relief.  Is that fair?  

So then whose pain is it?  When it comes down to it, the issue of pain is just a pain in the butt.  There is no simple way to approach it, treat it, report it, document it, or re-assess it.  The government can try to simplify it for us.  Hospitals can try to neatly fit subjective information into an objective box for us.  Abusers will always try to get more out of the system.  This pain of yours is also mine, the government's, the organization's who provides accreditation, the nurse's, the doctor's, and the guy who's in the room next door to you.  

Just remember when you're ill or injured, we all own your pain.  We're all feeling it in our own ways.  We want to fix your pain, but it will take fixing the entire healthcare system to make it all better.  In the meantime, buck up and be happy with your tolerable level of pain.