Ouch, I am in Pain!

Pain is becoming a new vital sign along with blood pressure, heart rate, respiratory rate and body temperature. Most medical professionals are required to measure and record pain as part of your health history. There are two primary categories for pain: acute pain, defined as pain present less than three to six months, and chronic pain, which persists more than six months.

Amazingly, around 100 million Americans suffer from chronic pain, according to several medical resources. This number is staggering if you do the math. The U.S. census for 2015 reported 321,216,397 citizens; of that number 23 percent are under the age of 18. That means that roughly 1 of every 2.5 adults reports suffering from mild to severe pain that does not go away, is described as shooting, burning, electrical or aching, and is accompanied by feelings of discomfort, soreness, tightness or stiffness.

What’s the biggest difference between the four main vitals and this new fifth one? The first four are physically measurable, while the fifth is completely subjective. Simply put, my experience of pain is different than yours. Genetics, environmental experiences and social influences have directly affected our perception of pain. As a physical therapist, I’m required to have clients describe symptoms. “On a scale from 0 to 10, how bad is your pain? Ten being you need to go to the emergency room.” I’ve asked this question hundreds of times over the past 20 years and am still astounded by the variety of answers. I’ve looked at x-rays of someone’s spine and wondered, “How is this person even walking?” Yet they may tell me they have very little pain, only weakness and instability. On the opposite end of the spectrum is the person who says their pain is “12 on a scale of 10”, yet they are standing and talking to me, not lying on the floor in tears.

In 2016, the Centers for Medicare and Medicaid will be aggressively migrating toward outcome based health care services or “Pay for Performance.” Pain ratings will be documented and tracked then plugged into formulas for reimbursement. You will be inundated with questions and interventions focused around your pain. So whose pain is right? My answer is, your pain is your pain. You have the right to feel the “ouch” in your pain. But I might suggest a few thoughtful parameters:

• Where is the pain located? - This is important for your medical provider to know in order to determine the origin of pain, not the intensity. If you answer, “It hurts everywhere,” we may consider it a system wide problem, such as cancer.

• When is the pain present? - Pain usually changes in intensity, and that is normal. Giving specific responses helps your provider make an accurate diagnosis and choose the best intervention.

• Does the pain interfere with life? - Is your pain restricting your ability to complete normal activities of daily living or doing your normal work? This is very important! Your quality of life directly affects your overall health and wellness.

#health