The Universal Pain Assessment Scale

Universal Pain Assessment Scale
I discovered a new “trigger” this week. Twice this week people around me used the Universal Pain Assessment Scale to describe how they were feeling. “… I’m at an 8 or 9…”

I wasn’t directly involved in the conversations but I could hear them. The first time I had to leave the room to calm down. I didn’t say a word. I can’t. It is not fair for me to say something that would make less of what anyone else is feeling. There is no way to have a conversation like that without judgement. And I know as well as anyone, when you hurt – no matter how much you hurt – the last thing you need is to be judged for it.

Instead, I went to the rest room and sat in a stall until I calmed myself down.
My mind raced. What is wrong with me? I know she does hurt. So what if she says it’s an 8 or 9 right after laughing. She likes to laugh. She probably uses laughter to keep from crying. What is wrong with me? Her saying that doesn’t change anything about the pain I described as an 8 or 9. It hurt. It is over. I even talked myself through how I felt at that moment. Probably a 2, not bad, and certainly not in my way.

After 10 minutes of basically hating myself for thinking crazy things, I went back and tried to put it out of my head. My ultimate conclusion: I HATE the “universal pain assessment scale.” Judging all pain on a scale of one to 10 is about as useful as it would be to rank the pollution level across the globe 1 to 10.

All pain sucks. Almost no one knows what the absolute 10 feels like. How can everyone be expected to gauge pain that way?

I talked with a few residents about this before my surgery. I brought it up to them because I gaged my pain prior to surgery at typically a 7, occasionally spiking to an 8.5 or 9 and I wanted to know what to expect from my care team if I had that amount of pain after surgery. They asked me “What’s your 10” and I explained I know I’ve never felt a 10 because I imagine that to be something like sawing off my own arm to get out of a situation, or being beaten and then shot — something you don’t want to imagine. EVER. But 9 was when moving made me cry, 8 was when I couldn’t talk to my husband while doing something because I had to focus or I would bawl and 7 was bitting my lip and pushing though because I don’t have a choice.

They told me to tell the nurses what my 10 was, and that typically they assume people exaggerate the number. Exaggeration would be common, we can assume, because you’re judging the pain you currently feel against other pain you’ve felt.

Whether my care team understood me didn’t really matter in the hospital because I woke up from surgery with completely different pain. I felt like I had been through something, but it was so different. It only hurt when I moved and only in the muscles that had been clamped during the procedure. I was on regular pain pills for the first three weeks, and occasionally for another two weeks after that. But, post surgery, the challenge was as much about having to depend on other people and getting comfortable with the wheelchair as it was about physical pain.

Now that I’ve had this experience, everything I think about pain is different. I know what it is like for walking to make me cry. That is not a reflection of toughness or weakness, it was me doing what I had to do.

Now I’m getting mental health treatment to deal with the fact it felt like no one who had the power to do something about it cared that I was in serious pain. I finally got that x-ray because I nearly cried to my doctor’s nurse. It was scheduled six weeks out from that phone call, more than six months after my injury.

This experience has changed my life forever. If you are in pain and you feel like you are not being listened to, don’t wait as long as I did to fight back tears on the phone with a nurse. Make them understand you in a way I could not.


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