Pains in my Fifth Point of Contact

Pain Scales Are Tools of The Devil!

“Pain level of 15/10”

For those who did not know, sometime in the eighties, The Powers That Be ([T]PTB), in their unlimited wisdom, determined that Pain Was Undertreated!, and, of course, Something Must Be Done! This, as is usual in these initiatives,  meant that the untermenschen must be thrown beneath the proverbial bus, and, not surprisingly, we were.

We Peons were instructed that “Pain is the fifth vital sign”, and that “Pain must be adequately treated!” And so, “Pain Scales” were inflicted upon us. (I leave as an exercise for the student, what the connection between the foregoing and the present PANDEMIC! ZOMG! Of DEATH! BY! OPOIDS! Happens to be.) (Of course, it is the EVIL! Drug companies, and EVIL! Physicians who are at fault. Therefore, let the Benevolent PTB ride to our collective rescue with The Answer, right?)

So, TINS©, there I was, in the emergency department at this time in my life, Nursing away, FDASL©. I was in triage one shift, and, of course, interviewing and vital signing and pain assessing the teeming millions seeking cures (and work notes) (and narcotic scripts).

Pain assessment involves asking the patient how severe his/her pain is, with zero being no pain at all, and 10 being “the worst pain in the world”. Folks are asked to scale their pain against this imaginary yardstick. Mostly, people try to be fairly straightforward, and generally rate their, say, sprained ankle, at the time of assessment as something like a “4/10”. or maybe a “7/10”. Then, there are those creative souls who try to game the system. This is my shocked face.

One night, one soul arrived, reporting back pain, or some other malarkey. Strolling into the triage room, said soul sat, and I cataloged allergies, medications, medical history, pulse, blood pressure, respiratory rate, temperature. I asked about pain, with my usual spiel.

Sir/Madam, if zero is no pain, and 10 is the worst pain in the entire world, what is your pain level at right now?”

This person, appearing for all the world to completely nondistressed, looked me steadily in the eye, and replied “15”.

I blinked. “So, if zero is no pain whatsoever, and 10 is the worst pain ever, your pain is 15 on that scale?”

My correspondent paused to take a handful of chips from the bag on his/her lap, chewed thoughtfully for a moment, and responded, “Yep.”

Again, I blinked. “And, 10, T-E-N, is the worst pain in the entire world, right?”


And, your pain is 15, F-I-F-T-E-E-N, correct?”

Again, with the chips. “Yep.”

So, you’re telling me that your pain is one-and-a-half times as severe, as the worst pain ever, anywhere, in the whole world, right?”


So, that would make your (chip eating, non screaming, non writhing, non weeping, non wringing-wet-sweating) pain, the worst pain in the world, am I hearing you correctly?”

Rumination, in both senses of the word. “Yep.”

So, if ’10’ is the worst pain in the world, and you, right now, have the worst pain in the world, and your pain is ’15’ out of ’10’, then you’re telling me that your pain, right now, is half again as severe, as the pain that you are having right now, am I hearing you right?”

More cud chewing. “Yep”.

What could I say? “I’ll make certain that the doctor learns all of this. Please have a seat in the waiting room, we’ll call you as soon as we can.”




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