Friday, February 1, 2013

10 out of 10

When a doctor or nurse asks a patient to rate their pain on a scale of 1 to 10, the example usually given for 10 out of 10 pain is "being in labor."

Here's the thing: I was in labor twice and I can't say I ever had 10/10 pain. Maybe 7 out of 10 at worst. I mean, the contractions didn't feel like kittens were licking me or anything, but it wasn't the worst pain I could possibly imagine. The L&D nurse actually yelled at me at one point for being "too stoic" and not telling her I was in pain (?).

And then I got my epidural prior to actually giving birth, so that didn't hurt very much at all.

I know women have all kinds of different experiences, but for me, labor was just not all that painful. My husband looked like he was having way more pain than that when he had kidney stones.

48 comments:

  1. I definitely spoke with a patient recently who said that her kidney stones hurt more than giving birth to her son...

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  2. I have had 3 unmedicated childbirths...no epidurals. My babies were big too: 10.3, 8.7, 8.5 lbs. I have also had a kidney stone and by far it was a 10/10 for pain. I would definitely put labor 7/10 in retrospect. I asked for pain meds for the kidney stone but not childbirth!

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    1. Maybe you just have a very loose vagina.

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    2. You must speak from firsthand knowledge of owning a very loose vagina.

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  3. 10 out of 10 pain is having a C-section with no anesthesia. Well, they did TRY to give it to me, but for some reason that no one could seem to figure out, it didn't work. I can very honestly say now that I know what it feels like to be disemboweled. After they pulled baby out, they had to put me under general anesthesia to put me back together. Apparently they were worried that I would go into shock. @@

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    1. But yes, I have had two vaginal births and in comparison to that C-section, I would rate them 8 out of 10. So yeah, labor is bad, but not as bad as some other things.

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  4. The back labor I had with my first kid was the worst I've had, but I don't know if it was a 10/10. It may have gotten there had I not gotten the epidural. My other two kids never approached 10/10 territory at all, but I'm an epidural girl because the pain I had was more than enough. It seems to me that there could always be another level of pain from whatever is the worst I've experienced so far. Like the time I threw my back out so badly that I couldn't stand was awful, but I'm sure breaking my hip would be worse and getting burned in a fire would be even worse than that.

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  5. I've never given birth, but I've had on average a kidney stone a year since early adolescence (I'm 25. we're not sure why this happens.) They are usually 8s and 9s out of 10.

    Since I'm a vet student, I think about my pain scale in relation to a horse colicking. If the horse's pain is completely refractory to drugs and she is throwing herself on the ground, I would imagine that to be a 10. I hope I never experience it!

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  6. I think epidurals should be available for kidney stones. Worst pain ever - much worse than the kid, but then I got the epidural for him. He still owes me anyway.

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  7. My labor wasn't that bad, but I got an epidural right before I went into transition, so I didn't have the pleasure of experiencing the worst of it. I'm sure it hurts some women a lot more than it hurt me.

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  8. The best part of the pain scale is when you are in the ED yourself waiting to be seen and some person with a migraine with 10/10 pain (who was just chatting with their seatmate in triage) walks up to the desk begging for her pain meds "because she is going to die if she doesn't get her drugs". Labor was painful up until the epidural but not unbearable. To me, 10/10 pain means a gunshot or pain so severe that you are literally lying on the floor unable to cope with it and you should probably be yelling or groaning or something while you're at it. I've had 6 kidney stones and those weren't 10/10 pain either. Maybe 9/10.

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    1. I agree, 10/10 is lying / sitting completely still unable to function OR writhing around unable to function +/- vomiting. Pain so bad that you don't care if you died right then.

      I've actually heard that getting shot isn't SO bad, though it probably depends on where you're shot.

      My friend had horrible back labor. She still talks about how bad it was and how she's so afraid of going through it again that she doesn't know if she wants more kids. I have no doubt that her pain was worse than mine, which is why I totally withhold judgement when people talk about labor being 10/10. I.e. maybe it was for them.

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    2. Very good point, OMDG. Pain is a highly subjective, personal experience.

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    3. I am not trying to say that women in labor don't have horrible 10/10 pain. I'm sure plenty of them do... I guess I was just lucky in that respect (or at least, I wasn't unlucky).

      But it does really piss me off when I see someone just sitting there, completely comfortable, and they say they're in 10/10 pain. Because I undoubtedly looked less comfortable in labor, and I don't think I had 10/10 pain. When my husband was writhing around with his kidney stones, *that* was believable as 10/10 pain.

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  9. This comment has been removed by a blog administrator.

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  10. After two unmediated births and a bout of late-treated shingles, I'd say the former was much worse. I even remember saying at the time, "This is worse than being in labor!"

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  11. I have easy labors, and don't think I ever rated the pain as more than a 4/5. I've never had a kidney stone, so I can't compare that, but I can think of a lot of things that seem like they'd be more painful than labor. I had surgery to repair a tendon in my hand, and woke up in the middle of the night when the pain meds had worn off. While waiting for my mom to get me more (it's hard to open a pill bottle with only one usable hand!) I honestly thought cutting my hand off would hurt less.

    The resident at my most recent labor put 10 as being mauled by a bear.

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  12. I explain that 10 means the worst pain anyone could ever have. If they say ten and are not actively writhing in pain, I say, "ten would be like getting eaten alive by a shark while you're on fire." Reasonable people then usually think for a moment and say 6 or 7. (Unreasonable people say 50.)

    I used to say "ten would be like being run over by a truck." Then I had a patient who came in after being run over by a truck. He rated his pain 7/10 on that scale and so I had to recalibrate.

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    1. Let's just hope the shark tank at the local aquarium doesn't shatter during a fire.

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  13. I always use "actively mauled by a bear while being on fire"- and i agree- you should never be able to SAY 10/10- you should be whimpering or screaming it- it's not like i'm going to withhold pain medications just because it's not a perfect 10!!

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  14. No discussion of the pain scale is complete without hyperbole and a half's chart. Just saying. http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html

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    1. Oh my goodness, you are so right! I love that post. I second updating the pain scale to hyperboleand a half.

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  15. Pain is incredibly subjective. While I agree that people who look calm and relaxed who claim a 10/10 pain are probably full of it, what's very painful to one person may not be to another.

    I thought my first kidney stone was the worst pain I'd ever had in my life until my leg got infected, and my calf swelled up bigger than my thigh. The pain was as if the inside of my leg was on fire, and every touch to it felt like someone was poking at the fire with their marshmallow stick.

    The leg reinfected twice since the original infection and I've had 7 more kidney stones since the first. If I had to choose which one to ever have again, I'll take the kidney stone!

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  16. Moose is correct. Pain is subjective.
    For my two, the pain was 14/10 for the first and 11/10 for #2. And the epi wore off halfway on #2(literally, my left side was in labor my right side, not at all! Then I felt the episotomy(OUCH!!!! but kept quiet because the baby was more important than me)and let the resident know that I could feel the stitches going in and he was a lousy seamstress. Got local stat. WHEW!

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    1. For my two, the pain was 14/10 for the first and 11/10 for #2.

      No, it wasn't.

      The scale only goes up to 10, with 10 meaning the worst pain possible for anyone, in any situation, anywhere in the universe. If you're feeling the most excruciating pain you can even imagine, you are at 10/10. Anything below that is a number less than ten.

      Giving higher numbers is meaningless and silly, and doesn't give any useful information to the people who are trying to help you. It's on the same level as if we ask where you're hurting, and you say "Cleveland."

      If a patient rates their pain at 14/10 in my ER, we explain the scale to them a second time. If they still insist on being contrary, we chart no number, with a note that says they refused to use the pain scale.

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    2. Way to show that patient, Brian. Do you tell them that they can't have any pain medication also because they disobeyed you?

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    3. No, of course not. It's not about "disobeying" or about "showing" the patient, and you know it.

      Of course every patient is given medication appropriate to their condition and their level of distress. But when patients refuse to use the pain scale as explained, that just makes it much more difficult to tell whether their pain is getting any better, and by how much.

      Why would you want to intentionally make it harder for us to help you?

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    4. Given that a # by itself without context is not very meaningful, why not accept 14/10 if the patient insists, and then see what their pain level is after medication? If it's 11/10 after pain meds, then you can see you've made progress...

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    5. If you don't understand what "a number between 1 and 10" means, then you clearly have problems understanding simple numbers and abstraction. That means we can't be sure you understand that higher numbers mean greater discomfort, so a number would be meaningless.

      If you do understand the question but give some other number anyway, then you're obviously disregarding instructions for this question. We can't be sure you will follow instructions later and lower the number as your pain goes away. That means a number would still be meaningless.

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  17. A friend of mine had four unmedicated births. Her first 3 were relatively tolerable but she was writhing and screaming in pain with her last one. It sounds like the same person may experience labor pain differently from one kid to the next.

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  18. I used to say 1-10, where 10 is your arm going down the garbage disposer... Still got a lot of "12"s. A doc dealt with difficult patients by saying 10? Couldn't get ANY worse? What if I jumped on that postop knee? Not nice but funny and effective.

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  19. Couldn't resist the relevant xkcd
    http://xkcd.com/883/

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  20. When I arrived at L&D in active labor and told them my pain was 3/10, they said I can;'t possibly be in labor so. It hurt, a lot, but I figured it was going to get worse so based my number on how much worse I thought it was going to get...

    Had a kidney stone too and I would agree the pain is worse. Not sure it would be objectively worse, but with labor, you know why you are in pain and you know it's going to end. With the kidney stone, I didn't know what it was until several hours into the excrutiating pain.

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  21. When I was in the hospital for acute pancreatitis, I rated my pain 8/10. the nurse said it was too bad I didn't say 10/10 because then she could give me dilaudid for the pain. I changed my rating, not because I am a drug seeker, but because I really, really hurt badly and needed relief.

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  22. When I was in the hospital for acute pancreatitis, I rated my pain 8/10. the nurse said it was too bad I didn't say 10/10 because then she could give me dilaudid for the pain. I changed my rating, not because I am a drug seeker, but because I really, really hurt badly and needed relief.

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  23. When I use the pain scale, I say "with 10 being the worst pain you've had in your entire life". For the 10/10 ratings that are reported, I will describe the patient in my notes. "Writhing, diaphoretic, grimacing" and list their v/s. On the flip side: "Laughing and talking to a visitor and asked for something to eat."
    I had this one patient who was obviously in intense pain and rated his pain 5/10. The man couldn't stay still, all v/s reflected such pain. "Only a 5/10 pain?" I asked. He said he's been in far worse pain, but it still hurts.

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  24. I used to think my unmedicated vaginal delivery was about a 9/10 or 10/10 until recently. Now I'd rank it around a 7/10. My kidney stone was an 8/10, the hemmrhoidectomy was a 9/10, and the doctors examination during an emergency visit to the hospital after complications with the hemmrhoidectomy ended up with me screaming and intertwined with the bed rail before I realized what was going on (which was rather embarrassing after I was given painkillers and could think again). I hope my body's done trying to raise the bar with that damn pain scale, because I don't think I can take it.

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  25. If it wasn't that bad, why'd you get an epidural??

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    1. Because I've seen enough deliveries to know that at the point it gets really bad, it may be too late.

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    2. "Too late" means that it's all over faster than the anesthesiologist can put it in. Would you really risk an invasive procedure for a few minutes of pain relief?

      I'm a labor and delivery nurse, and it seems that most women choose epidurals from fear of pain. I had three children without medication, but like most healthy women it was the most painful experience I had been through and would rate a "10" despite being endurable. Then I had sepsis. My fourth labor would rate, in comparison, about a 4.

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    3. I don't know that much about the timing of epidurals, but I saw several women in labor for over an hour (not to mention pushing time) when it was already "too late" for the epidural. If it were a minute or two, no, I probably wouldn't risk it. For a couple of hours of excruciating pain? Yes, I sure would. (And did.)

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    4. Fizzy is right on this one.

      The CRNAs and anesthesiologists in my hospital will not place an epidural after the mother has gotten to the transition phase. Once she starts pushing, it's difficult to get her into the proper position, and difficult for her to hold still long enough, so they won't risk blowing that stick.

      Transition is usually short, but might last hours, and it is usually reported as quite painful. I know I wouldn't want to be forced to experience pain if I didn't have to.

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    5. That was what I thought and had observed, Brian, but I didn't want to contradict an L&D nurse.

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  27. Multiple dry sockets after wisdom tooth extraction is 7/10 and doesn't respond to painkillers.

    I dented the side of my skull while riding my bike by slamming into a pole without a helmet on: 5/10.

    Neighbor's kid wrestled me to the ground and a stick went in my ear and scraped up my ear canal: 5.5/10 until my mom decided some mix of isopropyl alcohol and hydrogen peroxide was needed to disinfect it 8.5/10 dropped to the floor screaming and was taken to the hospital. I was twelve.

    Seperated shoulder 5/10.

    Migraine 6-8/10.

    Menstrual cramps 5-8.5/10. I've never been pregnant and have endometriosis. I'd take the epidural without question.

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  28. Yes, pain is very subjective, and the pain scale is relevant only to the person experiencing the pain. I have had numerous events that were pain-producing: Lumbar and cervical disc herniations, two spinal surgeries, GYN surgeries with post-op complications, small bowel obstruction, and I am now recovering from a total knee replacement.

    Why don't nurses amd doctors just ask the patient to describe what "10" is on their pain scale? That way, you both have the same point of reference. It makes no difference what the nurse or doctor thinks a "10" should be; it is entirely up to the patient to define and describe it. Really, how can we "imagine the worst pain, ever" especially if someone is using "being eaten by a shark while on fire" as a reference point? Who can imagine that?

    The thing is, 10/10 pain absorbs all of your senses. You cannot effectively communicate. You don't care what is on TV, or even whether there is a TV in the room. You cannot think about eating. You are probably gripping something or someone, just to stay in reality. I think this is what medical people are thinking when we use the number 10. On the other hand, the patient is afraid that s/he won't get appropriate medical attention unless they say that their pain is a "10," so the whole scale thing has become useless.

    I have to admit a certain bias against patients who insist that their pain is >10, despite an explanation of how and why the scale is used. Their insistance on a higher score always makes me a little frustrated and more than a little suspicious.

    As a post-script, I always used the post-op pain from my lumbar fusion (with hemorrhage into the donor site) as my "10" until I had a small bowel obstruction. I have had 3 episodes of SBO and it is this pain that is still my "10" reference. (Similar to the horse as described by the student vet, above.)

    My final comment (that will seem to contradict the rest of my post) is that chronic pain is an animal of a different stripe than acute pain. The tenacity and relentlessness of chronic pain exhausts a person to the point where an actual "4" escalates to a "10" simply because one cannot stand it any more.

    Tricia

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  29. Yes, I had two unmedicated births. I felt sort of bad when I was asked to quantify my pain, because for me it wasn't really pain-more like uncomfortable. The nurses face! All I can say is, maybe more people should try hypnosis for birth, because it worked great!!

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