Summary: Pain clinics often ask patients to rate their pain scores from “zero to 10”. But some experts warn that these pain scores, though useful, do little to guide chronic pain treatment. Patients describe pain in different ways, and their life experience varies. Studies also show that pain does not always match how serious the disease is. And where it hurts does not always point to the cause. For example, many people with chronic low back pain are helped by antidepressants, anti-inflammatory drugs or painkillers.
Pain doctors need to know how bad their patients’ pain is. So they often ask patients to rate their pain on a “zero to 10” scale. But some health experts warn that this approach may not be perfect. In many cases it may even mislead doctors. For example, the pain a patient reports does not always match how serious the cause is. Worse, pain can spread, so the root cause may lie somewhere else. Researchers are not saying to stop using pain scores. They are saying to use them with care and not lean on them too much. A pain score should never be the only reason for choosing a treatment.
Some doctors also warn that this kind of pain rating, though helpful, often does little. For one, people describe pain in different ways. One person may handle pain better than another. And life experience varies. One person may have had few painful problems. Another may have had many health problems, injuries and bouts of severe pain. So the pain score a patient reports does little to decide which treatment to choose. Experts put it this way. If you take a flat tire to a mechanic, they won’t ask how loud it was when the tire blew. The mechanic knows that does not matter, so they focus on fixing the problem.
Of course, the comparison is not fair. A broken-down car and human pain are very different things. Still, the point stands. How bad the pain feels tells you little about its cause. It also says little about how serious the underlying problem is. In fact, a scoring system might distract doctors and lead to the wrong diagnosis. So the focus must be on finding and treating the root cause of chronic pain. Here is a well-known example. A study looked at 3110 people aged 20 to 80 years old who had no symptoms. On their scans, doctors found that 37% of 20-year-olds had disk wear (degeneration). That rose to a whopping 96% in 80-year-olds. Yet none of them had symptoms. This imaging study showed that scan findings, like those on an MRI, do not always match the pain.
Radiologists often cite this study because it raises many questions. For example, when someone comes in with back pain, doctors assume a low back or disk problem, and the MRI seems to confirm it. But many of these patients get no help from anti-inflammatory drugs or even opioids. So experts warn: if so many people without symptoms have disk wear, an MRI cannot prove that disk changes are the cause of a patient’s low back pain. There may be other causes.
So doctors must remember that the human body is complex. Where pain sits, and even what imaging tests show, must be read with care. Even exact, sensitive tests like imaging cannot prove what causes chronic pain. In fact, many patients report relief from antidepressants or anti-anxiety drugs. So focusing too much on pain scores and pain location may mislead doctors. For example, people with chronic, hard-to-treat low back pain often live with depression or anxiety. And people with long-lasting muscle and joint pain in other places often have depression or other chronic illnesses.
So experts advise that when treating chronic pain, doctors must avoid the simple habit of rating pain from “zero to 10” and then handing out painkillers. Instead, they must work harder to find the root cause of chronic pain.
Where can I get chronic pain treatment in St. Louis?
Padda Institute of Pain Management in the St. Louis area treats chronic pain and related conditions, including pancreatitis pain management, migraine headache treatment and diabetic neuropathy treatments. As a well-known complex regional pain syndrome specialist, Padda Institute offers treatment matched to your needs.
Frequently asked questions
Why do doctors ask you to rate your pain from 0 to 10?
Pain specialists need a sense of how intense your pain is, and a zero-to-10 rating is a quick way to get it. The number has a place, but its practical value in chronic pain treatment is limited. It should never be the only reason for choosing a treatment. The real job is finding the root cause of the pain and treating that.
Is the 0-10 pain scale accurate?
Only as a rough guide. People describe pain in different ways. Some handle pain better than others. And someone who has lived through many injuries and painful illnesses will rate the same pain differently from someone who has not. That is why a pain score alone says little about which treatment will work.
Does a high pain score mean something serious is wrong?
Not always. The pain a patient reports does not always match how serious the cause is. Pain can also spread, so the place that hurts may not be where the problem starts. A high number is a reason to look hard for the cause. It is not a measure of how much damage there is.
Can an MRI show what is causing my back pain?
Not reliably. A study looked at 3,110 people aged 20 to 80 who had no symptoms at all. On imaging, 37% of 20-year-olds and 96% of 80-year-olds already had disk wear. So disk changes on an MRI do not prove they cause your low back pain. Other causes have to be checked.
Why do antidepressants help some people with chronic back pain?
Because chronic pain and mood are often tangled together. People with chronic, hard-to-treat low back pain often live with depression or anxiety. Many report relief from antidepressants or anti-anxiety drugs. It is one more sign that where the pain sits, and even what the imaging shows, does not tell the whole story about its cause.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
