Summary: It is common practice in pain clinics to ask patients to rate their pain scores from “zero to 10”. However, some experts warn that though these pain scores have importance, their practical value in chronic pain treatment is limited. Patients have different ways of describing pain, and they have varying experiences. Moreover, studies show that pain does not always correlate to disease severity. Similarly, pain location does not essentially help find the cause of pain. For example, many of those reporting chronic low back pain benefit from antidepressants, anti-inflammatory drugs, or painkillers.
Pain specialists need to know about the pain intensity of their patients. Therefore, they often ask their patients to describe their pain on a “zero to 10” scale. However, some health experts warn that it may not be a perfect approach and may even misguide doctors in many instances.
For example, pain intensity reported by patients is not always proportional to the severity of the underlying cause. Even worse, the pain might propagate, and the root cause may lie elsewhere. Of course, researchers are not saying to stop using pain scores. Instead, they are proposing to use these findings cautiously and not to focus too much. Pain score should not be the only justification for choosing a therapeutic approach.
Further, some specialists warn that though such pain classification may be helpful, it is often of limited use. For example, most people have different ways of describing pain. Thus, one may have higher pain tolerance than others. Similarly, patient experiences vary, as someone may not have experienced many painful conditions, while others may have many health issues, traumas, and severe pain episodes. It means that the pain score patient reports have only limited value in deciding treatment choice.
The health experts note that if you have a flat tire, and you go to a mechanic workshop, he or she is unlikely to ask you how loud the noise was when your tire went flat. Since mechanic knows this has little importance, they would focus on resolving the problem.
Of course, the comparison is unfair, as automobile breakdown and human pain are two very different things. Nonetheless, there is a point that pain intensity has limited importance in understanding the cause of pain, and it does not provide much information about the severity of the underlying condition. In fact, doctors might be distracted by such a scoring system, resulting in the wrong diagnosis. Thus, the focus must be on finding the root cause of chronic pain and treating it.
To explain the concept further, consider one of the most popular studies done in 3110 asymptomatic patients aged 20 to 80 years old. In this radiological examination, doctors found that 37% of 20-year-old individuals had disk degeneration, which rose to a whopping 96% in 80-year-old individuals. And, yet, all of them were asymptomatic. This was a radiological study, which showed that radiological findings, like those using MRI, do not essentially correlate to the pain.
Radiologists often quote this study as it raises many questions. For example, if someone comes with back pain, it is assumed that someone has issues with low back or disk degeneration, and the MRI also confirms it. However, many of these patients fail to respond to anti-inflammatory medications and even opioids. Hence, experts warn that if so many asymptomatic people live with disk degeneration, thus MRI findings should not be treated as a confirmation that the cause of low back pain is due to the changes in the intervertebral discs. There might be other causes of low back pain.
Hence, doctors need to remember that the human body is complicated, and the location of pain and even findings of imaging tests must be interpreted cautiously. Even objective and sensitive tests like imaging tests cannot be affirmative of the cause of chronic pain. Instead, many patients report benefits from antidepressants or antianxiety drugs.
Hence, paying too much attention to pain scores and location may misguide doctors. For example, it is not rare for people reporting chronic and difficult-to-treat low back pain to live with depression or anxiety. Similarly, people reporting chronic musculoskeletal pains of other locations and severity often have depression or other chronic ailments.
Hence, experts advise that during chronic pain treatment, doctors must avoid the simplistic approach of classifying the pain from “zero to 10” and then prescribing painkillers. Instead, they must make a greater effort to find the root cause of chronic pain.
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By Gurpreet Singh Padda, MD, MBA, MHP