Pain by numbers – how to measure pain

• Pain management programs should measure pain continuously.
• Patients are the experts on their pain and pain is subjective.

Continuing on the topic of how we talk about pain, think back to the last time you talked to a health care provider about your pain.

Perhaps you had a list of questions you planned to ask. Maybe you wanted to describe how your pain has changed. Or you may have wanted to tell them that—after doing everything you’ve been asked to do—you are still struggling with pain. But you don’t get the opportunity to say any of these things because the visit focuses on a single question: “How much pain do you have, on a scale of 0-10?”

Let’s step back for a moment and reflect on how absurd this question is. Imagine if we were to ask you…

How good does pain relief feel, on a scale of 0-10?

On a scale of 0-10, how delicious is this dark chocolate mousse cake?

How strong is your existential angst about the pandemic, on a scale of 0-10?

You get the point. A single number suggests that all your pain can be wrapped into a single idea, or a single word, or a single moment in time. We all know this isn’t true. So how should you measure pain?

Pain management and the difficulty of finding a pain measure

Why do health care providers rely on number scales in the first place? The reason is that it’s difficult for one person to understand another person’s internal experience of pain. There is no way to perfectly communicate how your pain feels in your body at that moment. Nor to put your personal history, your expectations, and your hope for relief in simple words that are easy to understand. More importantly, pain numbers are used to track your pain relief! If you are given the choice between a treatment that reduces your pain by 3 points versus a treatment that reduces your pain by 5 points, numbers can help you make practical decisions. But ultimately every way we have of expressing pain will have strengths and weaknesses.

Over the years, pain researchers have experimented with many different ways to measure pain. They have compared the intensity of pain with how unpleasant it feels. They have tried to measure pain with facial expressions, pain behaviors, even how much someone works to avoid pain! Understanding how pain changes is important for pain management.

A different approach

One of our heroes, Ronald Melzack, took a different approach. Melzack is affectionately called the “Father of Pain Research.” The title isn’t as sadistic as it sounds! Ronny devoted his life to understanding the physical and psychological experience of chronic pain. He worked in one of the first multidisciplinary pain centers in the world. Ronny noticed that when chronic pain patients described their pain to him, they used a variety of colorful words. When he reviewed all of these pain descriptors, he was surprised to find that they fell into word “families.” For example, chronic pain patients described heat-related pain as “warm,” “hot,” or “burning.” Other patients described pressure-related pain as “sore,” “tender,” or “aching.”

Ronny also noticed that people with different kinds of pain tended to use certain groups of words to describe their pain. For example, about 50% of people with chronic back pain use words like “aching,” “tiring,” “tender,” or “punishing” to describe their pain! This doesn’t mean that everyone with back pain experiences the similar pain. But it does mean that there may be some biological connection between certain types of pain and what the experience of that pain feels like. Many international research groups have replicated Melzack’s findings over the years.

The missing piece to measure pain

Like Ronny Melzack, Aivo has looked to patients to understand what pain is, rather than defining what pain is for a patient. We look at your pain from every possible angle. We combine numbers, pain descriptors, rating scales, how pain makes you feel, and even what pain prevents you from doing. Because these are all ways of describing how pain affects your lived experience.

This approach has led us to realize that how your pain changes over time is the missing piece of measuring pain.

After working with hundreds of back pain patients, we learned that back pain can change all the time.  For example, back pain can steadily climb throughout the day. Or you may wake up with pain that reduces once you start moving. These conversations helped us realize that we need to understand how your pain changes over a day, over a week, even over a month.

Your ups, your downs, your windows of relief.

Putting the missing piece into pain management program practice

This is the basis of why Aivo uses continuous monitoring. Our health coaches and data scientists—real human beings—actually look at your data every single day. We relieve you of the responsibility of having to decipher your pain so you can live your life. That frees up your time to experiment with different kinds of coping, stress reduction, and fine-tuning strategies that work best for you. We won’t leave you guessing what to do next. Your Aivo Health Coach is there to guide you step by step. Learn more about our approach here.

We don’t give up. And neither should you.