Pain scales and other subjective issues with reporting pain
So I hate pain scales. When you’re hurt and in a decent amount of pain and want a doctor to take you seriously, you’re naturally going to rate your pain highly on a scale of 1 to 10. But the reality is that a 10 should be akin to natural childbirth or that the pain is so great that you’re going to pass out. In my not so humble opinion, if you’re going to say you’re at an 8 on a 1-10 pain scale, a bone needs to be sticking out of your skin or you are on fire. I like this pain scale from Hyperbole and a Half (by Allie Brosh) if you haven’t read her blog or her books, you’re missing out.
At any rate, you get the gist. If a health care provider asks you to rate your pain, ask them to set the high and low number values for you. Pain is subjective at its core because we all experience it differently. Some people have bulging discs with little to no nerve pain, others have significant nerve pain and other neurological issues which gets me to objective findings coupled with subjective reports of pain.
Many doctors (mostly back doctors) are going to want to see objective findings that correlate to your subjective reports of pain and they can get those objective findings a number of ways during a physical exam or scan. A common method of testing for exaggeration of faking is the use of Waddell’s signs.
These signs include:
Positive Waddell’s sign for tenderness- if there is deep tenderness over a wide area, that is a positive sign.
Stimulation – downward pressure on the head causes low back pain is a positive sign. The examiner holding the shoulders and hips in the same plane and rotating patient, resulting in pain is a positive sign.
Distraction – straight leg raise causes pain when formally tested, but straightening the leg with the hip flex 90 degrees to check Babinski sign does not cause pain, is a positive sign.
Regional – if there is weakness in multiple muscles not enervated by the same root sensation, such as a “glove and stocking” loss of sensation, this is a positive sign.
Overreaction – if there is an excessive show of emotion, this is a positive sign.
Test to detect false paresis (weakness or loss of voluntary movement) is the “arm drop” test. The examiner holds the paretic hand above the patient’s face and drops it, if that hand misses the patient’s face on the way down, the paresis is non-organic.
Bottom line, don’t malinger or try to seem like you’re worse than you actually are. You’ll get caught because doctors are good detectives when assessing their patients and then you’ll alienate your doctor.