Dear 1 to 10 Pain Scale, I Hate You

Let’s talk about the pain scale here for a minute. You know, the chart you see in the ER with the happy and sad faces numbered one to ten so you can better convey the level at which you are suffering. Can we finally call BS on that thing and come up with something better? I mean seriously.

Mad props to whoever came up with this right here, because they are on the right track.

Over the years I have come to hate the pain scale and the fact that doctors ALWAYS ask me to quantify my pain using it. I get it. It’s a tool, but a majorly flawed one considering what a spectrum of pain and tolerance to pain there is. I have seen people in migraine inpatient units describing a level ten and how it impacts their ability to function at work. Umm...yeah. Their ten is not my ten. If it was, then maybe I too would be able to have a job in the traditional sense. But a job requires you to be able to function with a certain degree of reliability and predictability, at least most of the time. 


So how can we communicate pain in a more productive and understandable way? In my house, I do it by levels of functionality. It’s a little thing I came up with in rebellion to the pain scale and so far it works pretty well for us. Basically I have four tiers:


Tier ONE: I am fully functional. I am never fully without pain, but the level of pain I am in is so mild that I can do everything and not be at all impaired by it. These are the best days ever. These are the days I get to be Supermom, slay all the household chores and have FUN with my family. I can do ALL THE THINGS. More of these, please.


Tier TWO: I’m still functioning, but I’m struggling. In this tier, you may not even realize I am in quite a bit of pain, but I am and I’ll seem a bit off. In this tier I worry that people find me unfriendly, quiet, antisocial, distracted, preoccupied. I have less patience for my kids. I wish I could drop everything to lie down and fight this, but I keep going as long as possible and hope I don’t cross the threshold to tier 3.


Tier THREE: I’ve crossed over and can no longer function. I've gone into hiding at this point. I can’t drive anymore so activities are done for the day. I’m scrambling to find a neighbor to watch my kids if possible. I no longer have any choice but to lie down, because remaining upright is no longer possible. If I’m alone with the kids, they have to put on some movies and fend for themselves for snacks. We launch into survival mode until daddy can get home and take over. I can get up if absolutely necessary in short bursts, but it is extremely difficult and takes a huge toll on me. This is the stage where if my kids need dinner I stagger out to sit by the stove with my head on the counter and try to make a Mac and Cheese while vomiting. Things are HARD, but doable with great difficulty if absolutely necessary. Until...


Tier FOUR: Once here, I can no longer function under any circumstance. This is where we REALLY go into hiding. Outside of my immediate family, I can count the friends who have seen this up close on one hand. I am reduced to an animal like creature whose body contorts into horrific twisted shapes while screaming, sweating and vomiting. My husband gets the kids out of the house if he can, so they aren’t scared. I fight as long as possible on my own, knowing that caving in and getting help in the form of a heavy cocktail of drugs in the ER likely means rebound and prolonged agony, even if I get a short break from the worst of the pain. But when my body can take no more and I tell him I can’t live through it any longer, we go. He’ll get a wheelchair and wheel me in with my head in a bowl, screaming. We’ll check in and tell them it’s a migraine and roll the dice. Will it be a sympathetic doctor who has a loved one that gets migraines and says, “Tell me what has helped in the past. Let’s get you some relief right away.” Or will it be one that disdainfully tells me that I need to take deep breaths and calm down because I am making it worse? Believe me, doc, I tried all the calm breathing and the relaxing and the drinking water and the ice pack and the dim lights and the lying down and the medications and nothing could stop the runaway train that took me here to the place where the calm deep breaths are no longer in the realm of possibility because I am basically a THING now that can only pray for death to escape this pain even though I really really really want to live because I have this beautiful family that I love and I want to be here for but my mind is hijacked by being in this much pain for this long and violently vomiting for ten hours straight so this is me FIGHTING TO STAY ALIVE LONG ENOUGH TO GET THROUGH THIS ONE. Tier 4. I am literally pausing right now to say a prayer for all of you that know tier 4 intimately like I do.


So there you go. My four tiers of functionality. When my husband checks in on me throughout the day, he can get a solid idea of how things really are if I say I’ve been hovering at a 2+ for several hours, but I’m worried I’ll cross over soon and can he head home from work before too long? It’s a system that works for us and makes me feel more understood. And let’s be honest. In the world of migraine, even a little understanding goes a long way.