Four Letter Word

It’s inevitable. At every doctor appointment, the question is asked.  I know it’s coming, yet I’m never prepared for it.

Soon after I arrive, the nurse asks “What is your pain level?”

Asking a patient to rate pain seems like a reasonable request, but there are many variables that make the question difficult to answer.

The nurse patiently waits while my mind races with thoughts.

We generalize by describing negative sensations simply as “aches and pains”, but those sensations can be much more complex. What’s the difference between an ache and a pain anyway? says that an ache is “a continuous or prolonged dull pain in a part of one’s body”, and that pain is “physical suffering or discomfort caused by illness or injury; mental suffering or distress.” Notice that the description for ache uses the word pain – if the dictionary uses one to describe the other, are they different or the same thing? Maybe an ache is slow and constant, possibly throbbing; while a pain increases in intensity or can be sharp, shooting, stabbing or steady. Pain can be waxing or waning, it can surge once or be repetitive.

As I try to answer the nurse’s question, I’m sitting motionless in my wheelchair. I quietly assess every body part, none of which is screaming for attention at the moment. Zero to 10 are the options. It’s not zero, but that leaves nine other numbers to choose from. Which number do I select?…the one I feel at the moment?   The one when I’m moving? Or the number when pain is at its worst?

I’ve been shown a universal scale; but how do I place myself on that pain scale when I don’t know if my perception of pain is weaker or stronger than another person’s? Is my tolerance for pain higher, lower, or the same as most of the population?




There are many different scales, created by different organizations. There are even funny ones. Googling “pain scale” is entertaining.

The nurse shares that patients don’t like the scale, but it’s a helpful tool.  I try to pick a number.

Body awareness is a challenge. As much as I can, I treat my pain as an unwanted guest, giving it as little attention as possible, tending to ignore it until it can no longer be ignored. My pain can be lessened by distractions of noise, activity or anything that requires focus.  Pain visits stronger, more boldly, at night when quiet and dark leave more room for it to be noticed. It’s best, when I can, to use whatever is available to help distract myself from it – conversation, TV, computer, music, phone.

In the habit of ignoring pain, I’m suddenly faced with acknowledging and rating it. I need information to give. Specifically, where on my body is it? Is the ache or pain a new sensation or recurring/familiar? Is there an activity or movement that may cause it? Is there a time of day when it is more prevalent? Do I know it’s coming?, or does it take me by surprise? Dull or sharp? Throbbing or stabbing? Have I noticed any patterns or timing?

The nurse smiles as she waits.

Pain is personal and pain can feel private. Most people don’t want to talk about or hear about pain and I often downplay its intensity. I don’t want to be that person who always complains about ailments; and I feel the people I encounter are more comfortable believing that I feel okay, and hearing me focus on the positive. I don’t have to share my pain with everyone, but it’s important to be truthful with medical staff. Out in the world, there can be an unspoken expectation to be strong in the face of adversity, to downplay your pain. But the doctor’s office is not the place to do that. Downplaying my pain there doesn’t help me at all.

I tell the nurse that, from the 1 to 10 scale,  the number “11” must be dead; and since I haven’t died yet, I don’t know what 10 feels like. Joking doesn’t work, she still wants an answer.

I know there is such a thing as good pain -the sensation caused when a wound is healing.  And we all know the phrase “no pain, no gain”, referring to building strength through exercise. But most pain is, well, just a pain to deal with.

I found it helpful when a nurse once watched my face and identified my pain as an 8 when I would have guessed a 4. Perhaps others can rate our pain more accurately than we can rate it ourselves.

Finally, I give the nurse a number. It represented my present non moving self. My facial expression, however, indicates that the thought process to answer the question warranted a strong 6 on the pain scale.

I realize it’s productive to recognize, identify, evaluate, and rate the pain I experience, and be able to describe it…not concentrate on it more than necessary, but be self-aware enough to consider possible causes and solutions. Recognizing that as my goal, I promise myself to rate my pain more correctly….next time.

Pain is a four-letter word. Pain can bring me to say other not-so-nice four-letter words. I don’t like to think about it, but I will take the time and effort to evaluate my pain once-in-awhile; and next time I go to an appointment, I will be more prepared for that inevitable question about the four letter word I’d rather not talk about.

Anyone else have trouble rating pain?


About Climbing Downhill

Wife and mother of grown kids, in my 60's and dealing with MS, making life's moments count and trying to offer something of value to others along the way.
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