Pain Tolerance and the 1 – 10 Scale

Last night I watched a friend of mine break a stack of bricks with his bare hand. As a trained martial artist he’s no stranger toadam board break┬ábreaking things with his body. In fact, he’s been putting his hands and feet through wood, ice and concrete since he was a kid. You don’t just show up one day and decide to┬ábreak a stack of bricks. It takes practice. It takes skill. And it takes something else.

If you check out the photo here you’ll see my buddy seven bricks into an eight brick stack.. That’s about the moment that he also broke his hand.

You might think that breaking a hand on a stack of bricks would cause someone to groan in pain or cradle their hand gingerly. Not this guy. He broke another brick with the same hand just a few short moments after this photo was taken. And thirty minutes later he shook my hand with his broken hand. (Not a flinch.) I didn’t even know his hand was broken until he let me examine it. (My request, not his.)

And that brings me to my point. We frequently gauge peoples pain on our 1-10 scale. When asking the pain scale question, we also need to keep in mind the patients own personal pain tolerance. The 1-10 scale is subjective. It also doesn’t take into account the patient’s personal tolerance for pain.

Not everyone feels pain the same. I’ve broken my hand before. I didn’t walk around letting people squeeze it after the fact. A career football or rugby player probably won’t rate pain the same way an accountant or lawyer might. A military veteran or farmer might not have the same “seven” as an auto parts salesman. And the elderly (especially elderly women) seem to be the toughest of all.

You can’t always predict who be hyper-sensitive to pain and who will have a blunted sense of pain. One way to gauge a patients pain tolerance is to tell them that the ten on the 1-10 pain scaleadam ice break would be the worst pain they have ever felt. After the patient ranks their pain ask them specifically what injury or illness caused them the worst pain ever. …In other words, what do they consider a ten? Allowing the patient to compare their current pain to a previous painful event can help you gauge their personal pain tolerance.

It’s also worth adding that, regardless of our own opinion of the patients pain tolerance or personal “toughness” we need to accept that their pain is real to them and treat them accordingly.