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The Pain Scale

I recently introduced my children to the 1987 classic, “The Princess Bride.” While watching I thought about the pain that was inflicted on our hero Wesley. One of the more frequently asked questions at the doctor’s office deal with pain. Describe your pain, rate your pain, what makes it better, what makes the pain worse etc. You have more than likely seen a pain scale like the one seen here.

The Pain Scale

Using the pain Scale

When asked to rate their pain on a scale of 0 to 10, some patients will claim higher than 10. “I have 11/10, or 14/10 pain!” If you have seen the movie “The Princess Bride” you might enjoy this clip from the ‘Pit of Despair’ scene in the movie, which will help me explain the extreme end of the pain scale and hopefully be able to put it to scale, pun intended. Wesley, the hero in the movie, is hooked up to a suction pump torture machine. I know, most people will not be hooked up to such a device, but, I submit to you that this is “the worst possible pain” that you would rate 10/10. But, then, when Prince Humperdinck wants to ensure that Wesley doesn’t return to save Princess Buttercup, he tries to kill him by turning the machine to the maximum setting. This is the maximum of the pain scale.

‘Pit of Despair’


Equivalent to Child Birth

When taught how to interview patients, my instructors frequently mentioned that 10/10 pain is equivocal to child birth. Having seen my wife experience this level of pain five times, I can tell you that when you tell the doctor or medical assistant that you’re currently experiencing 10/10 pain and you’re talking through it like you’re catching up with an old friend, it just doesn’t add up. No strain in your face, no catching of your voice. Other colleagues that I have discussed this with suggest that one should reserve 10/10 pain for those who are about to pass out.

Using the pain scale in the future

For those in pain, I do not mean to belittle your pain in anyway. I have had pain of broken bones and other injuries. Please know that the scale is a way for you to communicate with your provider your level of pain. Looking at the facial expressions of our smiley face scale above, you could almost look in the mirror to see how your pain can be adjusted to be able to fully communicate your pain level.

The Concern

The greater concern that I foresee in the future is the abuse of the higher level of pain, 7-10 on the pain scale. Providers encounter drug seeking patients on a frequent basis. Different injuries will typically be accompanied by similar types of pain. Think of the Emergency department and the broken arms, fingers, ankles, or feet. If you’re really not in that much pain, people can see it in your expression so don’t say 10/10 pain or 11/10 pain. It may be the worst pain you can remember ever having, but if you don’t look like you’re in pain, the images above say you can’t have 9 or 10/10 pain.