The subjective nature of pain is tough for patients because it means that their pain is often dismissed. The patient cannot point to a test result proving that the severity of the pain that they claim is "real". One chronic pain patient I met told me that she was regularly "punished" for her extraordinary coping efforts because the more effectively she coped, the less she appeared to be in pain, the less concern, attention, and patience she received from others around her who interpreted her coping as an indication that she was in less pain. This really is a terrible problem for people with chronic pain and can add to their suffering considerably.
The subjective nature of pain is tough for clinicians because it is difficult to determine the efficacy of their treatments. First, two individuals may rate their pain as 7 on a 0 to 10 scale, but that doesn't mean they their pain experience is equal. This may be because of differences in past experience; that is ratings are relative to each individual's extreme experiences. Patient A may be in excruciating pain that patient B would rate as a 9 or 10, but because Patient A has experienced even worse pain, to her, the pain is perceived at about 7 out of 10. Second, there may be differences in patient motivations. Some individuals may use opportunities to rate their pain as a means of expressing their suffering. They might really feel more like a 5 or 6 but boost it a notch as a means of communicating that they're feeling a great deal of hurt.
There exist several subjective pain scales. The most popular are...
Numeric Rating Scale
Visual Analog Scale
Category Intensity Scale
Faces Scale
Wong et al (1995)
Wong-Baker FACES Pain Rating Scale. Note: From Wong, D.: Whaley and Wong's Nursing Care of Infants and Children, ed 5, 1995, p. 1085. Copyrighted by Mosby-Year Book, Inc.
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