WhiteCoat

Describing The Pain Scale

A post at GirlVet’s blog made me crack up about the pain scale that the Medical Marijuana Advocates make us document on all our patients. I know that the pain scale is one of Nurse K’s pet peeves, too.

When we describe the pain scale, we try to give example to illustrate what a “10” on a 1-10 scale is. Some people just don’t seem to know what 10 out of 10 pain really means. How do we get the point across?

I have heard the following descriptions:

“The most unimaginable, indescribable pain you could ever have in your life.”
“Someone lit your body on fire and put it out with a track shoe.”
“Someone ripped both your arms and legs off.”
“You got run over with a steamroller.”

The one I use is that 10 out of 10 pain is pain that is bad enough that you are “on the ground wailing and pounding your fists on the floor because the pain is so bad.” This gives me an objective way to follow up the subjective ratings of “10.”

“So using my description, how bad is your pain from 1-10?”
The patient, sitting on the bed munching Doritos and watching TV, says “Oh, it’s definitely a 10.”
I reply, “That’s funny, because you’re still sitting on the bed, you’re not pounding your fists on the floor, and you’re not wailing. In fact, you appear to be rather comfortable.”
The usual response?

“Oh, then it’s a nine and a half.”

Yeah, right. Even Paris Hilton can act better than that.

So how does everyone else describe 10 out of 10 pain? I’d like some fresh ideas.


UPDATE FEBRUARY 27, 2008

First, thanks to everyone who responded to this post. All of your experiences have helped me (and hopefully others) put things into a little better perspective.
One of the things I have noted is how variable people’s perception of 10 out of 10 pain really is. Kind of like having a bunch of different rulers. On one ruler an inch equals 2 centimeters, on another an inch equals 5 centimeters, and on a third an inch equals 16 centimeters. How can we have an accurate measurement of pain if we don’t have a standard way to measure it? We can use “gall bladder attack” or “kidney stone” as baselines, but people who have never had those problems would have nothing to compare their pain to. Similarly, guys have no idea what “labor pain” feels like. Right now everyone is walking around with different “rulers.”
Second, it is interesting to me how many people commented on how useless this “fifth vital sign” really is. People in true pain under-report their pain and those with the “worst pain in their lives” go about their daily activities as if nothing is wrong while waiting for their magical pain shot.
All that this extra administrative burden of “pain scale” reporting has done is to make health care personnel look at patients complaining of severe pain with a questioning eye and to make patients afraid of accurately rating their pain because they are afraid of being labeled as drug seekers.
So these “standards” that health care personnel are required to use aren’t really “standards” at all. In practice, they seem to be harming patient care more than they help.
Isn’t there something fundamentally wrong with this picture?
Are you listening, Joint Commission?

85 Responses to “Describing The Pain Scale”

  1. EA says:

    Does it help if the patient compares it to a previous experience (gallstone attack, say, or childbirth w/o anesthesia)? Or does that not really work since everyone’s response is different?

  2. TK says:

    Well, I usually tell women that have had children it is like giving birth with no anesthesia.

    I tell young men it is like someone pulling your penis off. I bet this one would evoke a few grimaces.

    I tell other people it is like having acid poured into your eyes.

  3. GeorgeH says:

    Lets also look at the other end of the pain scale. No one over 40 ever feels better than a 3 without major medication. If they think they do, they have simply forgotten what it is to be pain free.

  4. Steve says:

    GeorgeH…that sounds very ageist…(is that a word?). Yet, I have to agree with you. What with gimpy knees from milking too many cows, a tweaked back from lifting too many hay bales (and too many fat accident victims) and joint pain from everyday life…….
    I would say my background pain is a constant 3…..even with NSAIDS. MAJOR meds are out of the question…got to be alert when answer those call lights!

    Steve

  5. C. says:

    I’d say a gall bladder attack is an 8 and the surgery after when the nursing assistant puts the bed all the way down so I couldn’t breath from the pain was a 9.75. If I experience pain worse I better be dead.

  6. Finn says:

    I first encountered the scale when I was discussing post-op pain meds with my surgeon prior to a TAH & BSO a few years ago. The version they were using at that hospital described 10 as “The worst pain you’ve ever felt.” I told my surgeon I had been smacked by a truck while riding my bike when I was 19, and that was 10 on my scale. I wasn’t wailing because I didn’t want to scare the little kids around me and I wasn’t pounding the sidewalk because it would only have added more pain, but I was definitely on the ground writhing and not quite managing not to grunt and gasp.

    I’ve also been in the ED and heard the patient on the other side of the curtain, who had just been chatting with her husband before sending him out to get her a snack, describe her pain as 8–the same number I would have used if the resident had asked me to rate my agonizing chest pain instead of describing it, which I did by likening it to having one of the fanged horrors from the movie Alientrying to claw its way out of my chest.

    I think two things tend to make patients rank their pain very highly. One is fear; not knowing what’s causing the pain (or fearing that it’s something fatal) tends to magnify it. The other is fear that if they rate their pain 7 or lower, they’ll be fobbed off with a couple of Advil.

    Unfortunately it becomes a cat and mouse game sometimes. Patients rate their pain higher and higher even with few symptoms and eventually everyone gets treated as if they are crying wolf. Like the meteorologist who calls for a rainstorm every day for a month. Eventually people won’t pay attention to his predictions and will just look outside to try to determine the forecast on their own.

  7. A. says:

    WhiteCoat – I have been enjoying your blog for over a week now. How would any of you who read this characterize a pain that is a 7 one night , a 4 the next and back to a 6 on the third ? Several days, also no pain. Time to see someone or just forget about it ?

    I don’t think you’re going to get a definitive answer from a blog – especially without a thorough description. I will relay to you one quote that stuck in my head from one of my professors in medical school, though: “Bad things don’t get better.”
    Not that everything that doesn’t get better is necessarily bad, but the chronic symptoms may need to be evaluated more thoroughly. Better safe than sorry.

  8. CinderRN says:

    I think people who are eating or chatting and say they are a 9 or 10 have not ever experienced real pain. Since I fell and broke my back and was in such excruciating pain I looked at the heavens and said to myself “So this is how I’m going to die”,I have never rated anything over a 5-6 including post op choley.

  9. R says:

    Breakthrough trigeminal neuralgia pain(all three branches). (my anti-seizure meds had failed) This includes half of your tongue that you want to rip out of your head, teeth that are no longer there,the inside of your nose, facial bones, hair follicles & more. I compared it to my experience with pancreatitis being a walk in the park 3. My experience with childbirth would be ranked a 2. Gall bladder attack? Please…a 1

    I was sitting calmly although wanting to kill myself. The zaps were coming so frequently that the pain seemed continous. It had been going on for 5 days. The reason I was calming myself was because to give in to the pain would have made it unmanageable, then I WOULD have been out of control and I think the pain would have been even worse. I have never cried during this, only when doctors have not believed me or when I am hungry and afraid to eat after a few days.

    I got through up to that point by doing heavy gardening (pulling bushes, digging and stuff)
    They didn’t believe me until they took my blood pressure: 225/195.
    I recieved fentanyl, twice. I was never even dizzy;and it got rid of the pain. I was sent home with a prescription for a low dose of percocet,it helped until the flare-up went away, five days later.

    I think burning to death would probably be worse or being ripped apart,limb by limb.

    literature says narcotics do not help this type of pain, obviously whoever wrote this has never had it. The pain is so bad that narcotics don’t even make me drowsy. I imagine when narcotics fail to help, it is time for MVD surgery. I’m 40, I hope I die before I have to have that

  10. SeaSpray says:

    WhiteCoat – If the criteria for a 10 out of 10 is that one has to be on the ground wailing and pounding their fists on the floor then a stuck kidney stone has to be a 9.99 because I could only lie on the stretcher holding myself while writhing in pain and whimpering slightly or vomiting. Horrendous labor is a little under the kidney stone although I ended up with a c-section…but had the continual back labor that never let up with hideous contractions for hours and hours. Kidney stone still worse! The pain indescribable…even with morphine and Dilaudid. Hitting something would take too much energy for someone who is trying to self protect.

    C’mon. You have to give us ED folk a little credit. I think that most of us wouldn’t bother even asking for a pain scale in someone who had the symptoms you presented with. You’d be off to la-la land as soon as we got an IV in place.
    I think the post was more intended to deal with the people sitting in the bed eating chips or texting away on their cell phones who look annoyed when you interrupt them to ask how bad their pain is. In these circumstances, the pain scale has become an inside joke for most medical providers.

  11. R says:

    Oh, sorry for the long post; but wanted to add that I am a female paramedic.
    Once we dropped off a man who complained of severe chest pain from a “possible collapsed lung from a broken rib maybe the x-ray missed” caused by a MVA two weeks prior.
    After we had finished up our paperwork and were leaving, we saw him walking outside in his gown (at a fairly good pace)with a lit cigarette, towards the smoking area.
    Just another fun day.

    Let me guess … his pain was 10 out of 10. Right?

  12. SeaSpray says:

    P.S. Not only is kidney stone pain indescribable even with the drugs -the pain comes right through but I felt like I was being turned inside out too.

    Also…interesting what George and Steve say about background pain for people over 40. If it wasn’t for the darn knee pain (thank you torn meniscus)I would be pain free. Or it just trumps anything else I might feel. :)

    BTW – I never realized how squirrelly you docs and nurses get when someone tells you their pain is a 15 out of 10 or a 25 out of 10 (saw that in a pt blog)until I started reading the med blogs. Then I understood why my urodoc winced just a fraction of a second (I picked up on that instantly)when in describing a bad post-op experience that he rescued me from that I was a 12 out of 10.

    Speaking as a patient…we are only exaggerating for emphasis. If there is a next time for me I think I am going to say 39 out of 10…just for a little fun. ;)

  13. whitecap nurse says:

    I think it is hopeless to get fools to use the pain scale appropriately. Kids get it immediately – and are usually very honest in their answers. I have found that a good follow-up question for people in chronic pain is “on a good day, how bad is your pain?” Many, many people are living at 7-8 in their minds. It is unrealistic for us to aim for 0/10 pain in these cases. I call it success when they get to the level they have “on a good day.” I also don’t know any providers that treat the pain scale instead of the patient. People who say 10 when objectively they look like a 2 are way more likely to just get ibuprofen in my ER than people who say 2 but have real pathology.

    This is a very good point. I never thought of obtaining a “baseline” pain scale similar to a baseline peak flow in asthmatic patients. Might not work with everyone, but an excellent way to help standardize some of the responses. Thanks for sharing.

  14. GruntDoc says:

    I have a colleague who describes 10/10 as “Imagine someone removing your eye with a grapefruit spoon”.

    I just use “hit by a train”, but it’s not quite the same.

  15. Anne says:

    “Your entire body is covered in paper cuts and you are sitting in a kiddie pool of lemon juice.”

  16. cj says:

    Heh – this is a funny thread. It is so individual, too.

    We have alot of farmers and ranchers, so I say, “A 10 is like being drug by a running horse”. (of course, just a guess. But it has got to be bad, right?) I definitely think that natural childbirth is a good comparison for 10/10 pain, but there seems to be fewer and fewer folks that have that as a reference point.

  17. Rev Don says:

    I’m a patient with a lumbar level cord injury. Finally reasoning this out in my own life dealing with doctors for the last 18 years — My 10 is when I pass out. With that in mind, my DPL is around 6, but with medical marijuana instead of the narcotics, it goes as low as approx. 3.5

  18. DocBot says:

    I like comparing it to how horrifying it would be if you visualised it. “Like you’re melting from the inside out” and the like. Although, admittedly, I’ve never met/caught a drug seeker (I’m a 5th year med student).

  19. Patrick says:

    Well, for women of childbearing age, I’ll offer them the “childbirth without any meds” as their worst rating. For all males, it’s definitely “ever been kicked in the nuts?”

  20. crankyprof says:

    “Take an umbrella, see? Sharpen the pointy end. Then, dip the whole thing in sulfuric acid, jam it up your ass, and open it. Then, remove it, reapply the acid, jam it up your nose. After a snort of wasabi and a cayenne enema, you’ll have 10 out of 10 pain.”

    Sorry, wouldn’t work. By the time I finished this description, I would be laughing too hard to listen to the response.
    P.S. Do I owe you another box of chocolates now?

  21. Suzanne says:

    I haven’t been asked often to rate pain, but I think back to the days when I had pleurisy as being a 10/10 if I use the “most pain” I’ve ever been in as a criterion. Otherwise, contractions after childbirth on pain medication still rate pretty high!

  22. T says:

    The pain scale is a little ridiculous. How can anyone expect an objective rating? If someone’s depressed and they go to a psychiatrist, does the psychiatrist say “rate your depression on a scale from 1-10″? I’m sure everyone would say 10 there too. You (as in doctors) would be better off giving your own rating based on observable criteria (screaming, writhing around, etc) or the patient’s descriptions of how their pain has restricted normal activities.

    This is what I try to do in my charts – give an objective opinion of how the patient is acting in response to their pain.

    My worst pain ever was the thawing of frostbite, which did in fact meet Whitecoat’s 10/10 criteria. I have never heard anyone else mention frostbite as one of these notoriously painful conditions though (like kidney stones.) Probably because it isn’t common.

    You’re right about the frostbite – most people who have never experienced it would stare at you with the “deer in the headlights” look.

  23. Piotr says:

    “1 being no pain at all, and 10 is being married to Hillary Clinton.”

    Bill is either remarkably stoic or he’s got Fentanyl patches all over his body, then.

  24. MM says:

    This is so subjective…
    An 18 old old whose worse pain memory is when he fell off his bicycle when he was 8, will then rate everything from there: “If 9 or 10 was when I fell off my bicycle, then etc.-”
    An 80 year old who has a lot more life experience will come up with a different answer.

    To this day, I still can’t answer the question.

  25. Carol says:

    pain so bad you can’t breathe, can’t talk and it hurts to open your eyes.

  26. SeaSpray says:

    Then again…you could have a stoic person who doesn’t accept pain even though they are feeling it big time and even if they accept they have the pain…will never let on to you. My husbands family is like that.

    An aunt has been battling cancer since 9/06-breast cancer that had spread to her neck and groin. They were finally able do the mastectomy the following April. She went home the same day.

    I think that is just plain wrong! She must’ve still been feeling the effects of the anesthesia and I am guessing the surgeon injected her incision with pain med. She was given a prescription of Percocet.

    If this woman takes 1 Tylenol it’s a big deal. Just the way they are. Her sister (my m-i-l) mentioned to me that she thought she was in pain. So I asked aunt if she was taking Percocet and she said no. I then said I thought she should because that will help the pain and then her body can get the rest it needs instead of fighting the pain and that her body would heal faster. I honestly have no idea if that was the right thing to say but it seemed logical and I thought it was wrong to be in that kind of pain unnecessarily.

    So…I know med staff sometimes questions pts need for pain meds based on over exaggeration, but does staff question the stoic pt who won’t own up to pain but perhaps should for better facilitation of healing?

    • Artrvlrn says:

      Yes, the med staff that I work with, will question the stoic pt, and suggest that they take something for the pain so that they can be comfortable.

  27. Robin says:

    I find the pain scale interesting. Partly because I was talking to my mum when she needed some help a couple of months ago when her neck / shoulder had gone into spasm. Basically, if she calls and says “can you come and keep me company” I know she’s in considerable pain And when I spoke to her about it, she said in the night it was a 10 – which I don’t think I’ve ever heard her say before. (She has psoriatic / osteoarthritis in most joints, a prolapsed disc, subluxing ribs, migraines – basically pain has just become part of her life).

    So then I started thinking about the scale, and wondering how I would catagorise pain, because to me, depending on where the pain is, changes its effect on me. A headache, neck pain, or gut pain – I can’t do anything but whimper, even if it’s only a 3 or 4. Back pain I can get on with up to about 5 or 6. Pain in my limbs doesn’t become a huge issue until about 6 or 7. Gallbladder pain sounds like my idea of hell.

    Is this a common experience? That the location of the pain changes how people can deal with it?

  28. BlackSails says:

    Although I realize it would be completely unworkable and impractical to constantly be doing in an ED, couldnt you use some sort of EEG measurement as an objective measure of pain?

  29. Cindy says:

    When I get the 10 out of 10 response, I sometimes reply, “So, it couldn’t possibly hurt any worse even if I set you on fire?”. Of course, the drug seekers will say “no, it wouldn’t”, and most days it’s just not worth my time to reason with people about the pain scale. I just chart their response and something objective like “pt eating chips, drinking soda, and talking on their cell phone while describing their 10/10 pain.” Personally I think the pain scale is a huge waste of time-if someone is truly in pain, my assessment skills are adequate to determine that.

  30. Meg says:

    I would say that if the patient is making voluntary noises they are not at a 10. At ten people start losing control of bodily functions. After my husband was wounded in Iraq, he was in the hospital for several weeks. One holiday weekend the narcotics vault was locked and his medication was delayed. Later he rated the pain at an 8 – he was lying silently on the bed, muscles clenched, eyes closed with tears running out the side. When people come in and say they are at a 10 sometimes I want to scream at them that they have never really felt real pain.

  31. whitecap nurse says:

    Dear SeaSpray,
    Yes, we’re all over those stoic patients. My mother is one of those. When she couldn’t get out of a chair due to back injury, her pain was a 4; after 6hr. abd surgery, her pain was a 2 (on a PCA, but still). I usually tell the nurses to take her number and double it.

  32. anon says:

    Since I’m not a healthcare professional, I can only speak from the patient side of the encounter, but I hate the pain scale. I really do. First of all, without knowing what I’m comparing it to (ambulance going over speedbumps in a parking lot when I had several subluxed joints after a collision with another figure skater — definitely hurt more than med-free induced-labor childbirth) how can my answer be meaningful? Second, the magnitude of the pain doesn’t necessarily matter compared with how bothersome it is. Mouth/teeth pain is a good example of this, at least for me. A much much loewr absolute pain level drives me nuts, compared with other body parts. It’s not that it _hurts_ more, it’s just that for some reason the pain is difficult to ignore. And then when I’m actually a patient, it seems like if I am being asked this question, it is going to determine if I get treated for pain or not (or treated at all, if the problem is one that isn’t obvious, like muscle pain). So I fear that if I say that the annoyingly painful neck spasms that got me to wake my husband for a trip to urgentcare at 4am is a 3 and a half, will they just send me home? Or will I be able to get some cyclobenzaprine so I can maybe get some sleep? So far I haven’t had a problem with answering honestly, but I’m always afraid when I do, and I’d much prefer to give a more descriptive answer in terms of how it is interfering with my life. Thankfully I’ve only had a few times in which I needed to answer the question. I did once have a nurse say, how would you rate your pain? 10 out of 10? And I just sorta gaped at her, and thought she probably didn’t know what she was doing, since how could I sit there calmly talking to her if I was in that much pain? But now I think she was just jaded and expecting exaggeration.

    Since no one seems to find the out-of-10 pain scale useful, what would it take to get rid of it?

  33. Steve says:

    Getting your arm cut off with a rusty hacksaw then blow torching the stump to cauterize.

  34. Ramses II says:

    I’m not a doctor, but it really isn’t the number that matters, is it? It’s how the person answers the question. If they put down the coke, mute the TV, smile, and say, ‘Gosh, it’s got to be a 10,’ then you can safely move on. If you have to repeat the question before they’ll look up from where they’re grinding their face into the pillow to grunt out, ‘5,’ it’s probably a good idea to get them something.

    It’s human nature to exaggerate when you want something, and to understate when you need something. Most of the people I’ve seen in real pain felt exposed, uncertain, and out of control, so they spoke about their pain in minimizing terms to try to take back control.

    My 2 cents.

  35. MS says:

    I’m a hospital chaplain at a level-II trauma center in the Pacific Northwest. My feeling is that the pain scale is about a patient’s self-assessment of his or her pain. There’s no way for pain to be objective–it’s always going to be subjective. One persons 9 will be another persons 5, especially people who live with chronic pain who never expect to be pain free. Like it or not, the person who’s sitting up chatting who reports a pain level of 10 is a 10.

  36. Nurse K says:

    Mine are “Ten is getting run over by a Volkswagen and them being dragged 50 feet through a field of cacti” or “someone stabbing through your belly with a dull icepick” or “a professional bodybuilder bashing you upside the skull (knee, shoulder, foot) with a hammer as hard as they can”…

    The pain scale is 99.99% useless in the ER.

    I had a friend get punched in her belly so hard her vertebrae perforated her colon. She described being in so much pain that she was almost disoriented, had to be carried in, and it hurt a lot, but was almost an “out of body experience”—hurt so much she had to ‘check out’ for awhile. If they don’t look like Ally, they’re not a 10/10.

  37. Ladyk73 says:

    Hmmmm…..I have had three very painful things that may have been up there as a 10. Except they only lasted for a few moments. Once I moved something on me that was broken. Two distinct moments when I was getting an IUD, and once when I had a body peircing in a sensitive area (I will not ever ever do that again!).

    Those 10’s only lasted a moment of time. And my body reflectively acted. Breathing stopped, reflective movement, a vocal reflective grunt or moan, and the feelings of passing out.
    I could deal with these, cause they were small moments.

    The pain scale does not account for time variable. Perhaps a minute of childbirth is not as painful as a minute of the pain of an unsplinted broken bone (just work with me here) But the childbirth pain goes on for HOURS!!!!

    Seriously for patient descriptions:
    a 9-10 would be a patient having trouble breathing and trying not to move.
    an 8-9 would be a person in movement trying to “run away” from the pain. I would imagine someone pacing, rocking, rubbing another body part for another sensory stimulus. Crying, moaning.
    7-8 would be constant pain, and makes concentration on other topics difficult
    6-7 Would be constant pain
    5-6 Would be like a bad headache
    4-5 Would be the immediate pain of a bruise or cut
    3-4 Cronic Pain
    3-below a boo boo
    ?????

  38. Jersey says:

    I know someone who recently went to the hospital and said she doesn’t use the 10-scale to describe her pain. Every time the nurse tried to tell her it was to get a better perspective of the pain, the friend threw a hissy-fit.

  39. diggher says:

    Personally, I’ve never rated anything above a 6 in the doctor’s office, which has generated surprised looks in the past. I have a pretty good imagination when trying to come up with a 10 as the worst pain imaginable, but since all of my pain has been addressable so it seemed more bearable (kind of I only have to last this much longer mentality). The worst pain you’ve ever felt doesn’t work so well for me either, because I have little to no memory of pain. I know it hurt, but not how much. I play contact sports and tend not to notice problems or pain until the adrenaline subsides a bit.

    However, I would say that approaching 10/10 pain (probably this would be around 9) would be when the idea pops into your head that immediate removal of whatever is hurting with whatever tools are in reach might actually be better than your current state. But again, as many have said, it’s all subjective and some people just seem to be better at handling pain than others.

  40. teresa says:

    Whitecap Nurse suggests, “Yes, we’re all over those stoic patients.” No, I’m sorry, not all of you are. I broke my leg. Snapped it completely in two and momentarily, my shin was not on the line drawn from my knee to my ankle. I found myself on the ground, screaming uncontrollably. I normally can get control of something like that through sheer force of will, but was unable to do so for several minutes. I do not normally scream about anything, so this came as something of a surprise.

    By the time EMS reached me, I was no longer screaming, just repeating over and over, “Don’t touch my leg; don’t touch my leg.”

    I did not receive any pain meds in the ambulance, and none in the ED until the X-rays were taken hours later, and then I didn’t get nearly enough. Why? Because I was waiting, as calmly as I could, for them to get to my needs. Later I was told that I looked too calm to be in much pain.

    And it seemed that there was some doubt as to whether my leg was actually broken; I had self-diagnosed, which also makes medical people nuts. They kept asking me why I thought that; I could barely bring myself to talk about what had happened.

    So no, you are NOT all over those patients.

    As for the original question, why don’t you ask all patients, whether they are complaining of pain or not, where they are on the pain scale? Right now, on a scale of 1 to 10, I’m a 1. I would say “0” but if I learned anything from this thread, going off the scale causes you medical people to become sarcastic. ;) If you asked all patients the question, perhaps you’d get a better feel for the responses of those truly in pain.

  41. GuitarGirlRN says:

    Teresa: Going off the scale immediately makes me think the patient is FOS. And I’ve HAD 25/10 pain before.

    I (and most nursing references) consider pain to be whatever the patient says it is. I always say, “On a scale of zero to ten, where zero is no pain and ten is the worst pain you can imagine, how bad is this pain now?” Note I say worst pain YOU can IMAGINE.

    Then I compare what they’re telling me with what I’m seeing in their vital signs and the way they’re acting, holding themselves, walking, etc. If you’re sitting comfortably, leaning back in the chair, and with warm, dry skin and normal vital signs, looking at me and saying, “Oh, man, this has got to be about a ten. I’m really hurting here!” while smiling and shoving corn chips in your cakehole, you are NOT in pain.

  42. Celeste says:

    9 is so bad you are not talking, not moving, and only breathing as much as you have to.

    10 is when you don’t even care if you die because being in pain like this is not living.

  43. Frederica says:

    for me: 10 is when I want to just faint and disappear. or when I lose control of my breath of so much pain

    for my patients with hemophilia, when they are in pain in their bleeding joints, they describe it: 10 is when they feel like knives penetrating a open wound or when it´s like a constant beating

  44. jen_m says:

    I broke my arm when I was hit by a car as a pedestrian, and it wasn’t a 10/10, because I could sure imagine worse pain. (I put it at 6 or 7 without meds and guarding, 2 after medication if I held absolutely still, and 4 with meds and some guarding.) I still don’t quite understand why anyone bothered with trying to make an objective and quantitative scale out of something so subjective, though – it was a self-splinting break of the humoral neck, it couldn’t be cast and my pain was probably going to be pretty similar to the next guy’s pain with this injury. If it got worse despite meds, that would be worrisome, but that’s something that can be asked without the phony objectivity, right? And there’s no way to try to measure whether my broken arm hurts more than her punctured lung or his barfing migraine – pain is unique to the person having it.

    What I think is interesting is that of course the pain medicine didn’t actually make the pain go away – it mostly made me not care as much I was in pain, and forced me to relax so I didn’t make the part of the pain that arose from muscle injury worse in the long term by the (unconscious) short-term strategy of guarding. Ultimately, though, the cause of most of my pain was the bone and soft-tissue injuries, which would heal only with time. Pain medication reduces some of the neurohormonal messages of alarm, but mostly it knocked me out so the time passed more quickly.

  45. jen_m says:

    Whoops, “humoral” should read “humeral,” of course.

  46. AnnaM says:

    I had to keep a pain log for a few months and my doctor just laughed at me for the pain scale I wrote in the front.
    I think her highlight was that 6 was a full on migraine and 10 just said “unconscious”. If I’m awake and not screaming, it can’t be 10.

    On the other hand, twice I have been in the ER in intense pain that was not being treated because I tend to grit my teeth and leak tears rather than scream and complain. I have to say I sometimes envy the people with no shame. They always seem to get their pain treated first. It seems that the lesson is that stoicism is just a stupid plan in hospitals.

  47. Donna says:

    I’ve had a broken collarbone, tibial plateau fx, 2 c sections, gallbladder attacks, kidney stones, broken neck, and a fallopian tube that ruptured and then caused my appendix to go bad too.
    When the pain is to the point that you don’t want to leave a scalpel in the room with me because I will try to get it out myself? That’s a 10. The fallopian tube rupture actually felt better when it went, the pain eased off for a little bit, but was the worst. The neck is giving me ongoing 2 or 3 out of 10 everyday, but then like the other guy said, after forty, you are always at 2 or 3.

  48. Steph says:

    I posted my detailed thoughts on a pain scale, but I think patients have an equal obligation to communicate what a given number means to them to their doctor. Additionally, I think acute and chronic pain are two very different animals – I would willingly go through the back labor without drugs every month if I could reduce my chronic pain a few notches, even though the peak periods were more immediately painful than my day-to-day pain. They need to be handled in different ways, and that’s also something that requires the patient to be proactive in ensuring the doctor has the correct understanding.

  49. Chrys says:

    I’d say, when you can barely squeak out the answer t-e-n.

  50. Penny says:

    I’m one of those stoic patients and had to go to the ER with a gallbladder attack and what turned out to be inflamed pancreas and liver, to boot. They didn’t even ask for a pain scale number, I guess they could just tell by my posture, face, and breathing? I dunno, but they had me in a room and on IV pain meds in no time.

    Becuase I read medical blogs I was half afraid they were going to think I was a drug seeker!

  51. Yvonne ED RN says:

    I do write down exactly what my patient tells me their pain is then I also summarize my assessment of their presentation(reading a book, out to smoke, laughing with visitors etc)to give clarification if the scale does not reflect what I see.The pain scale is only helpful (sometimes) in documenting pre and post intervention pain because as we are told “Pain is subjective” anyways. My father is one of those who have incongruent reactions to pain. He starts out stoic then laughs maniacly and rocks his body as if to soothe himself.
    If I get little Suzie or Bubba Twit in a stretcher nonchalantly snapping their gum and texting me reporting 13/10 pain I have told them I will knock them back to 3 because the scale only goes to ten so I start over again at the bottom.Childbirth sans analgesia was nothing compared to 3 rd degree burns over 20% BSA.I still get nauseated remembering that pain.

  52. Elizabeth says:

    I thought that my 10 was breaking my L5 two weeks after having my second son. I was wrong. *My* 10 was the day they took away my Demerol pump after my emergent C-section with my youngest. The DeathMarch to the bathroom where I was curled up like a shrimp and clinging to my IV pole while whimpering like a big baby is now my new pain benchmark. It felt like Wolverine was clawing his way out of my uterus.

    However, I thought that a 10 could be compared to snapping your thighbone. Or kidney stones. Isn’t that supposed to be one of the most painful things a person can feel?

  53. Reader 37 says:

    When I was 14, I was bitten by a Black Widow spider. About 4 hours later, I had what felt like a full-body charley horse that lasted well into the night. Screaming and flailing fists around was not an option.

    I was assured by the docs that the bite would not kill me, and there came a point at which I was genuinely pissed off by that fact.

    There’s probably worse pain out there, but I do not have any desire to imagine it, let alone experience it. 20 years later I still fear having that experience again.

  54. JPower says:

    10 In my mind I have not experienced this as of yet. Maybe its me just trying to stay positive and not ever quite get there I dunno.

    9 Bone infection post brain surgery

    8 Complications from getting shot in shoulder

    7 Appendix bursting

    6 The worst of my migraines (stroke like symptoms, severe vomiting, etc…)

    You get the idea. But if I need emergency pain relief chances are you the doc will have to make the call or rate my pain since 7-9 I was not able to really comminicate and on the rare occasion I was in the ER for migraine (twice) I was rushed for tests due to stroke like symptoms and my history of two brain surgeries.

    So, I don’t know the answer here. Maybe it should be strictly in the medical professional’s hands to determine pain level as long as it is understood that everyone shows pain a little differntly.

    J

  55. Rachel says:

    Hmm, I’m thinking that if I have to numerically describe my pain, I’m going to explain, “I hobbled around with a broken kneecap for weeks because some yahoo missed it on the x-ray. This is better/worse than that.” Would that be sufficient? :)

  56. efbq says:

    Um… I gave birth without pain medication, and then I did it again. It was the most intense pain I’ve ever had, but I’m not sure it was the worst (there’s that adreneline thing, which makes it very hard to judge). I have a friend who had a gall bladder attack very shortly before she went into labor, and there’s no doubt at all in her mind that the gall bladder was much worse. Actually, the only people I’ve heard describing natural childbirth as ‘the worst pain imaginable’ are men, usually talking to women who haven’t had children.

    On the other hand, I have migraines which are utterly and completely disabling, but I don’t perceive them as pain precisely. Sure, my head is melting from one side and ballooning out the front, but it doesn’t hurt as much as you’d think (unless there’s something untoward happening, such as sound or light or movement…)

  57. EdDunkle says:

    Pain so bad you can barely speak? That’s how I was during a pancreatitis bout (I always spell that wrong.) I was breathing very heavily because that seemed to help and was doubled over in pain and could barely talk. I kept thinking about running into traffic to kill myself if the pain didn’t go away. But because I had been in the ER the month before (and had received morphine), or because they were busy, they just ignored me for about an hour and the pain went away. By the time the doc finally got to me I was feeling pretty good.

  58. Diora says:

    9,10 – haven’t had yet
    7-8 – experiencing dental work in the Soviet Union in the 70s with old belt-driven drills, and nothing to numb the pain: they had shortage of novocaine so it was only available for extractions; maybe also in some paid clinics but those weren’t the ones the schools took all kids in every year. Add to it a dentist who shouts at you because you have saliva dropping into the tooth as if you have control over it (they hadn’t had suction pumps). I was so afraid of dentists that I walked for weeks with pain at 18 – hid it from everyone – rather than go to one. Knew it was stupid, knew I had to go to a dentist, but just couldn’t bring myself to do it until the pain got bad enough that dentist didn’t seem that scary by comparison. Ended up needing a root canal which was done pretty badly – a US dentist had to change it a couple of years later; the only tooth I ended up loosing many years later.

    I think the pain during tonsillectomy/adenoidectomy at 12 with only insufficient local anesthesia was pretty bad too, maybe 7 or 8. Maybe 7, with 8 once you add a fear factor of a 12 year old strapped to a chair.

    7 – post periodontal surgery pain, on the day of surgery, even after a vicodyn pill.

    5,6 – as above really bad headache, very painful periods

    3,4 – cut; falling and scratching my knees, bruise, not-so-painful periods, bee sting

    3 – what my cat causes if I really annoy her

  59. Isn’t the whole point that it’s a personal 1-10 scale? I thought the question is along the lines of “compared to the worst pain you’ve ever had, how would you rate this pain?”. Such a question is only useful if you then ascertain what the worst pain ever experienced was.

    It’s better than some arbitrary “10 is like acid in your eye” measure. Relieving pain is about relieving *that patient’s* pain, not all pain meeting some “scientific” threshold.

    I’m an ex-rugby player, the guy in the next bed is a golfer. Even if we have pseudo-scientifically the exact same pain, I bet we have different scales of pain. Even if we have some provable way to define that we’re both experiencing the exact same pain, maybe only one of us needs it medicated. That’s why you ask a patient compared to *their* experience, no?

  60. endochick says:

    I was once told a doc my pain was 10 of 10 and she goes “really, are you sure?” I replied with “well, seeing as I gave birth twice without drugs and survived without complaining yet here I am, on your table, praying for the largest needle filled with pain medicine to be shoved into my butt cheeck, I would say it’s a 10!” Needless to say, this doctor now believes me no matter what number I tell her.

  61. [...] by Rachel on March 14, 2008 I’ve read several blog posts about pain and labor pain recently, especially concerning individual differences and tolerance, and the like. [...]

  62. Kushka Harker says:

    It is impossible to rate pain 1-10. I have been going to the same pain clinic for 10 years and every visit being asked to rate my pain from 1- 10. And not just my pain now, but the maximum I felt in the last month and the least has been. It so frustrating for me. The first time I visited I said the worst my pain had been in the last month was a 7. Now 10 years later my condition has deteriorated greatly and I am in much more pain then I was then, but I still rate my worst pain as a 7. Because now, as then, l know that my pain level though very bad, could be a lot worst, and don’t feel I have the right to compare myself to someone with something like burns over 90% of there body. And I notice that everyone who has post to this thread has had a great time thinking up what a 10 is, but it much harder, to decide if t a very bad pain is a 6 or a 7. And how about avoidable pain? Like my pain is much greater if I try to stand for any length of time, and after about 10 minuets standing my pain is so bad it is impossible for me to remain upright. But, then on a month when I am feeling better overall, and thus I pushed myself to the point I stood for many minuets many times and reach that height of acute pain, would it be right to report my pain as worst then on a month when I was feeling so much pain generally that I never tried to stand at all?

    And everything is subjective. I had natural childbirth 30 years ago, and my pain was a lot less then my pain after standing for a few minuets is now, but then, I believe I had a very easy birth compared to some, but I can not know if that is true or not, because I can not experience anyone pain but my own. Pain is just to variable to be qualified, no matter objectified. The greatest pain I ever had was when I lost my husband, and I was completely physically healthy at the time. Pain has so many different flavors, taste and colors that trying to objectify it is impossible and I hate and resent being asked to do so. So all you doctors consider this, all those patients who tell you their pain is a 10 are just giving your absurd question the absurd answer it deserves.

  63. Diana says:

    The worst pain I’ve ever had–a 9 in my ranking–was from being stung by a stingray; the spine was under the toenail AND the toxin was moving up my leg. Nonetheless, I was coherent–when it wasn’t throbbing. When it was throbbing, I just moaned.

    Childbirth–the seven-minute contraction just before they gave me the epidural–was an 8. Childbirth is hopeful AND there are lots of people around encouraging you; that keeps down the pain.

    The surgery to remove my chondrosarcoma (and subsequent bone graft and plate) last June never got much above a 5 because the hospital did an excellent job with pain management. But there were still some moments when a sharp pain took my breath away. However, it took a small dose of oxycodone (2.5 mg) three or four times a day for THREE months to keep my pain level where I wanted it (around a 2 or lower), so that I could do the PT exercises, sleep soundly, etc.

    On the same scale, my knee pain was a chronic 1-2-or-3 for about six months before I saw a doctor about it. His question was: “Does it wake you up at night? That’s a 4. Does it keep you from falling asleep at all? That’s a 5 or 6. Does it make you think being knocked unconscious would be preferable? That’s an 8 or more.”

  64. K says:

    I have fibromyalgia, and because of that everyone has always underestimated my pain tolerance. For some reaso fibro translates to the medical community as wimp. Its not uncommon for me to experiance 10 out of 10 pain, but I often say that it is less than what it is because I’ve learned to tolerate it. I mean when i first started getting the attacks and migranes I would be on the floor under a desk slamming my head into the wall trying to get relief or go unconcious. When you hurt like that you want to die. I guess that’s why whenever I ask, 1 to 10, if I get a 10 i ask “do you want to be alive, or concious right now?” and if its a yes than that is more like an 8. THe problem is pain is so so subjective! I wish we could have a little monitor to hook up to the brain to count pain signals or something.

  65. Jennifer says:

    I’m 28.

    Gallstones were a 7. Kidney stone was an 8.5 at it’s absolute, writhing on-the-floor-and-vomiting worst. And even with both of those, I managed for months before knowing what they were (I assumed I had heartburn and a pulled muscle, respectively).

    I dread that 10.

  66. Lilianna says:

    Here’s a thought for ya. I know some 24, 25, 26 year old friends who are strippers (yes, my grown up daughter has an assortment of friends like a box of chocolates) by profession. These girls read the medical blogs faithfully in order to learn how to act at the E.R. to get pain meds.

    But those of us in chronic pain also read the blogs, feel all the sarcasm and then just start crying if we have to go to the ER. We know what is coming and frankly, I have never met a ER nurse who didn’t think I was drug-seeking. Of course, I try to explain but you don’t listen. You hear me but you are not listening. I might as well be Charlie Brown’s teacher.

    Well, how about telling you that I’ve had 58 shots in my vagina and anus. Does that tell you how much pain I’ve had to endure? How about I’ve lost 60 lbs because I can’t eat when I’m in pain. Or how about I lost my job because my boss couldn’t tolerate my weekly doctor appointments as we tried to stop the pain. Or how about I’ve been misdiagnosed three times when I complained of pain and ended up in the hospital with dire consequences because some doctor and/or nurse thought I was fos. (And no, I’ve never sued anyone). Or how’s this — I had the curve in the road in the mountains all picked out that I could make it look like an accident. Think that’s melodramatic? Pain is drama. Our lives are drama we didn’t ask for.

    That’s the whole problem in a nutshell. We get treated like the pain is all our fault. Yes, my body asked me if I wanted to give up my middle class life and become a bane on society and I wholehardly gave my body the thumbs up!

    If I told you all the above lines about my life, would you still want me to rate my pain or could you just trust me when I say, I normally take oxycodone every 4 hours but the pain has broken through and can I have a shot of dilaudid until I can get to my doctor in the morning. Oh we aren’t supposed to do that are we? I saw that on the DEA’s list of warning signs that someone maybe drug-seeking. Asking for a drug by name. Are you kidding? I know more about pain killers, visceral pain, the limbic system, corticol reorganization, nocebo effects, the Silver Spring monkeys, pain signals, central pain, having a cingulotomy, etc., etc. than most interns do.

    Chronic pain patients research. We are looking for a diagnosis, something that will give us hope that we will get our life without pain back. And then there comes the day when we have to accept it may never go away and we have to relearn how to live with pain always lurking in the background.

    And then I land in your emergency room with pain at levels I can no longer describe because every adjective I use brings on that look and the attitude. Then you ask me the dreaded question, what’s the number of your pain? I’m a chronic pain patient. You tell me what number will satisfy you…will make you not give me that look…will stop you from whispering at the nurses station but most of all, stop making me feel more isolated than I already feel. The pain scale. I just shake my head at the very though of it.

  67. Lilianna says:

    P.S., my website is http://journeytohope-lilianna.blogspot.com/. How about you doctors and nurses read the pain patients’ blogs. Think how interesting it will be to read what all those silly drug-seeking women in pain are thinking. You might learn something or maybe not.

  68. sarah says:

    It seems bizarre to ask for a pain rating when pain is clearly not the issue. I showed up with an asthma attack at the ER recently. It took me an eternity to figure out what the guy was asking and why and how it related to me. I was too busy trying to breathe. I think I rated it a 2, because it didn’t seem to make sense to be that distressed and not be in pain, but I really wasn’t focused on pain just then. It hurt a bit later on, once I was breathing properly again.

    It *is* very bizarre to ask for pain ratings on all patients, but that is what we are required to do by the payers. Things like this are what happens when people with little clinical experience dictate how medicine should be practiced.

  69. DP says:

    It *is* very bizarre to ask for pain ratings on all patients, but that is what we are required to do by the payers.

    So that’s what that’s all about. My doctor has me fill out a form each visit, and it has a question about pain. I always put none/zero (I forget how it it worded). I just figured it was a question thrown in there because probably a lot of patients see the doctor because of pain. But now that I think about it, the question does seem to ask about pain “related to the reason for your visit today.”

  70. Rhiannon says:

    I had a GI bleed that left me writhing and moaning incoherently on the floor while losing control of various bodily functions. I classify that as a 9.

    Personally, I’d give that one a 10. Hands down. Maybe even an 11.

  71. BP says:

    being sliced down with red hot cheese-graters is the worst pain I can imagine.

  72. Betty says:

    I have never used a 10 for myself, (2 torn discs in neck, awaiting surgery with a CSF leak). Without meds I have been in such pain I want to tear everything apart, feel intense anger, used as a release. Like a wild animal. When I control my reaction, which I prefer, I am treated with doubt. I always thought of a 10 as having your head sliced of with a butcher knife… and then a doctor described a 10 as something that would make you scream… quite a difference. Been there, done that. Meds makes it a 5 shortly after taking, then a 7 before the next dose. Trying to stop the meds…. howl. I think it would be different according to the number of nerves in the area under assault.

  73. glen says:

    Seriously for patient descriptions:
    a 9-10 would be a patient having trouble breathing and trying not to move.
    an 8-9 would be a person in movement trying to “run away” from the pain. I would imagine someone pacing, rocking, rubbing another body part for another sensory stimulus. Crying, moaning.
    7-8 would be constant pain, and makes concentration on other topics difficult
    6-7 Would be constant pain
    5-6 Would be like a bad headache
    4-5 Would be the immediate pain of a bruise or cut
    3-4 Cronic Pain
    3-below a boo boo

    I’d disagree to an extent. In my opinion chronic pain would or should be more than a 3-4, but it is the coping strategies that change the perspective. Chronic pain is a difficult thing to live with and people adapt amazing strategies for coping with chronic pain. Those coping strategies are different for pain that might have a propensity for being temporary.

    I’m a psychologist and have found myself fascinated by this debate (even though it is totally NOT my area of expertise) and, psychologically speaking I have some ideas how we might possibly develop a more effective scales for evaluating subjective pain.

    Never forget that we place our own subjective experiences of pain on to others. What hurts me, may not hurt you and vice versa. We need to find indices of pain that mean that we can ask a series of questions to patients that mean that we will be able to objectively evaluate their subjective pain levels. I don’t have all the answers, but I do have ideas.

    Fascinating.

  74. Mitsu says:

    This is all subjective. I mean, to me, a 10/10 pain would be when I sprained my ankle – it hurt so much taht I couldn’t even cry and I blacked out. A 7/10 would be when I got my nose pierced – felt dizzy, things fading, pretty much about to pass out but didn’t. In my opinion, if the person is conscious, then it’s not 10/10 pain! (Although, if they’re unconscious, they can’t rate their pain…)

  75. athenapink says:

    10/10 my labor with my over 8 pounder.
    3-10 centimeters in less than an hour pitocin and an epidural that moved out of place and only worked for the first 5 minutes.
    It got to a point where I could not move, I could not cry or scream any more.
    During the transition from 9 to 10 centimeters I could not even breathe or catch my breath.
    The nurse turned off the pitocin and the next contraction was instantly a 7-8 much much more manageable.
    I could have labored like that drug free any day or the 10/10 pain it had been. Pushed the baby out in 1 push and some panting!
    I used to think my migraines were 10’s, until this experience. Now I would have to rate them a 6-7.
    I think it is all based on the amount of pain you have suffered in life.

  76. Dave says:

    Gastroenteritis = most pain I personally have ever been in.

  77. Amy says:

    I agree that the pain scale is related to the worst pain you have ever felt. If I had injured myself and was in the hospital and someone asked me my pain level, I’d tell them, but I would also let them know I’d never broken any bones or given birth. It’s all relative. Also, The worst pain I’ve ever felt was gastric reflux. I had no idea it could hurt that bad, it made it hard to breath and it was scary because I didn’t know what was happening. I would equate that pain as a 6-7. I would still function but I panted to breath as a measure to control the pain.

  78. Anne says:

    My worst migraine feels like someone takes one of those bullet trajectory rods they use on dead people on CSI to determine the path that the bullet took through the body, and hurls it into the base of my skull through my head and out my eye. And they keep doing it over and over again. That is a 10 for me.

  79. sigh says:

    I’m always shocked a human being can be in so much pain without passing out. Not fair.

    I must also say when I am in excruciating pain and rocking in bed i tend to mindlessly eat like it’s been weeks because I’m really not thinking and have no idea what I’m doing I am so confused or trying to get the eating part of the day over so I can go back to the crying part. I will also say I would somehow suck it up in front of strangers even if my head was cut off.

  80. sigh says:

    An interstitial cystitis attack.. I feel like I want to take a flaming hot butcher knife and shove it in my bladder etc and dig around until I could rip it out. Now that sounds counter productive but I would do anything to get away from the pain and a knife sounds like it would feel oh so much better. Worse than labor b/c it never goes away.

    However during labor I did say.. so THIS is why they don’t sell guns in hospitals. Seemed like a logical thought at the time.

  81. emil says:

    If you are looking for a functional definition, then I would say that pancreatitis was the worst pain I have ever had (and for which I was hospitalized for about 2 weeks). I felt like I couldn’t even straighten myself out and things like walking and even breathing were difficult, because of the pain. Mental acuity was out of the question. The pain is overwhelming and consumes all of one’s attention.

    I have had gallbladder attacks, and while they are painful and I can feel pain when I breath, I can still walk and function, albeit more slowly than usual.

    Next I would rate tooth abscesses. I’ve had a couple of them and while I could carry out physical tasks, such as walking, breathing and the like, concentration or mental tasks were more difficult due to the pain.

    Finally, I remember cutting my hand severely and breaking a couple of fingers. This was probably the least severe of the pain sensations that I have described. I could function with broken fingers (and block out the pain to some extent) and a severely lacerated hand which required about 17 stitches.

    I can’t speak to other pains other than headaches, because I haven’t experienced them.

  82. emil says:

    P.S.: I also agree with Glen’s comment above. I’ve also had issues relating to chronic pain and I believe that doctors are awesome at treating acute pain, but are lousy at treating chronic pain. While my chronic pain was not nearly as severe as my attack of acute pancreatitis, it has a cumulative effect and also needs to be treated. It is very difficult to work at your job day after day with chronic, unrelenting pain, even if you are still technically functional and would rate it as a “3” or a “4.” In other words, you are able to function, but with increased difficulty and decreased efficiency.

  83. RSDS says:

    10. Never experienced it. The worst pain that I can imagine would be the torture that some of the POWs in Nam experienced. Pain to the level where a person is passing out, or very near to loosing consciousness.

    9. The worst pain that I have ever experienced. I have had level nine pain just a handful of times. This is the level where knees buckle, and/or writhing on the ground occurs.

    The first time was when I took liquid Tylenol (back in the days when it still contained alcohol) after having an incision & drain procedure for Quinsy. I ended up writhing on my barracks floor.

    The most recent occurred when the poorly applied spica thumb splint, for my fractured distal radius, gave me a very deep pressure sore at the base of my left thumb. My knees started to buckle, but I resisted falling by exerting extreme willpower.

    A few very severe toothaches, resulting in extractions, have also been at level nine.

    8. A few of my most severe migraines have reached level eight, and so have some very bad toothaches.

    7. Bad migraines often reach level seven.

    5-6. The usual level for migraines.

    2-3. The daily pain of Cervical Spondylosis.

  84. T 9 says:

    To me the key to dealing with pain is knowing if you are going to survive and how long it’s going to last. I have both been stung by a stingray and poisoned by a mushroom. I think the stingray hurt worse but I had someone there explaining it would be gone in 2 hours and I had nothing to worry about. It was like a test. I did have to growl and pound my fist though. The mushroom poisoning had me curled up on the ground and I thought I was going to die. Way worse since I didn’t know what to expect and for an hour it kept getting worse.

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