Friday, November 03, 2006

How do you "rate" your pain?

Nearly every Social Security disability client I see is asked if they have pain. Most do. Usually the next question is, "Rate your pain on a scale of 1-10". The problem is, no one really understands the meaning of the ratings. A person with back pain may have never experienced something as bad and say "10!"

Down the road, a judge might think that person is exaggeraing.

The most important thing you can do for your Social Security disabilty or SSI case is to be honest about your answers. The following ratings come from the McGill Pain Questionnaire, which is used by a number of anesthesioloogists.

0 . No pain. Feeling perfectly normal.

1. Very Mild. Very light barely noticable pain, like a mosquito bite or a poison ivy itch. Most of the time you never think about the pain.

2. Discomforting. Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails. Note that people react differently to this self-test.

3. Very noticable pain, like an accidental cut, a blow to the nose causing a bloody nose, or like a doctor giving you an injection. The pain is not so strong that you cannot get used to it. Eventually, most of the time you don't notice the pain. You have adapted to it.

4. Distressing. S
trong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma to part of the body, such as stubbing your toe real hard. So strong you notice the pain all the time and cannot completely adapt. This pain level can be simulated by pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails, and squeezing real hard. Note how the simulated pain is initially piercing but becomes dull after that.

5. Very Distressing. S
trong, deep, piercing pain, like a sprained ankle when you stand on it wrong, or mild back pain. Not only do you notice the pain all the time, you are now so preoccupied with managing it that you normal lifestyle is curtailed. Temporary personality disorders are frequent.

6. Intense. S
trong, deep, piercing pain so strong it seems to partially dominate your senses, causing you to think somewhat unclearly. At this point you begin to have trouble holding a job or maintaining normal social relationships. Comparable to a bad non-migriane headache, or a bad back pain.

7. Very Intense. S
ame as 6 except the pain completely dominates your senses, causing you to think unclearly about half the time. At this point you are effectively disabled and frequently cannot live alone. Comparable to an average migraine headache.

8. Uttery Horrible. P
ain so intense you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time. Suicide is frequently contemplated and sometimes tried. Comparable to childbirth or a real bad migraine headache.

9. Excruciating and Unbearable. P
ain so intense you cannot tolerate it and demand pain killers or surgery, no matter what the side effects or risk. If this doesn't work, suicide is frequent since there is no more joy in life whatsoever. Comparable to throat cancer.

10. Unimaginable or Unspeakable. P
ain so intense you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain and not blood loss, have experienced level 10.

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