Subjective pain scale and how to determine the objective pain level.

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The pain scale is subjective. It is essential to develop a methodology that will determine objective measures of chronic pain.

Pain scale.

Pain and discomfort accompany us all from the day we are born until death. At the same time, you will find no uniformity in the definitions and no transparent methodology for measuring "objective pain." This article offers a systematic method to examine objective pain levels and definitions of what pain is without using synonyms. The pain scale is a subjective measure of pain affected by the intensity of the pain, the duration, and the location. Pain endurance does vary from person to person, but pain intensification has more objective metrics.

 

How does your brain respond to pain? - Karen D. Davis.

The broad suggested definitions (without using synonyms) of inflammation and physical pain are mirror images of each other.

Links: | What is inflammation? (Inflammation vs. Infection) | Pain (Wikipedia)

If you look for definitions for physical pain, you will find that they are not uniform. It is worth emphasizing that pain and inflammation are mirror images of each other.

  • "Inflammation - is a short or continuous immune response caused by temporary or permanent cell damage, (above a certain threshold)" intended to rehabilitate the damaged tissue." 
  • "Physical pain - is a short or continuous alarm sensation caused by temporary or permanent cell damage (above a certain threshold) in tissue with sensory nerves (nociceptors)." Pain is a part of the self-defense mechanism. 

 

The pain scale is a subjective scale in which the patient gives a numerical value to the feeling of pain.

The pain scale is a subjective measure of pain affected by the intensity of the pain, the duration, and the location.

Is discomfort a symptom in itself?

Discomfort is low-intensity pain, usually tolerable, indicating slight damage to cells or tissues.

  • Discomfort is a prevalent symptom anywhere in our body where there is pain. Since the discomfort is a tolerable condition, we sometimes tend to ignore it.

What does it mean that I have intermittent discomfort?

  • Intermittent discomfort intermittently reaches a threshold where the body activates the pain alert mechanism.

If the discomfort is replaced by pain - what does it mean?

  • It means that the cumulative damage to the tissues intensifies.

If I take painkillers, is the tissue damage causing the pain healed?

  • Painkillers do not act to reduce inflammation but directly neutralize the pain.

 

Three factors determine the objective severity of pain.

The pain scale is a subjective measure in which the person is asked about the pain level. The objective measurement of pain tries to quantify the pain objectively. Primarily to assess the pain level of injuries & chronic patients are witnessing. To this day, to the best of my knowledge, there is no objective measure of pain. The subjective perception of pests has a relatively high variance.

  1. The Density of the sensory nerves (nociceptors) differs in different body areas. The head area, palms, hands, genitals, and nipples are rich in sensory nerves, which tend to hurt more.
    • Essential organs are not pain-sensitive, such as the brain and the liver. 
  2. Cumulative tissue damage = The multiplication of the affected tissue damage volume multiplied by the duration of exposure to the harmful agent.
    1. The intensity of tissue damage volume. (Per time unit) 
    2. Duration of exposure to the harmful agent.
  3. The Regeneration rate of the damaged tissue is directly proportional to the speed at which the pain passes. For example, skin cells recover quickly, so when we cut ourselves superficially with a knife, the pain passes relatively within a short time. 

It is possible (but challenging) to produce a statistical estimate of objective pain. Still, the patient's subjective response to pain is often more important than the intensity of the objective pain!

 

Gate Control Theory. (Pain has switches that can be turned off)

Gate Control Theory. (Pain has switches that can be turned off)

Applications of the Gate Control theory. (Regarding pain)

Link: Gate control theory. (Wikipedia) 

The theory was presented for the first time in 1965 and offered a physiological explanation for the phenomena observed in pain. The explanations are not very easy to understand; they describe the pain as a switchboard with switches that can be turned off. With these tools, you can control the pain.

You can find three primary methods using Gate Control tools to treat pain broadly.

  1. Complex surgeries can be performed, without anesthesia, only through acupuncture. This means that acupuncture can turn off the switches of the relevant pain.
  2. The inflammation can be diverted to another place where the symptoms are not painful; these tools are practical because of the close connection between inflammation and pain.
    1. Both methods are part of traditional Chinese medicine, including cupping and skin scraping. The explanation of Chinese medicine for these treatments is slightly different. Still, if you divert the location of the inflammation to a "more comfortable" place, you will cause relief of the symptoms in the desired area.
  3. Deep meditation can turn off the pain switch. The various martial artists make extensive use of the method. Indian fakirs walking on nails, hot coals in ritual ceremonies, and even swimming in ice water use the subconscious control of pain signaling. The disadvantage of this method is that it requires a lot of practice.

The fact that the pain switches can be "turned off" only shows that pain is a subjective matter. It affects mental state, age, practice, personality, sex (women have higher endurance), breathing, culture, and more.

 

Besides the brain and liver, most of the major organs in the human body are pain-sensitive.

  • We can feel pain in our bodies almost anywhere possible. Although there is no "brain pain," migraines are one of the most troublesome pests. (What hurts is not the brain itself)
  • The liver has no pain sensation, but the gallbladder and nearby organs feel pain. The pains of chronic liver patients (like me) are horrible because the body rots! But this is not a pain of the liver itself.
  • The pain intensity is often a subjective question; however, there are paralyzing pains in which the patient cannot function. Severe toothache, eye pain, earache, and prolonged migraines are paralyzing pains. (The head, because of the multiplicity of nerves in it, is especially susceptible to pain)

 

Painkillers block the pain without curing the inflammation that causes the pain.

Painkillers block the pain without curing the inflammation that causes the pain.

Frequently asked questions and answers regarding pain in general and chronic pain in particular.

Why do steroids reduce the intensity of pain?

  • Steroids secreted from the adrenal gland reduce the body's inflammatory response. At the same time, with prolonged use, steroids cause a weakening of the immune system and many side effects.

If nothing hurts me, a sign that I am healthy?

  • The answer is not necessarily. Damage to cells at low intensity often does not reach the threshold that requires an alarm! (Pain)

Is chronic pain a sign that I still have tissue damage?

  • Usually, the answer is "Yes."

If the chronic pain intensity increased, was it a sign that my health condition had worsened?

  • If the pain intensity has increased significantly over time, and there have been no other (mental) changes, the answer is probably "Yes."

I have intermittent pain; what does this imply?

  • Intermittent pain may indicate an unstable immune system. The difficulty is in locating the causes of the phenomenon. (Nutrition, physical and mental lifestyle)

 

Physical pain is often the result of injury (accidental or intentional) or illness.

  1. Blow, accident, burn, injury, etc. (Accidentally or intentionally) causes immediate inflammation. Sometimes, it also creates infection.  
  2. Local or chronic inflammation results from a pathogenic infectious processor without a present pathogen-producing inflammation.

Prominent examples:

  • When we have toothaches due to cavities in the teeth, the cause is a caries bacterial infection that causes inflammation, swelling, and pain.
  • If we are cut from a knife, the body's response is inflammatory: swelling, redness, and closure of the bleeding wound. The pain is usually temporary and subsides within a few minutes.
  • Migraines are an inflammatory phenomenon with pains that can last indefinitely for consecutive days. Migraine is also an inflammatory phenomenon, except for the swelling we usually do not feel or see. (Jugular veins.)

 

Healing chronic pain requires the rehabilitation of the damage to the tissues that produced the pain.

Link: Alleviating chronic pain by applying natural anti-inflammatory methods.

Any anti-inflammatory technique reduces pain.

  1. Anti-inflammatory nutrition. (The effect is relatively slow)
  2. Cleansing the Liver, Gallbladder, Intestines, Kidneys. (The effect is relatively slow)
  3. Herbs and various supplements. (The effect is relatively fast)
  4. Other anti-inflammatory therapies. (The effect is relatively fast)

There are 4 groups of anti-inflammatory therapies that have a relieving effect on inflammation. Their effect is slow compared to painkillers, but they treat the cause and not just neutralize the pain.

 

Prolonged pain severely impairs the patient's quality of life; however, painkillers and steroids do not cure the disease; they only alleviate the symptoms at a painful cost.

Frequently asked questions and answers:
What is the proposed definition of physical pain?
"Physical pain - is a short or continuous alarm sensation caused by temporary or permanent cell damage (above a certain threshold) in tissue with sensory nerves (nociceptors)." Pain is a part of the self-defense mechanism.
Why are painkillers and steroids unable to cure chronic diseases?
Painkillers and steroids have side effects in prolonged use and are not intended to cure the disease in the first place but only to alleviate the symptoms, as they cannot eliminate the disease's causes.
Is there a way to objectively quantify prolonged pain?
Doctors can determine from experience the level of pain in different situations; at the same time, I proposed a methodology that allows for the empirical measurement of the objective pain level estimate.
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