1 00:00:00,800 --> 00:00:03,559 Speaker 1: How to everybody. We're gonna take you back in time 2 00:00:03,600 --> 00:00:07,560 Speaker 1: to March fourteenth, twenty seventeen for this week's Selects episode. 3 00:00:07,600 --> 00:00:13,480 Speaker 1: Pick pain Scales colon eow exclamation point. I know that 4 00:00:13,520 --> 00:00:16,680 Speaker 1: was a Josh title because it's funny and creative and 5 00:00:16,760 --> 00:00:20,439 Speaker 1: he's great at those. So pain scales is pretty interesting stuff. 6 00:00:20,680 --> 00:00:22,599 Speaker 1: You've ever been to a doctor and they say like, oh, 7 00:00:22,840 --> 00:00:25,080 Speaker 1: it is a between a one and ten. That's one 8 00:00:25,160 --> 00:00:27,360 Speaker 1: kind of pain scale. But they are all kinds of 9 00:00:27,360 --> 00:00:30,360 Speaker 1: pain scales, and believe it or not, they're not arbitrary. 10 00:00:30,560 --> 00:00:32,479 Speaker 1: A lot of thought went into how they were formed 11 00:00:32,520 --> 00:00:36,280 Speaker 1: and built and put together. So check out pain Scales 12 00:00:36,560 --> 00:00:38,120 Speaker 1: colon EOW. 13 00:00:38,680 --> 00:00:47,040 Speaker 2: Right now, welcome to Stuff You Should Know, a production 14 00:00:47,320 --> 00:00:57,600 Speaker 2: of iHeartRadio. 15 00:00:54,640 --> 00:00:58,240 Speaker 3: Pay and welcome to the podcast. I'm Josh Clark, Hi, 16 00:00:58,680 --> 00:01:05,559 Speaker 3: there's Charles Tivchuk hi, and Jerry's over there in silence. Well, 17 00:01:05,600 --> 00:01:08,840 Speaker 3: you put us three together, you get stuff you should know. 18 00:01:09,600 --> 00:01:13,840 Speaker 1: Sorry, in advanced those three you just had a disassociative experience. 19 00:01:14,240 --> 00:01:17,440 Speaker 3: I did because I want to be anywhere but where 20 00:01:17,440 --> 00:01:19,839 Speaker 3: I am right now, which is in a lot of pain. 21 00:01:20,880 --> 00:01:21,559 Speaker 1: Are you in pain? 22 00:01:22,240 --> 00:01:25,399 Speaker 3: Yes? I just hit my hand with a hammer. Really 23 00:01:25,440 --> 00:01:28,600 Speaker 3: hard to get ready for this episode. Nice right in 24 00:01:28,680 --> 00:01:30,800 Speaker 3: the middle of the middle knuckle. 25 00:01:31,240 --> 00:01:33,639 Speaker 1: You know, the one of the very first dumb jokes 26 00:01:33,680 --> 00:01:34,360 Speaker 1: I made. 27 00:01:34,360 --> 00:01:36,679 Speaker 3: Like, really, I think I need to go to the hospital. 28 00:01:38,760 --> 00:01:44,640 Speaker 1: What In my very first podcast appearance with you, I 29 00:01:44,680 --> 00:01:47,680 Speaker 1: said that I was a method podcaster and that I 30 00:01:47,920 --> 00:01:50,280 Speaker 1: just got through brushing my teeth and drinking orange juice. 31 00:01:50,320 --> 00:01:55,360 Speaker 1: Oh yeah, yep, you have revived that dumb joke from 32 00:01:55,400 --> 00:01:58,920 Speaker 1: thirty seven years ago, right with a hammer, And here 33 00:01:58,960 --> 00:02:03,400 Speaker 1: we are, and here we are Chuck talking about pain. Yeah. 34 00:02:03,440 --> 00:02:07,000 Speaker 1: You know, I thought this one, for all its kind 35 00:02:07,040 --> 00:02:11,679 Speaker 1: of sameness and basicness, was way more interesting than I thought. 36 00:02:11,720 --> 00:02:14,400 Speaker 1: Once you dig in a little bit more. Yep, pain, 37 00:02:14,800 --> 00:02:15,280 Speaker 1: how about that? 38 00:02:15,960 --> 00:02:17,880 Speaker 3: Yeah? I thought this one was pretty cool too. We 39 00:02:17,960 --> 00:02:21,040 Speaker 3: need to do like a pain episode just on pain, 40 00:02:22,480 --> 00:02:23,520 Speaker 3: just in general. 41 00:02:23,560 --> 00:02:24,160 Speaker 1: House of pain. 42 00:02:25,400 --> 00:02:28,440 Speaker 3: Yeah, the TV show and the group. 43 00:02:28,919 --> 00:02:30,120 Speaker 1: I didn't know this was a TV show. 44 00:02:30,240 --> 00:02:31,720 Speaker 3: Yeah, it's a Tyler Perry show. 45 00:02:31,880 --> 00:02:33,200 Speaker 1: Oh okay, well that explains it. 46 00:02:33,200 --> 00:02:36,800 Speaker 3: It's about the Pains and their house. 47 00:02:36,960 --> 00:02:37,640 Speaker 1: Yeah, I get it. 48 00:02:38,800 --> 00:02:40,720 Speaker 3: I think it's kind of like Mama's Family a little 49 00:02:40,760 --> 00:02:45,240 Speaker 3: bit that either same production quality, that kind of stuff 50 00:02:45,320 --> 00:02:47,680 Speaker 3: looks like it's recorded on a stage. 51 00:02:47,960 --> 00:02:52,320 Speaker 1: Sure, probably is you know what I'm talking about. Mama's Family. Yeah, 52 00:02:52,320 --> 00:02:52,960 Speaker 1: I didn't watch that. 53 00:02:54,400 --> 00:02:56,519 Speaker 3: Well, had you, you would have known pain. 54 00:02:56,639 --> 00:02:58,720 Speaker 1: Which is weird because I love the Carol Burnett Show. 55 00:02:59,440 --> 00:03:03,440 Speaker 3: Yeah, this is a pretty far cry from that. Mama's House, 56 00:03:03,919 --> 00:03:08,480 Speaker 3: Mama's Family, Mama's Family with Bubba the grandson. Oh man, 57 00:03:08,560 --> 00:03:15,840 Speaker 3: it was bad, it was bad. But anyway, Yeah, there's 58 00:03:15,840 --> 00:03:18,000 Speaker 3: no segue. Let's just get back to pain. 59 00:03:18,680 --> 00:03:22,040 Speaker 1: Yes, and not just pain because like you said, we're 60 00:03:22,080 --> 00:03:23,800 Speaker 1: going to do one on that one day, but pain 61 00:03:23,919 --> 00:03:28,000 Speaker 1: scale specifically, which is are I should say, because there 62 00:03:28,000 --> 00:03:32,400 Speaker 1: are many, many of them. As this article astutely points out, 63 00:03:32,480 --> 00:03:36,240 Speaker 1: there really is no physical instrument, although they have tried 64 00:03:36,280 --> 00:03:40,000 Speaker 1: over the years, that can accurately measure pain, and so 65 00:03:40,160 --> 00:03:44,440 Speaker 1: doctors rely on a couple of methods, which is, hey, dummy, 66 00:03:44,840 --> 00:03:45,720 Speaker 1: how much do you hurt? 67 00:03:46,640 --> 00:03:50,360 Speaker 3: Hey, hey, you stop crying? Tell her how much your pain. 68 00:03:50,240 --> 00:03:53,760 Speaker 1: Is, or I'm going to look at you and talk 69 00:03:53,800 --> 00:03:55,320 Speaker 1: to you a bit, and I'm going to make my 70 00:03:55,320 --> 00:03:57,200 Speaker 1: own assessment because I'm the doctor. 71 00:03:57,360 --> 00:04:01,800 Speaker 3: Right, and I'm going to write like could could brush 72 00:04:01,920 --> 00:04:04,920 Speaker 3: his hair a little more? And it does too. I'm 73 00:04:04,920 --> 00:04:07,360 Speaker 3: gonna make my own observations about you man. 74 00:04:07,400 --> 00:04:09,720 Speaker 1: I haven't used a hair brush since I was probably thirteen. 75 00:04:10,600 --> 00:04:12,160 Speaker 3: I have two once in a while because my hair 76 00:04:12,240 --> 00:04:15,600 Speaker 3: is kind of longish now, and when the wind blows 77 00:04:15,640 --> 00:04:18,159 Speaker 3: it really turns it into a bird's nest. So so you. 78 00:04:18,160 --> 00:04:19,680 Speaker 1: Get out of the comba from her pocket. 79 00:04:19,960 --> 00:04:22,440 Speaker 3: Yep, I stand in front of the mirror like Marsha 80 00:04:22,520 --> 00:04:26,360 Speaker 3: Brady right before bed and count off one hundred brush trucks. 81 00:04:28,000 --> 00:04:32,000 Speaker 1: Yeah, so let's talk about you know, basically we're talking 82 00:04:32,040 --> 00:04:34,760 Speaker 1: about self reporting or observation. Those are the kind of 83 00:04:34,760 --> 00:04:37,960 Speaker 1: the two methods because it's important, you know, you gotta 84 00:04:38,560 --> 00:04:40,880 Speaker 1: There's a lot that goes into determining how much pain 85 00:04:40,960 --> 00:04:43,800 Speaker 1: someone's in, from the kind of meds they get to 86 00:04:43,880 --> 00:04:47,000 Speaker 1: relieve that pain, to diagnosis of what the heck's going on. 87 00:04:47,320 --> 00:04:50,360 Speaker 3: Well, yeah, the medical community just in the last probably 88 00:04:50,400 --> 00:04:52,640 Speaker 3: decade or so, is really waking up to the fact 89 00:04:52,640 --> 00:04:55,479 Speaker 3: that it's doing a lousy job, or traditionally has done 90 00:04:55,480 --> 00:04:59,159 Speaker 3: a lousy job of managing pain. There's a lot of 91 00:04:59,160 --> 00:05:03,680 Speaker 3: assumption that people are big babies who don't really need medication, 92 00:05:03,839 --> 00:05:06,960 Speaker 3: they just need to suck it up. Sure, there's a 93 00:05:06,960 --> 00:05:10,240 Speaker 3: lot of problems with med seeking where people pretend that 94 00:05:10,279 --> 00:05:13,880 Speaker 3: they have pain that they don't actually have, and they 95 00:05:14,480 --> 00:05:18,640 Speaker 3: because they want the drugs. But then there's also just 96 00:05:18,720 --> 00:05:23,680 Speaker 3: this idea that managed pain care isn't quite as good 97 00:05:23,680 --> 00:05:27,160 Speaker 3: as it should be. So part and parcel of that 98 00:05:27,640 --> 00:05:29,679 Speaker 3: is realizing like, well, then we need to be able 99 00:05:29,680 --> 00:05:33,040 Speaker 3: to quantify levels of pain a lot better. And this 100 00:05:33,160 --> 00:05:35,560 Speaker 3: is the idea that they're waking up to. It is 101 00:05:35,800 --> 00:05:40,080 Speaker 3: fairly new, but the idea that we can't quantify pain 102 00:05:40,520 --> 00:05:43,479 Speaker 3: is a pretty old one. People figured it out pretty 103 00:05:43,480 --> 00:05:47,520 Speaker 3: early on that pain is subjective. It's a subjective, horrible, 104 00:05:47,880 --> 00:05:51,400 Speaker 3: terrible experience. And actually ran across one definition of pain 105 00:05:52,200 --> 00:05:55,480 Speaker 3: from a researcher that said pain is whatever the person 106 00:05:55,560 --> 00:05:57,000 Speaker 3: experiencing it says it is. 107 00:05:57,279 --> 00:05:59,200 Speaker 1: Yeah, it's as simple as that. 108 00:05:59,200 --> 00:06:01,920 Speaker 3: That doesn't really help a doctor who's trying to figure 109 00:06:01,960 --> 00:06:05,520 Speaker 3: out how much medication to give you or whether to 110 00:06:05,680 --> 00:06:08,120 Speaker 3: just go ahead and like put a pillow over your 111 00:06:08,120 --> 00:06:09,280 Speaker 3: face or something make. 112 00:06:09,240 --> 00:06:11,320 Speaker 1: You go to sleep, Yeah, because that's what doctors do. 113 00:06:11,800 --> 00:06:14,520 Speaker 3: Well, yeah, it's a last resort, but they it's in 114 00:06:14,560 --> 00:06:15,400 Speaker 3: their toolbox. 115 00:06:16,560 --> 00:06:20,440 Speaker 1: Yeah, and they It's become so important that there's a 116 00:06:20,480 --> 00:06:23,520 Speaker 1: group called the American Pain Society, which is a great 117 00:06:23,600 --> 00:06:28,279 Speaker 1: band name. Oh it really is? Yeah, right, probably some 118 00:06:28,320 --> 00:06:31,200 Speaker 1: sort of metal, right, or I. 119 00:06:31,160 --> 00:06:35,000 Speaker 3: Could see like kind of like a sex pop kind. 120 00:06:34,800 --> 00:06:36,240 Speaker 1: Of I don't even know what that is. 121 00:06:36,520 --> 00:06:37,200 Speaker 3: I don't either. 122 00:06:37,920 --> 00:06:41,760 Speaker 1: You just invented a genre. Yeah, they're calling it the 123 00:06:41,800 --> 00:06:46,159 Speaker 1: fifth vital sign, which means that's important. 124 00:06:46,400 --> 00:06:51,359 Speaker 3: Kind of like thrill Killed cult or who is the 125 00:06:51,400 --> 00:06:52,880 Speaker 3: other Lords of Acid? 126 00:06:53,160 --> 00:06:57,800 Speaker 1: I don't know who they are. What, dude, that's your 127 00:06:57,839 --> 00:07:02,279 Speaker 1: what you got? Requested our San Francisco show to say 128 00:07:02,320 --> 00:07:04,720 Speaker 1: that you're so famous for saying that when I haven't 129 00:07:04,720 --> 00:07:05,320 Speaker 1: heard of something. 130 00:07:06,240 --> 00:07:10,520 Speaker 3: What, Well, go listen to those bands and you'll be like, oh, 131 00:07:10,600 --> 00:07:14,080 Speaker 3: sex pop Okay, but that's more like sex tech. No, 132 00:07:15,560 --> 00:07:16,520 Speaker 3: I don't know what sex pop. 133 00:07:16,520 --> 00:07:19,000 Speaker 1: Way doesn't sound like it's up my alley, okay, but 134 00:07:19,040 --> 00:07:19,880 Speaker 1: I'll give it a shot. 135 00:07:20,040 --> 00:07:20,440 Speaker 3: All right. 136 00:07:21,040 --> 00:07:27,480 Speaker 1: So pain, quantifying pain specifically was or pain in general 137 00:07:27,520 --> 00:07:30,880 Speaker 1: actually was, like you said, misunderstood for a long time, 138 00:07:31,360 --> 00:07:33,880 Speaker 1: and it took all the way into the twentieth century. 139 00:07:34,120 --> 00:07:37,200 Speaker 1: Quite a bit into the twentieth century with doctors still 140 00:07:38,000 --> 00:07:41,280 Speaker 1: kind of struggling with how much you know anesthesia to give, 141 00:07:41,720 --> 00:07:43,720 Speaker 1: how many meds to give? If you were in pain 142 00:07:43,760 --> 00:07:46,640 Speaker 1: if you were in surgery and childbirth, like you know, 143 00:07:47,520 --> 00:07:51,000 Speaker 1: literally people waking up in surgery and going, oh, well, 144 00:07:51,920 --> 00:07:55,760 Speaker 1: we didn't give that person enough anesthetic, And we talked 145 00:07:55,960 --> 00:07:58,880 Speaker 1: about that in our anesthesia episode a little bit. There's 146 00:07:58,880 --> 00:08:00,800 Speaker 1: just a lot of trial and error, like, I guess 147 00:08:00,880 --> 00:08:03,640 Speaker 1: that's not enough because someone's screaming on the table in 148 00:08:03,680 --> 00:08:04,160 Speaker 1: front of me. 149 00:08:04,480 --> 00:08:09,720 Speaker 3: Well. Plus also, so pain apparently is pretty widespread. I 150 00:08:09,760 --> 00:08:12,040 Speaker 3: saw that in the US alone, nine out of ten 151 00:08:12,120 --> 00:08:17,080 Speaker 3: people regularly suffer from pain at any given time. Twenty 152 00:08:17,080 --> 00:08:20,440 Speaker 3: five million people, well I guess, over the course of 153 00:08:20,440 --> 00:08:23,520 Speaker 3: a year suffer acute pain in the US, and another 154 00:08:23,600 --> 00:08:26,720 Speaker 3: fifty million suffer chronic pain, and many of those people 155 00:08:26,840 --> 00:08:30,960 Speaker 3: report suffering chronic pain for five years or more. So. Yeah, 156 00:08:30,960 --> 00:08:33,200 Speaker 3: so the medical community says we need to do something 157 00:08:33,240 --> 00:08:35,160 Speaker 3: about this, and it's like you were saying. The American 158 00:08:35,200 --> 00:08:38,600 Speaker 3: Pain Society, they say that pain is the fifth vital sign. 159 00:08:38,800 --> 00:08:45,800 Speaker 1: Yeah, the fifth beetle. What was his clarence, Yeah, it's 160 00:08:45,880 --> 00:08:47,240 Speaker 1: great Eddie Murphy's gay. 161 00:08:47,200 --> 00:08:47,400 Speaker 3: Yeah. 162 00:08:48,559 --> 00:08:50,600 Speaker 1: So if we go back in time to the time 163 00:08:50,600 --> 00:08:54,080 Speaker 1: where they were trying to be a little more objective 164 00:08:54,080 --> 00:08:57,640 Speaker 1: about it and actually come up with a little more 165 00:08:57,720 --> 00:09:01,640 Speaker 1: what they thought were like foolproof ways to determine pain measurement. 166 00:09:02,559 --> 00:09:06,920 Speaker 1: In nineteen forty, there were some researchers a trio, one 167 00:09:07,160 --> 00:09:11,600 Speaker 1: James Hardy, one Harold Wolf, and one Helen Goodell of 168 00:09:11,640 --> 00:09:13,000 Speaker 1: Cornell University. 169 00:09:13,559 --> 00:09:18,440 Speaker 3: Those are some nineteen forties names. Sure, Harold Wolf, yeah, 170 00:09:18,640 --> 00:09:19,600 Speaker 3: James Hardy. 171 00:09:19,520 --> 00:09:25,520 Speaker 1: Yeah, Helen Goodell, all three of them. They actually built 172 00:09:25,520 --> 00:09:31,320 Speaker 1: a device called a dolarimeter. And what this was was 173 00:09:31,360 --> 00:09:34,800 Speaker 1: basically a one hundred watt lamp with a lens that 174 00:09:34,840 --> 00:09:37,079 Speaker 1: they could focus you know how you do when you're 175 00:09:38,679 --> 00:09:42,200 Speaker 1: burning ants, Yeah, with a magnifying glass. Yeah, that's kind 176 00:09:42,240 --> 00:09:43,800 Speaker 1: of what they were doing. And they were cranking up 177 00:09:43,800 --> 00:09:46,320 Speaker 1: heat on the the you know, they got these nurse 178 00:09:46,400 --> 00:09:50,640 Speaker 1: volunteers apparently, and I think they were all pregnant, which 179 00:09:50,640 --> 00:09:53,000 Speaker 1: is even a little more sadistic, but they what they 180 00:09:53,000 --> 00:09:55,320 Speaker 1: were trying to do was compare it to their pregnancy pains, 181 00:09:55,440 --> 00:09:56,320 Speaker 1: their labor pains. 182 00:09:56,480 --> 00:09:58,520 Speaker 3: Yeah. And I was like, why would you do that 183 00:09:58,600 --> 00:10:03,400 Speaker 3: to like women in Well, you could predict, yeah, that's 184 00:10:03,440 --> 00:10:05,760 Speaker 3: when something was going to happen. It was one of 185 00:10:05,760 --> 00:10:08,000 Speaker 3: those few instances when you can predict somebody's going to 186 00:10:08,040 --> 00:10:08,480 Speaker 3: be a pain. 187 00:10:08,840 --> 00:10:10,559 Speaker 1: Yeah, Yeah, I get it, but it was also the 188 00:10:10,640 --> 00:10:13,360 Speaker 1: nineteen forties, right, so they didn't care. 189 00:10:13,640 --> 00:10:17,000 Speaker 3: Right, so like that hurts a lot, They're like great, great, right. 190 00:10:17,760 --> 00:10:19,800 Speaker 1: But I guess these were volunteers, so take that for 191 00:10:19,840 --> 00:10:22,599 Speaker 1: what it's worth. Sure. And they were either nurses or 192 00:10:22,640 --> 00:10:25,199 Speaker 1: wives of doctors, which is even a bit more sadistic. 193 00:10:26,679 --> 00:10:29,120 Speaker 1: And they would focus this light on the back of 194 00:10:29,160 --> 00:10:33,400 Speaker 1: their hand and make it hotter and hotter and said, 195 00:10:33,600 --> 00:10:36,000 Speaker 1: you know, compare that to your the intensity of your 196 00:10:36,040 --> 00:10:40,960 Speaker 1: labor pains by tricking. I guess yeah. And they even 197 00:10:41,040 --> 00:10:41,839 Speaker 1: made up a unit. 198 00:10:42,200 --> 00:10:43,600 Speaker 3: We've reached equilibrium. 199 00:10:44,920 --> 00:10:49,440 Speaker 1: They even invented a pain unit called Dolls DLS and 200 00:10:49,840 --> 00:10:52,080 Speaker 1: you know, it went supposedly one to ten, but there 201 00:10:52,200 --> 00:10:56,600 Speaker 1: was a lady, one of them, tough Marge, who cranked 202 00:10:56,600 --> 00:10:59,320 Speaker 1: it all the way up to ten point five, maxing 203 00:10:59,320 --> 00:11:02,640 Speaker 1: out the machine, and she was still like, nope, I 204 00:11:02,679 --> 00:11:05,079 Speaker 1: can take it. Yeah, which is amazing. 205 00:11:05,640 --> 00:11:09,400 Speaker 3: Yeah, she was like, oh hurts so good. But she 206 00:11:09,600 --> 00:11:11,120 Speaker 3: loved sex pop music. 207 00:11:12,600 --> 00:11:15,320 Speaker 1: But there was a problem with the dolerometer, which is 208 00:11:15,360 --> 00:11:18,680 Speaker 1: they in subsequent experience by other doctors that could not 209 00:11:18,760 --> 00:11:20,679 Speaker 1: reproduce this, which means it's junk. 210 00:11:20,920 --> 00:11:24,559 Speaker 3: Well not only that, like I don't understand how it 211 00:11:24,720 --> 00:11:29,120 Speaker 3: quantifies pain, right, What you're really saying is compare your 212 00:11:29,160 --> 00:11:32,920 Speaker 3: labor pains to the amount of heat energy that we're 213 00:11:32,960 --> 00:11:36,000 Speaker 3: applying to you. Yeah, I don't. It just didn't translate 214 00:11:36,040 --> 00:11:40,040 Speaker 3: to me. I didn't understand it. But apparently that it 215 00:11:40,160 --> 00:11:46,360 Speaker 3: created this this new cottage industry for machines that were 216 00:11:46,480 --> 00:11:50,600 Speaker 3: used to measure objectively pain. And there's some still around today, 217 00:11:50,800 --> 00:11:55,040 Speaker 3: but they do slightly different things, Like there's one that 218 00:11:55,040 --> 00:11:58,680 Speaker 3: that is like a ray gun that's used to see 219 00:11:58,720 --> 00:12:04,040 Speaker 3: if someone under anesthesia is under deep enough, Right, he 220 00:12:04,200 --> 00:12:07,400 Speaker 3: just there and shoot him with it for fun too. Yeah, 221 00:12:07,559 --> 00:12:09,920 Speaker 3: and if they don't wake up, great. 222 00:12:10,160 --> 00:12:10,839 Speaker 1: The fun gun. 223 00:12:11,240 --> 00:12:12,400 Speaker 3: Yeah, that's right. 224 00:12:12,559 --> 00:12:14,719 Speaker 1: And then in nineteen forty five, I guess this was 225 00:12:14,760 --> 00:12:16,520 Speaker 1: just sort of the decade of trying to perfect these 226 00:12:16,559 --> 00:12:20,080 Speaker 1: things before they realized they couldn't. Time Magazine wrote an 227 00:12:20,120 --> 00:12:24,000 Speaker 1: article on doctor Lauren to Julius Bella glutesk great name, 228 00:12:24,960 --> 00:12:30,040 Speaker 1: and he had a machine. It didn't use heat, but 229 00:12:30,080 --> 00:12:33,440 Speaker 1: it put pressure on the shin bone and increasing amounts. 230 00:12:33,559 --> 00:12:34,480 Speaker 3: That sounds awful. 231 00:12:34,600 --> 00:12:35,559 Speaker 1: Does sound awful? 232 00:12:35,760 --> 00:12:38,000 Speaker 3: The shin is like surprisingly sensitive. 233 00:12:38,120 --> 00:12:42,040 Speaker 1: Oh yeah, like you know, just put a coffee table 234 00:12:42,040 --> 00:12:42,600 Speaker 1: in any room. 235 00:12:42,800 --> 00:12:44,840 Speaker 3: Yeah, it doesn't make any sense. It should be like 236 00:12:44,880 --> 00:12:47,360 Speaker 3: tougher than leather, like run DMC, but it's not. 237 00:12:47,720 --> 00:12:50,240 Speaker 1: No, it's not. And this one, actually I don't know 238 00:12:50,320 --> 00:12:53,040 Speaker 1: what the name of it was, but he measured it 239 00:12:53,080 --> 00:12:56,640 Speaker 1: in grams to quantify it and was supposedly and I 240 00:12:56,640 --> 00:13:01,360 Speaker 1: think this is self reported by doctor Bella Glutes ninety 241 00:13:01,360 --> 00:13:05,000 Speaker 1: seven percent accurate. But since you've not heard of it 242 00:13:05,320 --> 00:13:07,640 Speaker 1: most of you, that probably means that was not true. 243 00:13:07,920 --> 00:13:11,000 Speaker 3: Yeah, he thought if he said ninety eight percent accurate, 244 00:13:11,040 --> 00:13:13,280 Speaker 3: people would have been suspicious of his findings. 245 00:13:13,520 --> 00:13:16,920 Speaker 1: Yeah, that's right, So he seven. The funny thing though, 246 00:13:16,960 --> 00:13:21,200 Speaker 1: is while all this I wasn't gonna call it quackery 247 00:13:21,240 --> 00:13:24,400 Speaker 1: because they were they were trying to legitimately invent something. 248 00:13:25,080 --> 00:13:26,959 Speaker 1: But while the same time all this is going on, 249 00:13:27,480 --> 00:13:31,719 Speaker 1: there was a guy named Kenneth Keel who said, why 250 00:13:31,720 --> 00:13:33,040 Speaker 1: don't we just ask people. 251 00:13:33,120 --> 00:13:35,040 Speaker 3: Let's use our brains people, how about that? 252 00:13:35,120 --> 00:13:37,520 Speaker 1: Why don't we just ask folks and tell them like 253 00:13:37,720 --> 00:13:41,520 Speaker 1: zero one or two or three on the scale of 254 00:13:41,840 --> 00:13:44,360 Speaker 1: you know, not painful to severely painful. Why don't we 255 00:13:44,360 --> 00:13:45,920 Speaker 1: just ask them and see what they say? And that 256 00:13:46,120 --> 00:13:47,479 Speaker 1: kind of caught on as the standard. 257 00:13:47,720 --> 00:13:49,520 Speaker 3: Well, let's take a break, man, then we'll get back 258 00:13:49,559 --> 00:13:54,360 Speaker 3: to when sensible pain scales came into effect. 259 00:13:54,760 --> 00:13:59,120 Speaker 4: That's why I say that you should know that. 260 00:14:02,760 --> 00:14:21,800 Speaker 3: We should knows all right, Chuck, So the forties were 261 00:14:21,800 --> 00:14:27,280 Speaker 3: full of ding bad ideas. The sixties, Well, actually, I 262 00:14:27,320 --> 00:14:30,920 Speaker 3: guess the guy you mentioned, doctor Kenneth Keel. He came 263 00:14:31,000 --> 00:14:34,080 Speaker 3: up with his idea of a pain scale, a subjective 264 00:14:34,200 --> 00:14:37,280 Speaker 3: self reported pain scale, in the forties, but it seems 265 00:14:37,280 --> 00:14:39,320 Speaker 3: to have really caught on in the sixties. 266 00:14:39,400 --> 00:14:39,720 Speaker 1: Agreed. 267 00:14:40,240 --> 00:14:45,360 Speaker 3: And so with a self reported pain scale, with any well, yeah, 268 00:14:45,400 --> 00:14:48,360 Speaker 3: any kind of self reported pain scale. It's basically you 269 00:14:48,400 --> 00:14:51,720 Speaker 3: were asking the patient how much pain are you in? 270 00:14:52,480 --> 00:14:54,920 Speaker 3: And it's not enough for them to be like a lot, 271 00:14:55,600 --> 00:14:58,640 Speaker 3: you know, you have to give them, say, like you said, 272 00:14:59,120 --> 00:15:01,400 Speaker 3: a scale of like zero to ten, or zero to 273 00:15:01,400 --> 00:15:04,600 Speaker 3: twenty or zero to one hundred. Yeah, some people just 274 00:15:04,640 --> 00:15:09,080 Speaker 3: for fun have one that goes up zero to a million. Sure, 275 00:15:09,760 --> 00:15:12,120 Speaker 3: and everyone chooses a million. It's crazy. 276 00:15:13,480 --> 00:15:15,360 Speaker 1: I always have a difficult time because I have a 277 00:15:15,440 --> 00:15:16,480 Speaker 1: high threshold for pain. 278 00:15:18,600 --> 00:15:22,160 Speaker 3: But that's that makes sense because pain is subjective. 279 00:15:22,440 --> 00:15:24,760 Speaker 1: Yeah, but I have a high threshold for pain, but 280 00:15:24,800 --> 00:15:29,680 Speaker 1: I also you know I want the good pills, So 281 00:15:29,760 --> 00:15:30,120 Speaker 1: do you. 282 00:15:30,120 --> 00:15:33,000 Speaker 3: Wink when you're talking? No, Like how I'm in a 283 00:15:33,040 --> 00:15:35,880 Speaker 3: tremendous amount of pain, doctor, please help me. 284 00:15:36,120 --> 00:15:38,040 Speaker 1: I usually try to quantity and this doesn't happen much 285 00:15:38,080 --> 00:15:42,160 Speaker 1: because I don't often need or have an injury to 286 00:15:42,160 --> 00:15:46,000 Speaker 1: where I like would need pain pills or something. But 287 00:15:46,040 --> 00:15:48,560 Speaker 1: I always try to quantify it as if I didn't 288 00:15:48,600 --> 00:15:52,680 Speaker 1: have a high threshold for pain, you know what I'm saying. Like, 289 00:15:52,720 --> 00:15:54,880 Speaker 1: I also think of my number and then I'll add 290 00:15:54,880 --> 00:15:58,640 Speaker 1: a couple so you can I can get juiced up. 291 00:15:58,920 --> 00:16:03,320 Speaker 3: You objectively self report then, rather than subjectively. 292 00:16:02,760 --> 00:16:06,280 Speaker 1: Yeah, which they say is very much wrong. Sure, and 293 00:16:06,360 --> 00:16:10,920 Speaker 1: you should be super honest with your doctor. Yeah, because, 294 00:16:11,000 --> 00:16:13,440 Speaker 1: like you said, there are addicts who seek this out. 295 00:16:14,480 --> 00:16:14,720 Speaker 3: Yeah. 296 00:16:14,760 --> 00:16:16,840 Speaker 1: I'm not one of those, but I'm just like you know, 297 00:16:16,880 --> 00:16:18,880 Speaker 1: the pain pill makes the pain feel a little bit better. 298 00:16:18,920 --> 00:16:21,280 Speaker 1: Even if I have a high threshold, doesn't mean I 299 00:16:21,280 --> 00:16:23,040 Speaker 1: don't want that pain to go away some you know. 300 00:16:23,440 --> 00:16:25,720 Speaker 3: Yeah. Well, the way to get around that though is 301 00:16:25,720 --> 00:16:27,720 Speaker 3: to just like dress up, you know when you go 302 00:16:27,760 --> 00:16:30,080 Speaker 3: to the hospital, like wear a suit to be sure, 303 00:16:30,720 --> 00:16:31,640 Speaker 3: tie that kind of thing. 304 00:16:31,680 --> 00:16:33,680 Speaker 1: Yeah, I walk in with my baseball hat and beard 305 00:16:33,720 --> 00:16:34,160 Speaker 1: and a tie. 306 00:16:34,560 --> 00:16:36,440 Speaker 3: Well, see you would seem med seeking. 307 00:16:36,560 --> 00:16:37,520 Speaker 1: Yeah, I totally would. 308 00:16:37,600 --> 00:16:39,480 Speaker 3: It would at the very least like cross their mind. 309 00:16:39,480 --> 00:16:44,280 Speaker 3: Whereas if you dressed up and you said and shaved, sure, 310 00:16:45,200 --> 00:16:47,600 Speaker 3: they'd be like, what, what drugs can we give you? Right, 311 00:16:48,200 --> 00:16:50,440 Speaker 3: just write it down, write down whatever you want, yeah, 312 00:16:51,280 --> 00:16:52,080 Speaker 3: and we'll sign it. 313 00:16:52,800 --> 00:16:54,080 Speaker 1: I don't know the name of any of them. 314 00:16:54,120 --> 00:16:57,800 Speaker 3: So, Uh, Fentanyl is a big problem these days, is 315 00:16:57,880 --> 00:17:01,600 Speaker 3: making its way into heroine. 316 00:17:00,920 --> 00:17:02,160 Speaker 1: What taken with heroin. 317 00:17:03,000 --> 00:17:05,720 Speaker 3: Yeah, they're using fentanyl to cut heroin. I don't know 318 00:17:05,760 --> 00:17:08,000 Speaker 3: if they still are anymore. But like the little towns 319 00:17:08,000 --> 00:17:11,000 Speaker 3: around America were having, like you know, it'd be normal 320 00:17:11,040 --> 00:17:13,440 Speaker 3: to have one or two overdoses a year, they were 321 00:17:13,440 --> 00:17:15,919 Speaker 3: having like a dozen or so all of a sudden 322 00:17:15,960 --> 00:17:20,119 Speaker 3: because people were like, it's like heroin and then the 323 00:17:20,200 --> 00:17:26,320 Speaker 3: highest grade pharmaceutical heroin mixed in and apparently people didn't 324 00:17:26,320 --> 00:17:28,480 Speaker 3: have any warning or else. Maybe they were told this 325 00:17:28,520 --> 00:17:30,680 Speaker 3: will knock your socks off. I think that's what killed 326 00:17:30,680 --> 00:17:33,120 Speaker 3: Philip Seymour Hoffman too. I think he might have had 327 00:17:33,160 --> 00:17:36,840 Speaker 3: fentanyl in his heroin. But it's like what these people 328 00:17:36,880 --> 00:17:39,840 Speaker 3: are used to, the dose they're used to, right, normally 329 00:17:39,960 --> 00:17:42,359 Speaker 3: with heroin would not be a lethal dose, but with 330 00:17:42,440 --> 00:17:45,000 Speaker 3: fentanyl mixed in, it's they're dead. 331 00:17:45,359 --> 00:17:49,680 Speaker 1: Wow. That reminds me the old, the great Kamal Najiani joke, 332 00:17:50,440 --> 00:17:52,440 Speaker 1: which was my intro to him. I heard on him 333 00:17:52,440 --> 00:17:55,880 Speaker 1: on This American Life. He was talking about a new 334 00:17:55,960 --> 00:17:59,320 Speaker 1: drug that kids were doing, which was thailand ll PM 335 00:17:59,440 --> 00:18:01,600 Speaker 1: with heroin, and he. 336 00:18:01,720 --> 00:18:04,960 Speaker 5: Was just like, you're already doing heroin. It's like, what 337 00:18:05,040 --> 00:18:08,720 Speaker 5: could that possibly add to your experience? Yeah, very funny joke, Yeah, 338 00:18:09,400 --> 00:18:12,320 Speaker 5: but also sad at the same time. 339 00:18:13,520 --> 00:18:14,520 Speaker 3: Aren't the best jokes? 340 00:18:15,280 --> 00:18:20,440 Speaker 1: Yeah, a little sad sometimes. So with self reporting pain scales, 341 00:18:22,080 --> 00:18:25,000 Speaker 1: it sounds, like I said, so basic, like okay, it's 342 00:18:25,000 --> 00:18:27,919 Speaker 1: a no brainer. You ask someone you've got zeroo whatever, 343 00:18:28,000 --> 00:18:30,639 Speaker 1: three or ten or one hundred people say that and 344 00:18:30,640 --> 00:18:35,080 Speaker 1: then the doctor knows. But you don't think about like children, 345 00:18:35,720 --> 00:18:38,879 Speaker 1: or like in their understanding of pain, or maybe the 346 00:18:38,960 --> 00:18:44,200 Speaker 1: elderly and reasons how they experience pain, or people that 347 00:18:44,280 --> 00:18:48,080 Speaker 1: are cognitively impaired and their understanding of pain. And then 348 00:18:48,119 --> 00:18:50,959 Speaker 1: you start to think, oh, wait a minute, well we 349 00:18:51,040 --> 00:18:53,880 Speaker 1: need all kinds of pain scales and ways of asking 350 00:18:53,920 --> 00:18:56,400 Speaker 1: people because not everyone is the same. 351 00:18:56,640 --> 00:18:59,959 Speaker 3: And they do have them. Adults specifically are pretty good 352 00:19:00,160 --> 00:19:03,760 Speaker 3: at rating their pain on a scale using numbers. Yeah, 353 00:19:04,200 --> 00:19:07,440 Speaker 3: they can also use words like I'm in severe pain 354 00:19:07,600 --> 00:19:11,200 Speaker 3: or something like that. And usually if you're being presented 355 00:19:11,200 --> 00:19:14,240 Speaker 3: with the pain scale, it's not open ended, like describe 356 00:19:14,280 --> 00:19:18,640 Speaker 3: your pain in flowery language, it's which of these words 357 00:19:18,680 --> 00:19:23,320 Speaker 3: best describes your pain, like no pain, moderate, severe, intolerable. 358 00:19:23,640 --> 00:19:28,639 Speaker 3: The one that gets me is the worst pain imaginable. Yeah, 359 00:19:28,760 --> 00:19:31,719 Speaker 3: that's that's as bad as it gets. Like, I can't 360 00:19:31,760 --> 00:19:34,520 Speaker 3: conceive of any pain worse than what I'm in right now. 361 00:19:34,560 --> 00:19:37,159 Speaker 3: That's it just runs a chill down my spine. Thinking 362 00:19:37,200 --> 00:19:41,280 Speaker 3: that something could happen that could put any of us 363 00:19:41,280 --> 00:19:46,639 Speaker 3: in that situation where you're experiencing the worst pain imaginable. 364 00:19:46,920 --> 00:19:49,359 Speaker 3: It just I just don't think that should be able 365 00:19:49,400 --> 00:19:50,439 Speaker 3: to happen to a person. 366 00:19:51,000 --> 00:19:52,760 Speaker 1: Yeah, and it's weird too. It seems like a lot 367 00:19:52,760 --> 00:19:58,919 Speaker 1: of times injuries, like whether it's a cut or a 368 00:19:58,960 --> 00:20:01,920 Speaker 1: broken bone or something I've heard. I've never broken a bone, 369 00:20:01,920 --> 00:20:03,760 Speaker 1: but I've been cut open a lot of times. 370 00:20:03,840 --> 00:20:04,960 Speaker 3: You better knock on wood. 371 00:20:05,119 --> 00:20:09,920 Speaker 1: I know I'm knocking right now. It seems like those 372 00:20:09,960 --> 00:20:13,080 Speaker 1: injuries are less painful. A lot of times, and other 373 00:20:13,200 --> 00:20:15,760 Speaker 1: kinds of injuries. Like I hear people say, like, yeah, 374 00:20:15,800 --> 00:20:17,760 Speaker 1: I broke my bone, but it was just sort of 375 00:20:17,840 --> 00:20:21,880 Speaker 1: numb and it looked awful, But I didn't feel actual pain, right, 376 00:20:22,040 --> 00:20:26,280 Speaker 1: whereas like like pulled muscles and things like that are 377 00:20:26,320 --> 00:20:29,680 Speaker 1: the things that really hurt or bad pain, for God's sake, 378 00:20:29,920 --> 00:20:30,840 Speaker 1: is the worst. 379 00:20:30,720 --> 00:20:32,560 Speaker 3: You know. I'd like to do a call out to 380 00:20:33,600 --> 00:20:39,520 Speaker 3: emergency room physicians or nurses or orderlies, anybody who's seen 381 00:20:39,560 --> 00:20:42,760 Speaker 3: people in a lot of pain and tell us what 382 00:20:42,960 --> 00:20:46,879 Speaker 3: is reliably the worst type of injury pain wise? 383 00:20:47,160 --> 00:20:48,400 Speaker 1: I think burns. 384 00:20:48,760 --> 00:20:50,560 Speaker 3: Oh yeah, I'll bet burns. 385 00:20:50,119 --> 00:20:53,840 Speaker 1: I've heard that that's just you know, and you know 386 00:20:53,880 --> 00:20:57,360 Speaker 1: I've I've had small burns that it's just that pain 387 00:20:57,400 --> 00:21:01,040 Speaker 1: that won't stop mm hm. And you know, I can't imagine, 388 00:21:01,080 --> 00:21:03,040 Speaker 1: like working in a burn unit, the kind of pain 389 00:21:03,080 --> 00:21:03,879 Speaker 1: those people suffer. 390 00:21:04,119 --> 00:21:04,679 Speaker 3: Yeah. 391 00:21:04,920 --> 00:21:09,840 Speaker 1: Man. So talking about children, there's this really great story 392 00:21:10,280 --> 00:21:19,960 Speaker 1: about the Wong Baker Faces all caps that's right for 393 00:21:20,480 --> 00:21:23,880 Speaker 1: treating kids with discomfort and pain, And it was developed 394 00:21:23,880 --> 00:21:28,640 Speaker 1: in the early eighties by two women. Donna Wong who 395 00:21:28,800 --> 00:21:32,560 Speaker 1: was a well Connie Baker is I think first started 396 00:21:33,160 --> 00:21:36,399 Speaker 1: with the idea. And Connie Baker was a life child 397 00:21:37,240 --> 00:21:40,000 Speaker 1: child life specialist excuse me, which I had never heard of, 398 00:21:40,040 --> 00:21:42,720 Speaker 1: but it's a really cool job where they work in 399 00:21:42,720 --> 00:21:45,600 Speaker 1: hospitals and they work with children, not in like a 400 00:21:45,680 --> 00:21:51,520 Speaker 1: nursing capacity, but and jeez, I'd love to hear from 401 00:21:51,520 --> 00:21:53,520 Speaker 1: someone who does this, but it seems like they kind 402 00:21:53,520 --> 00:21:56,560 Speaker 1: of work in a more of a social services capacity 403 00:21:57,119 --> 00:22:03,000 Speaker 1: and helping a kid just deal with being hospitalized. Does 404 00:22:03,040 --> 00:22:03,800 Speaker 1: that sound about right? 405 00:22:04,160 --> 00:22:06,080 Speaker 3: Yeah, that's my impression, okay. 406 00:22:06,640 --> 00:22:10,080 Speaker 1: And then Donna Wong who was a pediatric nurse consultant 407 00:22:10,119 --> 00:22:13,480 Speaker 1: and apparently an author, well not apparently an author, very 408 00:22:13,560 --> 00:22:16,119 Speaker 1: much an author, but apparently just this legend in the 409 00:22:16,200 --> 00:22:20,359 Speaker 1: nursing industry, and she came to visit in Tulsa where 410 00:22:20,359 --> 00:22:23,960 Speaker 1: Connie Baker worked, and they got to talking and she 411 00:22:24,080 --> 00:22:27,479 Speaker 1: was like, I had this idea where we can do 412 00:22:27,600 --> 00:22:31,480 Speaker 1: better with trying to determine and get self reporting out 413 00:22:31,480 --> 00:22:34,720 Speaker 1: of children, because children don't you know, sometimes they're preverbal 414 00:22:34,880 --> 00:22:38,640 Speaker 1: or nonverbal, and sometimes they don't get like the numbers 415 00:22:38,720 --> 00:22:41,240 Speaker 1: or the color charts. So we need a better way. 416 00:22:41,840 --> 00:22:45,320 Speaker 1: And ingeniously they developed this with children. They started with 417 00:22:46,200 --> 00:22:49,919 Speaker 1: just blank circles and said, hey, you draw a face 418 00:22:50,760 --> 00:22:54,040 Speaker 1: that looks like the pain that you're having. 419 00:22:54,400 --> 00:22:56,399 Speaker 3: Right, And the kid would draw and maybe like this 420 00:22:56,480 --> 00:22:58,320 Speaker 3: is terrible. Do you do a better job than this? 421 00:22:58,880 --> 00:23:01,280 Speaker 3: What is that? Is that a chimney with smoke coming 422 00:23:01,320 --> 00:23:01,679 Speaker 3: out of it? 423 00:23:02,800 --> 00:23:06,040 Speaker 1: They're like that, I feel like I'm on fire. So 424 00:23:06,119 --> 00:23:07,719 Speaker 1: these kids, you know, you look at some of these 425 00:23:07,760 --> 00:23:09,600 Speaker 1: early drawings and it's super cute. You know, they've got 426 00:23:09,640 --> 00:23:12,520 Speaker 1: these crayons, and they put these details like hair and 427 00:23:12,560 --> 00:23:17,480 Speaker 1: noses and you know, the typical kids drawings. And interestingly, 428 00:23:17,600 --> 00:23:19,439 Speaker 1: some of them drew left to right, some of them 429 00:23:19,480 --> 00:23:22,240 Speaker 1: right to left. I don't know how to explain that, huh, 430 00:23:22,480 --> 00:23:25,400 Speaker 1: But I guess maybe kids hadn't learned to read yet 431 00:23:25,480 --> 00:23:28,800 Speaker 1: might have done right to left and not understood that 432 00:23:28,800 --> 00:23:31,160 Speaker 1: that's sort of the opposite of how we learned to read. 433 00:23:31,320 --> 00:23:33,240 Speaker 3: Or they grew up in a culture that reads right 434 00:23:33,280 --> 00:23:33,720 Speaker 3: to left. 435 00:23:34,840 --> 00:23:36,320 Speaker 1: I don't think so. I think these were just like, 436 00:23:37,160 --> 00:23:38,960 Speaker 1: you know, normal dumb American kids. 437 00:23:39,200 --> 00:23:39,920 Speaker 3: Oh gotcha. 438 00:23:41,359 --> 00:23:44,320 Speaker 1: And so these kids actually participated and started drawing these 439 00:23:44,320 --> 00:23:49,679 Speaker 1: little faces that range from smiling to tears, and they 440 00:23:49,720 --> 00:23:52,280 Speaker 1: got a little bit of heat for using tears as 441 00:23:52,359 --> 00:23:53,440 Speaker 1: well as the smiles. 442 00:23:53,920 --> 00:23:55,520 Speaker 3: Why, well, they. 443 00:23:55,680 --> 00:23:58,200 Speaker 1: You know, some researchers said, like, you probably shouldn't use those, 444 00:23:58,520 --> 00:24:01,960 Speaker 1: but they said, no, you know, every kid drew smiles, 445 00:24:02,480 --> 00:24:05,159 Speaker 1: so we think it should kind of. We think that 446 00:24:05,359 --> 00:24:08,800 Speaker 1: is really informative to us and them describing how they feel. 447 00:24:08,840 --> 00:24:12,199 Speaker 1: So let's let's keep that. They kept the tears. But 448 00:24:12,200 --> 00:24:14,080 Speaker 1: they told the kids, and they continue to tell kids 449 00:24:14,119 --> 00:24:16,639 Speaker 1: when they look at this thing, you don't have to 450 00:24:16,680 --> 00:24:19,720 Speaker 1: have tears necessarily to have the worst to be in 451 00:24:19,760 --> 00:24:23,200 Speaker 1: the worst pain, because not everybody cries when they're in pain. 452 00:24:23,640 --> 00:24:26,240 Speaker 3: Gotcha. That's why they said you shouldn't have tears on there. 453 00:24:26,720 --> 00:24:30,160 Speaker 1: Yeah, I think so, uh confuse the kids, yeah, exactly. 454 00:24:30,480 --> 00:24:30,680 Speaker 3: Huh. 455 00:24:30,880 --> 00:24:33,600 Speaker 1: So what they did was then they got a professional 456 00:24:33,680 --> 00:24:37,960 Speaker 1: artist and basically kind of picked out the most frequently 457 00:24:38,040 --> 00:24:42,960 Speaker 1: drawn features and had them draw like a professional composite 458 00:24:43,000 --> 00:24:44,920 Speaker 1: of these faces, you know, and I think they ended 459 00:24:45,000 --> 00:24:48,600 Speaker 1: up on six circles after experimenting with like less or more, 460 00:24:49,280 --> 00:24:53,800 Speaker 1: and children actually help develop the the faces chart, which is, 461 00:24:53,960 --> 00:24:55,080 Speaker 1: you know, it's an awesome story. 462 00:24:55,320 --> 00:24:57,639 Speaker 3: It is. It's pretty cute, yeah, in a sad way, 463 00:24:57,720 --> 00:25:02,400 Speaker 3: which makes it a joke. All right, So Chuck, let's 464 00:25:02,400 --> 00:25:04,200 Speaker 3: take another break and then we'll come back and talk 465 00:25:04,240 --> 00:25:06,320 Speaker 3: about some other ways of assessing pain. 466 00:25:06,960 --> 00:25:12,800 Speaker 4: That's why you should know. That's why s K. 467 00:25:15,000 --> 00:25:34,480 Speaker 3: You should know, Josh Clark, So Chuck, you've got pain 468 00:25:34,560 --> 00:25:38,280 Speaker 3: scales that use numbers, You've got some that use faces 469 00:25:38,320 --> 00:25:41,240 Speaker 3: for little kids. But one of the things they have 470 00:25:41,359 --> 00:25:45,040 Speaker 3: in common is that they exist on a spectrum. One 471 00:25:45,080 --> 00:25:48,600 Speaker 3: of them is so advanced that you you have on 472 00:25:48,600 --> 00:25:51,320 Speaker 3: one end no pain and on the other end extreme pain, 473 00:25:51,720 --> 00:25:54,560 Speaker 3: and an adult or somebody will point to them wherever 474 00:25:54,600 --> 00:25:57,879 Speaker 3: they are on that scale, and then the doctor has 475 00:25:57,920 --> 00:26:02,160 Speaker 3: to get out a ruler and measure it in millimeters, right, 476 00:26:03,040 --> 00:26:05,439 Speaker 3: and then they mark that down and then one of 477 00:26:05,440 --> 00:26:11,440 Speaker 3: the benefits of objectively assessing someone's pain, even through self reporting, 478 00:26:11,800 --> 00:26:14,560 Speaker 3: is that you can track whether it's getting better or 479 00:26:14,560 --> 00:26:20,800 Speaker 3: worse by assessing it several times over time. Right. But 480 00:26:21,000 --> 00:26:24,919 Speaker 3: part of the problem with self reporting pain scales is 481 00:26:25,359 --> 00:26:28,760 Speaker 3: there could be obfuscation. Like we said, like if you're 482 00:26:28,840 --> 00:26:32,720 Speaker 3: med seeking that elderly apparently don't like to talk about 483 00:26:32,760 --> 00:26:33,240 Speaker 3: their pain. 484 00:26:33,920 --> 00:26:35,560 Speaker 1: Yeah, I mean there's a lot of reasons for that, 485 00:26:35,680 --> 00:26:39,840 Speaker 1: from the shame of like getting older and not feeling 486 00:26:39,880 --> 00:26:44,440 Speaker 1: well to well, like you said, just like they don't 487 00:26:44,440 --> 00:26:45,040 Speaker 1: want to be a bother. 488 00:26:45,240 --> 00:26:49,040 Speaker 3: A lot of times, Yeah, I read that they don't 489 00:26:49,200 --> 00:26:51,879 Speaker 3: like to talk about their pain or whether they're in pain, 490 00:26:52,240 --> 00:26:56,440 Speaker 3: but they will respond to other words that are virtually 491 00:26:56,480 --> 00:27:00,840 Speaker 3: the same thing, like sore ache, discomfort, and that. If 492 00:27:00,880 --> 00:27:04,680 Speaker 3: you're a good physician, you're going to figure out what 493 00:27:05,320 --> 00:27:08,320 Speaker 3: word they respond to most and then just replace pain 494 00:27:08,400 --> 00:27:10,200 Speaker 3: with that to get them to talk about the type 495 00:27:10,200 --> 00:27:10,919 Speaker 3: of pain they're in. 496 00:27:11,040 --> 00:27:15,200 Speaker 1: They have a little a little translation chart pretty much. 497 00:27:15,600 --> 00:27:22,359 Speaker 3: Yeah, so it's like a two right, Achy say three point. 498 00:27:22,119 --> 00:27:24,119 Speaker 1: Five and doc oi, this is killing me. 499 00:27:24,880 --> 00:27:25,680 Speaker 3: That's eleven. 500 00:27:26,359 --> 00:27:28,199 Speaker 1: I wonder if there are any pain scales where it's like, 501 00:27:29,160 --> 00:27:33,119 Speaker 1: oh my god, like weather patterns like you know, spring 502 00:27:33,200 --> 00:27:34,960 Speaker 1: day to tornado of pain. 503 00:27:35,400 --> 00:27:38,359 Speaker 3: The tornado of pain. There's another band name. 504 00:27:38,280 --> 00:27:40,280 Speaker 1: And yeah, oh yeah, that probably is a band m 505 00:27:41,280 --> 00:27:42,520 Speaker 1: And then they make them draw that. 506 00:27:42,480 --> 00:27:46,040 Speaker 3: Too, right, draw a better tornado. 507 00:27:46,320 --> 00:27:49,040 Speaker 1: Oh. I meant to say something too about the the 508 00:27:49,680 --> 00:27:52,399 Speaker 1: faces chart for kids. A lot of times they'll still, 509 00:27:52,480 --> 00:27:54,760 Speaker 1: even though they have the chart, let kids draw it 510 00:27:54,800 --> 00:27:56,639 Speaker 1: because they found that kids really enjoy doing it. 511 00:27:57,280 --> 00:27:59,040 Speaker 3: It probably takes their mind off of things. 512 00:27:59,119 --> 00:28:00,600 Speaker 1: Yeah, and the kids will like draw it and then 513 00:28:00,600 --> 00:28:04,000 Speaker 1: take it home and stuff, and yeah, it's kind of cool. 514 00:28:04,080 --> 00:28:06,919 Speaker 3: And while they're busy drawing that, the doctor sneaks up 515 00:28:06,960 --> 00:28:08,960 Speaker 3: behind them and injects them with a heavy dose of 516 00:28:09,000 --> 00:28:14,679 Speaker 3: opioids right into their neck while they're distracted. Bams so 517 00:28:14,760 --> 00:28:18,640 Speaker 3: long pain. Most of those drawings have like a big 518 00:28:18,680 --> 00:28:21,680 Speaker 3: cran streak going off the edge of the page. 519 00:28:22,520 --> 00:28:26,840 Speaker 1: So some other reasons that you might need to pull 520 00:28:26,880 --> 00:28:30,679 Speaker 1: out different chartes. Maybe someone doesn't speak the language that 521 00:28:30,720 --> 00:28:34,040 Speaker 1: the doctor speaks, right, or maybe there's a cultural difference 522 00:28:34,600 --> 00:28:36,879 Speaker 1: that just makes the scale a little more difficult to 523 00:28:37,560 --> 00:28:39,959 Speaker 1: grasp or or translate. 524 00:28:39,840 --> 00:28:42,440 Speaker 3: Or like you said, they could be cognitively challenge Sure, 525 00:28:43,120 --> 00:28:46,640 Speaker 3: there's a lot of different reasons why self reporting scale 526 00:28:47,000 --> 00:28:50,080 Speaker 3: might not work in a situation. And so in that case, 527 00:28:50,440 --> 00:28:53,160 Speaker 3: the doctor needs to rely on his or her own 528 00:28:53,240 --> 00:28:56,360 Speaker 3: observations to come up with a pain assessment. And there's 529 00:28:56,400 --> 00:29:01,360 Speaker 3: actually I found this extremely interesting that wardless of your 530 00:29:01,440 --> 00:29:05,560 Speaker 3: level of consciousness, if you are conscious and receptive to pain, 531 00:29:06,240 --> 00:29:10,959 Speaker 3: your body's going to make you react in predictable and 532 00:29:11,000 --> 00:29:13,280 Speaker 3: from what I can tell, universal ways. 533 00:29:13,640 --> 00:29:14,200 Speaker 1: Yeah. 534 00:29:14,360 --> 00:29:16,000 Speaker 3: Right, so no matter where you are in the world, 535 00:29:16,040 --> 00:29:20,040 Speaker 3: no matter whether you are cognitively challenged or whether you 536 00:29:20,160 --> 00:29:26,320 Speaker 3: have Alzheimer's or whether you are a nonverbal baby, Like, 537 00:29:26,360 --> 00:29:28,840 Speaker 3: there are going to be things that you are going 538 00:29:28,880 --> 00:29:31,600 Speaker 3: to do when you're in pain, like, for example, facial 539 00:29:31,640 --> 00:29:38,880 Speaker 3: expressions tend to change and take on reliably or reliable expressions. 540 00:29:39,120 --> 00:29:41,160 Speaker 1: Yeah, Like if you have back pain and you go 541 00:29:41,200 --> 00:29:44,360 Speaker 1: to sit down, like they're assessing you before they've even 542 00:29:44,400 --> 00:29:47,920 Speaker 1: started asking questions. So you come into the room and 543 00:29:47,960 --> 00:29:49,520 Speaker 1: you do like, you know, you grab the arm in 544 00:29:49,520 --> 00:29:51,320 Speaker 1: the chair and do the ah when you sit down. 545 00:29:52,080 --> 00:29:54,719 Speaker 1: That's a big queue to a doctor. You know, this 546 00:29:54,800 --> 00:29:57,160 Speaker 1: person is having trouble sitting and standing there in so 547 00:29:57,240 --> 00:29:57,800 Speaker 1: much back pain. 548 00:29:58,080 --> 00:29:59,680 Speaker 3: Yeah, and if someone took a picture of you at 549 00:29:59,680 --> 00:30:02,040 Speaker 3: that ex moment, you would see that your eyes are 550 00:30:02,160 --> 00:30:05,560 Speaker 3: drawn shut tightly, your lips are drawn back away from 551 00:30:05,560 --> 00:30:09,040 Speaker 3: your mouth, and your teeth are clenched down. You're grimacing 552 00:30:09,080 --> 00:30:12,240 Speaker 3: and pain and you're doing it involuntarily. 553 00:30:12,480 --> 00:30:15,479 Speaker 1: So yeah, these are behavioral behavioral cues. 554 00:30:15,800 --> 00:30:19,720 Speaker 3: Yeah, there's there's basically two categories you can put observational 555 00:30:19,800 --> 00:30:23,800 Speaker 3: pain assessment into behavioral and physiological. Right. Yeah, So on 556 00:30:23,840 --> 00:30:28,640 Speaker 3: the behavioral hand, you've got facial expressions like grimacing, You've 557 00:30:28,640 --> 00:30:34,120 Speaker 3: got sounds like moans, grunts, even people just talking about 558 00:30:34,120 --> 00:30:36,960 Speaker 3: their pain, but not not because they're being interviewed, but 559 00:30:37,080 --> 00:30:40,160 Speaker 3: just being like, you know this, oh my back or 560 00:30:40,160 --> 00:30:44,240 Speaker 3: something like that, I ache him back. Yeah, they really 561 00:30:44,280 --> 00:30:45,640 Speaker 3: worked me like a dog today. 562 00:30:48,600 --> 00:30:50,720 Speaker 1: And these are super important for all the reasons we 563 00:30:50,760 --> 00:30:53,880 Speaker 1: talked about people either not being able to report their 564 00:30:53,880 --> 00:30:57,200 Speaker 1: pain accurately or and we talked about a couple of 565 00:30:57,240 --> 00:31:00,200 Speaker 1: reasons like the drug seeking, but like little kids may 566 00:31:00,200 --> 00:31:02,520 Speaker 1: not want little kids might be afraid of needles and 567 00:31:02,560 --> 00:31:04,479 Speaker 1: they might think I'm gonna get I mean, I actually 568 00:31:04,480 --> 00:31:08,520 Speaker 1: remember doing this. I remember under reporting pain because I 569 00:31:08,520 --> 00:31:10,880 Speaker 1: was afraid I was going to get a shot if 570 00:31:10,920 --> 00:31:13,880 Speaker 1: I said I was in too much pain. And so 571 00:31:14,080 --> 00:31:15,800 Speaker 1: maybe that's why I have a high threshold now. It 572 00:31:15,800 --> 00:31:17,920 Speaker 1: has something to do with it. But I used to 573 00:31:18,000 --> 00:31:22,320 Speaker 1: be really really needle phobic and am not anymore. Like 574 00:31:22,360 --> 00:31:25,160 Speaker 1: I don't love it still, but the needles have gotten 575 00:31:25,200 --> 00:31:27,000 Speaker 1: so tiny that it's not that big of a deal. 576 00:31:28,040 --> 00:31:29,920 Speaker 3: So you were a needle phobic huh oh. 577 00:31:29,800 --> 00:31:31,840 Speaker 1: When I was a kid, Yeah, needles, you know, they 578 00:31:31,880 --> 00:31:35,560 Speaker 1: were a lot bigger. It wasn't like I mean, obviously 579 00:31:35,640 --> 00:31:37,440 Speaker 1: wasn't like the eighteen hundreds where they had like a 580 00:31:37,520 --> 00:31:41,200 Speaker 1: railroad spike, right, but it's not like today where those 581 00:31:41,200 --> 00:31:44,000 Speaker 1: little tiny, tiny thin needles. I don't know the gauges, 582 00:31:44,040 --> 00:31:46,880 Speaker 1: but yeah, when I was growing up, they were Yeah, 583 00:31:46,920 --> 00:31:49,160 Speaker 1: they I hated getting shots. 584 00:31:49,320 --> 00:31:51,280 Speaker 3: Yeah, I wasn't really big on it either, But I 585 00:31:51,280 --> 00:31:54,000 Speaker 3: don't know if I would be needle phobic. 586 00:31:54,240 --> 00:31:56,120 Speaker 1: Do you watch the needle go in or do you look? 587 00:31:56,280 --> 00:31:58,800 Speaker 3: Sometimes it depends, see, I hapends on my mood. 588 00:31:59,120 --> 00:32:01,120 Speaker 1: Oh really yeah, it depends on your mood. 589 00:32:01,400 --> 00:32:03,840 Speaker 3: Yeah. I mean if I'm feeling curious and frisky, yeah, 590 00:32:03,840 --> 00:32:05,800 Speaker 3: I'll watch it and I'll be like ooh, ooh you 591 00:32:05,880 --> 00:32:08,960 Speaker 3: missed that one and just try to psych them out. 592 00:32:09,120 --> 00:32:10,880 Speaker 1: Yeah that is kind of bad when they can't find 593 00:32:10,920 --> 00:32:13,560 Speaker 1: the vein. Sure, yeah for blood drawing. 594 00:32:13,640 --> 00:32:16,680 Speaker 3: Right, but but yeah, sometimes I'm just like, I'm not 595 00:32:16,800 --> 00:32:19,160 Speaker 3: into it today. Look away. 596 00:32:20,800 --> 00:32:22,480 Speaker 1: The other cool thing too about when you get blood 597 00:32:22,520 --> 00:32:25,880 Speaker 1: drawn today is they used to They've just come so far. Man. 598 00:32:25,960 --> 00:32:28,520 Speaker 1: Remember they used to have to if you had multiple 599 00:32:28,760 --> 00:32:32,480 Speaker 1: blood tests, you would get stuck like six times. And 600 00:32:32,560 --> 00:32:35,040 Speaker 1: now they have those awesome little tubes that they can 601 00:32:35,080 --> 00:32:35,720 Speaker 1: just unscrew. 602 00:32:36,160 --> 00:32:40,360 Speaker 3: Yeah, but I still huh flobotomy is. 603 00:32:40,320 --> 00:32:44,680 Speaker 1: That what that's called it's whoever invented that, mister Flobo 604 00:32:45,440 --> 00:32:46,960 Speaker 1: or missus Flobo, doctor. 605 00:32:46,760 --> 00:32:49,320 Speaker 3: Flobo, Phoebe Flobo. MD. 606 00:32:49,640 --> 00:32:53,040 Speaker 1: I salute you because that has really changed things for me. 607 00:32:53,560 --> 00:32:59,920 Speaker 1: But I still weirdly have this fear of of like 608 00:33:00,040 --> 00:33:01,880 Speaker 1: when they're when they're doing that unscrewing it, I have 609 00:33:01,960 --> 00:33:03,960 Speaker 1: this fear that they're gonna knock the needle and it's 610 00:33:04,000 --> 00:33:05,080 Speaker 1: gonna kind of like rip out of. 611 00:33:05,080 --> 00:33:06,080 Speaker 3: My arm me too. 612 00:33:06,280 --> 00:33:08,520 Speaker 1: Oh okay, so that's is that a common thing? Maybe? 613 00:33:08,920 --> 00:33:11,560 Speaker 3: Oh yeah, for sure. It's so flimsy looking and it's 614 00:33:11,600 --> 00:33:14,120 Speaker 3: basically being held in by the needle, but there's this big, 615 00:33:14,160 --> 00:33:17,880 Speaker 3: top heavy tube that's attached to it. Yeah that Yeah, 616 00:33:17,920 --> 00:33:19,880 Speaker 3: it's just gonna rip it out, and it's gonna pull 617 00:33:19,920 --> 00:33:22,240 Speaker 3: like all of your veins and your muscle out right 618 00:33:22,320 --> 00:33:25,200 Speaker 3: after it like a bunch of bloody party streamers. Yeah, 619 00:33:25,240 --> 00:33:26,000 Speaker 3: I know what you mean. 620 00:33:26,440 --> 00:33:29,640 Speaker 1: And I'm a slightly phobic still about them not being 621 00:33:29,680 --> 00:33:31,200 Speaker 1: able to find the vein so like, you know, they 622 00:33:31,200 --> 00:33:33,880 Speaker 1: give you the ball to squeeze. I turned that thing 623 00:33:33,920 --> 00:33:37,160 Speaker 1: into dust. Oh yeah, because I want I want, like 624 00:33:37,520 --> 00:33:39,400 Speaker 1: and I'm watching them and they're like, I think I 625 00:33:39,400 --> 00:33:40,760 Speaker 1: got one here. I'm like, are you sure. I don't 626 00:33:40,760 --> 00:33:43,480 Speaker 1: see it, like I want to see that vein bulging 627 00:33:43,520 --> 00:33:47,080 Speaker 1: out for them to go in with that needle. I know, 628 00:33:47,280 --> 00:33:48,480 Speaker 1: maybe I'm still needle phobic. 629 00:33:48,680 --> 00:33:51,800 Speaker 3: It sounds a bit like it. Yeah, I don't think 630 00:33:51,840 --> 00:33:52,920 Speaker 3: you like the needles. 631 00:33:53,200 --> 00:33:55,360 Speaker 1: No, but I mean, hats off to the nurses. That's 632 00:33:55,360 --> 00:33:57,840 Speaker 1: a tough job because there are varying degrees of needle phobia, 633 00:33:57,880 --> 00:33:59,520 Speaker 1: and I know it's probably never any fun. 634 00:33:59,720 --> 00:34:02,640 Speaker 3: Sure, well, that's good though. That means your chances of 635 00:34:02,680 --> 00:34:04,920 Speaker 3: becoming an intravenious drug user. 636 00:34:04,800 --> 00:34:07,480 Speaker 1: Like zero, yes, exactly zero chance. 637 00:34:07,880 --> 00:34:12,960 Speaker 3: So chuck. In addition to those behavioral cues, right, like, 638 00:34:13,000 --> 00:34:15,759 Speaker 3: body language is another one too, where like you're you're 639 00:34:15,920 --> 00:34:18,560 Speaker 3: you've got your arm kind of guarding your broken rib 640 00:34:18,680 --> 00:34:19,479 Speaker 3: or something like that. 641 00:34:19,400 --> 00:34:21,759 Speaker 1: Like get back, get back, Yeah, sure, everybody, stay back. 642 00:34:23,480 --> 00:34:27,320 Speaker 3: That's fairly universal from what I understand. There's also physiological 643 00:34:27,400 --> 00:34:34,120 Speaker 3: changes too, like you may become nauseous, or your heartbeat 644 00:34:34,280 --> 00:34:40,080 Speaker 3: or respiration starts increasing, you sweat. There's a lot of 645 00:34:40,160 --> 00:34:44,080 Speaker 3: changes that the body undergoes that can be objectively observed 646 00:34:44,920 --> 00:34:48,160 Speaker 3: with that where it's like, oh, that guy's sweating like 647 00:34:47,239 --> 00:34:52,560 Speaker 3: a like a chuck. Okay, he must be at like 648 00:34:52,600 --> 00:34:55,640 Speaker 3: a ten right now, even though we can't talk. Because 649 00:34:55,640 --> 00:34:57,920 Speaker 3: that's another one too, Like, you may be in so 650 00:34:58,080 --> 00:35:03,000 Speaker 3: much pain that you can't you can't talk, you can't 651 00:35:03,080 --> 00:35:06,000 Speaker 3: focus or concentrate on talking, so you certainly can't self 652 00:35:06,040 --> 00:35:06,799 Speaker 3: report your pain. 653 00:35:06,920 --> 00:35:09,880 Speaker 1: Yeah, or have an injury that keeps you from talking. Yeah, 654 00:35:09,960 --> 00:35:11,839 Speaker 1: you know, like I've almost bit my tongue off when 655 00:35:11,840 --> 00:35:14,480 Speaker 1: I was a kid, oh man, and I you know, 656 00:35:14,520 --> 00:35:15,799 Speaker 1: I couldn't talk very well. 657 00:35:16,120 --> 00:35:19,560 Speaker 3: Yeah, Well now you talk great, so. 658 00:35:19,560 --> 00:35:21,440 Speaker 1: Much so that I do it for a living. Sure, 659 00:35:22,160 --> 00:35:23,839 Speaker 1: And they're all, like I said, there are so many 660 00:35:23,840 --> 00:35:26,960 Speaker 1: of these pain scales, and they some of them can 661 00:35:27,000 --> 00:35:30,040 Speaker 1: get very specific for the kind of person that they're 662 00:35:30,160 --> 00:35:34,040 Speaker 1: they're treating. There's one called the c n p I Checklist, 663 00:35:34,680 --> 00:35:40,719 Speaker 1: and this is specifically for cognitively impaired elderly. 664 00:35:41,680 --> 00:35:42,759 Speaker 3: Oh, that's specific. 665 00:35:42,880 --> 00:35:45,919 Speaker 1: And it's a nonverbal checklist basically that doctors can use. 666 00:35:46,480 --> 00:35:48,840 Speaker 1: And we've talked about cognitive impairments. Doctors have to be 667 00:35:48,920 --> 00:35:53,800 Speaker 1: really skilled and careful there because when they're assessing pain, 668 00:35:54,560 --> 00:35:58,520 Speaker 1: because if you're assessing behavioral traits and someone has a 669 00:35:58,520 --> 00:36:02,799 Speaker 1: cognitive impairment, it can be very confusing to assess that 670 00:36:02,840 --> 00:36:05,640 Speaker 1: because there may be another need not being met, like 671 00:36:05,719 --> 00:36:09,600 Speaker 1: they might be hungry or over stimulated or thirsty, right, 672 00:36:09,640 --> 00:36:12,560 Speaker 1: and that's coming out or anxiety maybe, and that's coming 673 00:36:12,560 --> 00:36:15,439 Speaker 1: out in the way they're acting, and the doctor has 674 00:36:15,480 --> 00:36:17,799 Speaker 1: to be able to kind of wade through that to 675 00:36:17,800 --> 00:36:19,359 Speaker 1: get an accurate reading, right. 676 00:36:19,440 --> 00:36:24,720 Speaker 3: And then so with these observational scales, in some cases 677 00:36:24,760 --> 00:36:27,120 Speaker 3: the doctor will just be like, ooh, that guy's really 678 00:36:27,160 --> 00:36:32,200 Speaker 3: grimacing horribly, so he's probably at like a ten. Other 679 00:36:32,280 --> 00:36:38,280 Speaker 3: ones actually quantify these different observations, like the Cries tool 680 00:36:38,960 --> 00:36:43,480 Speaker 3: for Infants and Pain, which is about as sad a 681 00:36:43,560 --> 00:36:49,880 Speaker 3: thought as there is, but it's basically several different observations 682 00:36:50,280 --> 00:36:55,400 Speaker 3: that fall into behavior and physiological trenches. And then you know, 683 00:36:55,480 --> 00:36:58,120 Speaker 3: the doctor rates each one on I think is zero 684 00:36:58,200 --> 00:37:00,520 Speaker 3: to two or something like that, and then if the 685 00:37:00,600 --> 00:37:03,719 Speaker 3: sum total of each category adds up to four or more, 686 00:37:03,960 --> 00:37:06,440 Speaker 3: then it's the baby's in a type of pain that 687 00:37:06,480 --> 00:37:08,280 Speaker 3: would require some sort of medication. 688 00:37:08,800 --> 00:37:11,320 Speaker 1: Yeah. I looked into this one a bit more. Cr 689 00:37:11,360 --> 00:37:17,680 Speaker 1: i e S stands for crying requires oxygen for saturation 690 00:37:18,000 --> 00:37:19,240 Speaker 1: greater than ninety five percent. 691 00:37:19,719 --> 00:37:21,600 Speaker 3: That is a terrible acronym. 692 00:37:21,760 --> 00:37:25,960 Speaker 1: No I for increased vital signs for expression s for sleepless, 693 00:37:26,760 --> 00:37:29,480 Speaker 1: A zero would be a cry that's not high pitched, 694 00:37:30,680 --> 00:37:33,680 Speaker 1: like a yeah, I guess, like a whimpering cry. A 695 00:37:33,719 --> 00:37:36,520 Speaker 1: two I'm sorry one would be high pitched, but the 696 00:37:36,920 --> 00:37:40,040 Speaker 1: kid is easily consoled, and a two would be high 697 00:37:40,120 --> 00:37:42,200 Speaker 1: pitched and not inconsolable. 698 00:37:42,600 --> 00:37:42,920 Speaker 3: Wow. 699 00:37:43,400 --> 00:37:51,160 Speaker 1: The oxygenation. Basically, then, is there an decrease sorry in 700 00:37:51,440 --> 00:37:55,640 Speaker 1: two at certain levels? Number three the vital signs, which 701 00:37:55,680 --> 00:37:58,200 Speaker 1: is heart rate and blood pressure. In this case zero's 702 00:37:58,280 --> 00:38:02,240 Speaker 1: unchanged increase less is the one greater than twenty percent 703 00:38:02,560 --> 00:38:08,200 Speaker 1: is a two? Expression No, grimace is zero just a 704 00:38:08,200 --> 00:38:12,640 Speaker 1: grimace by itself is a one, and a griminace, sorry, 705 00:38:12,840 --> 00:38:16,959 Speaker 1: a grimace with a non crying grunt. It's a two. 706 00:38:17,600 --> 00:38:18,520 Speaker 3: That's not a good one. 707 00:38:18,560 --> 00:38:20,960 Speaker 1: Well because they've already covered crying, so yeah, a non 708 00:38:21,000 --> 00:38:25,800 Speaker 1: crying grunt. And then sleepless continually sleep zero, awaken frequently 709 00:38:25,800 --> 00:38:30,719 Speaker 1: one and always constantly awake two. Man, And then they 710 00:38:30,760 --> 00:38:32,440 Speaker 1: total those up, like you said, that. 711 00:38:32,520 --> 00:38:33,680 Speaker 3: Is a sad scale. 712 00:38:34,080 --> 00:38:36,160 Speaker 1: It is, man. I think I've said before. I used 713 00:38:36,160 --> 00:38:40,160 Speaker 1: to do pa jobs in LA for this one company 714 00:38:40,160 --> 00:38:44,279 Speaker 1: who did well. They did two hospitals. They did City 715 00:38:44,320 --> 00:38:46,520 Speaker 1: of Hope Cancer Research, which is where I saw the 716 00:38:46,560 --> 00:38:50,600 Speaker 1: head in the bucket, right, and then Children's Hospital Los 717 00:38:50,640 --> 00:38:55,520 Speaker 1: Angeles CHLA oh Man, which was a really rewarding experience, 718 00:38:55,600 --> 00:39:00,560 Speaker 1: but the toughest job I ever had, Like you know, 719 00:39:00,600 --> 00:39:02,839 Speaker 1: the worst stuff you can imagine. And I gotta say, 720 00:39:03,600 --> 00:39:11,399 Speaker 1: kids are the bravest, best attitudeinal they had the best 721 00:39:11,400 --> 00:39:13,520 Speaker 1: attitudes and they were the bravest of it, like any 722 00:39:13,600 --> 00:39:15,759 Speaker 1: humans I ever saw in the face of like the 723 00:39:15,800 --> 00:39:19,120 Speaker 1: most daunting things, like compared to adults. I was just like, man, 724 00:39:19,239 --> 00:39:22,080 Speaker 1: adults need to take some lessons from kids, Yeah, because 725 00:39:22,120 --> 00:39:24,759 Speaker 1: it's amazing, like the attitudes these kids had. Man, that's 726 00:39:24,800 --> 00:39:27,239 Speaker 1: neat it was. And you know, I've also been in 727 00:39:27,280 --> 00:39:31,920 Speaker 1: the emergency room on the flip side and seeing adults 728 00:39:32,560 --> 00:39:34,200 Speaker 1: that I think they think they might be able to 729 00:39:34,200 --> 00:39:37,680 Speaker 1: get soon sooner if they wail in pain. 730 00:39:38,600 --> 00:39:42,400 Speaker 3: Right, like when they're wailing and whaling, and then you 731 00:39:42,440 --> 00:39:44,360 Speaker 3: see them like open one eye and look around. 732 00:39:45,400 --> 00:39:47,200 Speaker 1: And I hate to say that because maybe they are 733 00:39:47,200 --> 00:39:48,680 Speaker 1: in that kind of pain and that's just how they 734 00:39:48,760 --> 00:39:51,839 Speaker 1: express it. But usually when I'm in the emergency room, 735 00:39:51,880 --> 00:39:55,319 Speaker 1: there's one person that's just like oh, and I'm like 736 00:39:55,360 --> 00:39:58,439 Speaker 1: come on, man, you're just trying to You're just trying 737 00:39:58,480 --> 00:39:59,680 Speaker 1: to get to the front of the line. 738 00:40:00,200 --> 00:40:02,040 Speaker 3: H rt S. 739 00:40:02,200 --> 00:40:03,919 Speaker 1: And then I see these kids in the cancer war 740 00:40:03,960 --> 00:40:06,560 Speaker 1: that are just like smiling and playing. I'm like, you know, 741 00:40:07,680 --> 00:40:09,840 Speaker 1: it's hard to not be a little cynical about adults 742 00:40:09,880 --> 00:40:11,240 Speaker 1: and how they handle that stuff. 743 00:40:11,480 --> 00:40:14,200 Speaker 3: Yeah, no, it's true. It does seem like you do 744 00:40:14,360 --> 00:40:17,160 Speaker 3: kind of get warsier as the as you age. 745 00:40:17,520 --> 00:40:19,720 Speaker 1: Yeah, up to a point. Yeah, I agree. 746 00:40:20,440 --> 00:40:21,439 Speaker 3: So you got anything else? 747 00:40:22,600 --> 00:40:24,880 Speaker 1: Uh No, I mean there's you know, there's tons and 748 00:40:24,920 --> 00:40:26,879 Speaker 1: tons of pain scales that we didn't cover, and they're 749 00:40:26,920 --> 00:40:30,200 Speaker 1: all basically after the same thing in slightly different ways. 750 00:40:30,320 --> 00:40:31,600 Speaker 1: So let's just leave it at that. 751 00:40:32,120 --> 00:40:35,439 Speaker 3: Okay, pain scales. Who'd have thought we would do pain 752 00:40:35,480 --> 00:40:37,240 Speaker 3: scales before we did one on pain. 753 00:40:37,760 --> 00:40:39,960 Speaker 1: Well, now when we do one on pain, we can 754 00:40:40,000 --> 00:40:42,399 Speaker 1: just say and there are also pain scales, which we've 755 00:40:42,400 --> 00:40:44,320 Speaker 1: detailed thoroughly. 756 00:40:44,719 --> 00:40:47,359 Speaker 3: Yeah we do that, don't we. All Right, Well, if 757 00:40:47,400 --> 00:40:49,359 Speaker 3: you want to know more about pain scales, type those 758 00:40:49,360 --> 00:40:51,680 Speaker 3: words in the search bar at HowStuffWorks dot com. And 759 00:40:51,719 --> 00:40:54,400 Speaker 3: since I said that, it's time for listener mail. 760 00:40:56,719 --> 00:40:59,879 Speaker 1: Uh, I'm gonna call this just email from the seeming lever, 761 00:41:00,200 --> 00:41:04,960 Speaker 1: nice guy or a big phony. Hey, guys, been a 762 00:41:04,960 --> 00:41:06,560 Speaker 1: listener for three to four years. I think I've always 763 00:41:06,560 --> 00:41:08,600 Speaker 1: wanted to write in but with Shy, I thought it 764 00:41:08,640 --> 00:41:11,200 Speaker 1: was worth mentioning that I listened to about thirty hours 765 00:41:11,200 --> 00:41:14,399 Speaker 1: of podcasts per week and you are in my top 766 00:41:14,480 --> 00:41:17,839 Speaker 1: two favorites. This guy's a pro, which basically that means 767 00:41:17,840 --> 00:41:20,440 Speaker 1: we're number two, or he would have said we're his favorite. 768 00:41:20,719 --> 00:41:22,720 Speaker 3: Yeah, I guess you're right, which is fine. 769 00:41:23,080 --> 00:41:24,600 Speaker 1: I guess I kind of want to know what number 770 00:41:24,600 --> 00:41:27,799 Speaker 1: one is though, Yeah, I'd like to know as well. 771 00:41:27,920 --> 00:41:31,520 Speaker 1: To Scott follow up on this, please second, but related, 772 00:41:31,520 --> 00:41:35,960 Speaker 1: I'm a master's level Board Certified Behavior Analyst a BCBA, 773 00:41:36,440 --> 00:41:38,480 Speaker 1: and I am almost finished with my PhD. And I 774 00:41:38,520 --> 00:41:40,960 Speaker 1: think you might enjoy hearing that you guys actually do 775 00:41:41,000 --> 00:41:44,879 Speaker 1: a pretty decent job handling psychological concepts where many other 776 00:41:44,920 --> 00:41:48,880 Speaker 1: podcasts don't. Oftentimes you are to cursory, too credulous, or 777 00:41:48,920 --> 00:41:51,040 Speaker 1: they oversimplify or something else, and you guys do a 778 00:41:51,040 --> 00:41:54,120 Speaker 1: great job. And it brings me to my third point. 779 00:41:54,280 --> 00:41:56,760 Speaker 1: You guys have been on a super hot streak lately. 780 00:41:57,200 --> 00:41:59,080 Speaker 1: I think the last month contained some of my favorite 781 00:41:59,120 --> 00:42:01,759 Speaker 1: material to date. I don't know what's going on, but 782 00:42:01,920 --> 00:42:02,399 Speaker 1: keep it up. 783 00:42:02,960 --> 00:42:04,440 Speaker 3: I've been listening for two months. 784 00:42:05,400 --> 00:42:09,920 Speaker 1: We're on steroids, that's it. And finally, I really loved 785 00:42:09,960 --> 00:42:13,080 Speaker 1: your episode on pacifism. Actually consider myself on the more 786 00:42:13,080 --> 00:42:16,160 Speaker 1: extreme end of pacifism. I do not wish harm on 787 00:42:16,280 --> 00:42:21,759 Speaker 1: anyone under any circumstance. That's nice, right. I like to 788 00:42:21,800 --> 00:42:24,640 Speaker 1: believe I would die to protect my enemy, to save 789 00:42:24,640 --> 00:42:29,160 Speaker 1: a life. Wow, he really is on the far end. Yeah, 790 00:42:29,320 --> 00:42:32,840 Speaker 1: he makes Gandhi look like Edie. I mean yeah, although 791 00:42:33,239 --> 00:42:36,040 Speaker 1: actually I've never actually tested this to be fair. That 792 00:42:36,080 --> 00:42:37,880 Speaker 1: being said, I also don't think that I could allow 793 00:42:37,920 --> 00:42:40,839 Speaker 1: someone to come to harm if I could do something 794 00:42:40,840 --> 00:42:43,840 Speaker 1: about it, although I'd prefer to take their place and 795 00:42:43,920 --> 00:42:48,120 Speaker 1: then rather than hurt their attacker. Also, similar to what 796 00:42:48,160 --> 00:42:49,960 Speaker 1: Chuck said about his wife, I cannot stand to see 797 00:42:49,960 --> 00:42:53,200 Speaker 1: harm come to animals. As John Lennon said, war is over. 798 00:42:53,320 --> 00:42:56,239 Speaker 1: If you want it, You guys are fantastic. I wish 799 00:42:56,280 --> 00:42:58,160 Speaker 1: you all the best. If you ever have any questions 800 00:42:58,200 --> 00:43:01,040 Speaker 1: about behavioral psychology, be happy to be as much of 801 00:43:01,040 --> 00:43:02,640 Speaker 1: a resource as I can be. And that is from 802 00:43:02,640 --> 00:43:07,520 Speaker 1: Scott Miller of the University of Nebraska. 803 00:43:07,640 --> 00:43:11,160 Speaker 3: Go Corn dogs corn huskers. Oh yeah, that's right. 804 00:43:11,640 --> 00:43:13,360 Speaker 1: You gotta husk the corn before you can make it 805 00:43:13,400 --> 00:43:14,200 Speaker 1: into a corn dog. 806 00:43:14,480 --> 00:43:17,719 Speaker 3: That's true unless you're doing it like farmhouse style, in 807 00:43:17,760 --> 00:43:20,800 Speaker 3: which case you would include the husk into the ultimate 808 00:43:20,840 --> 00:43:21,359 Speaker 3: corn meal. 809 00:43:21,560 --> 00:43:23,320 Speaker 1: Yes, and you can find those at county fairs. 810 00:43:24,520 --> 00:43:26,799 Speaker 3: Thanks a lot, Scott. If you want to get in 811 00:43:26,840 --> 00:43:29,440 Speaker 3: touch with us, like Scott did, you can send us 812 00:43:29,440 --> 00:43:32,520 Speaker 3: an email to Stuff podcast at HowStuffWorks dot com and 813 00:43:32,600 --> 00:43:34,280 Speaker 3: has always joined us at our home on the web, 814 00:43:34,480 --> 00:43:38,920 Speaker 3: Stuff Youshould Know dot com. 815 00:43:39,000 --> 00:43:41,880 Speaker 2: Stuff You Should Know is a production of iHeartRadio. For 816 00:43:42,000 --> 00:43:46,160 Speaker 2: more podcasts my heart Radio, visit the iHeartRadio app, Apple Podcasts, 817 00:43:46,280 --> 00:43:48,120 Speaker 2: or wherever you listen to your favorite shows.