WEBVTT - Selects: Pain Scales: Yeeeow! 0:00:00.800 --> 0:00:03.559 How to everybody. We're gonna take you back in time 0:00:03.600 --> 0:00:07.560 to March fourteenth, twenty seventeen for this week's Selects episode. 0:00:07.600 --> 0:00:13.480 Pick pain Scales colon eow exclamation point. I know that 0:00:13.520 --> 0:00:16.680 was a Josh title because it's funny and creative and 0:00:16.760 --> 0:00:20.439 he's great at those. So pain scales is pretty interesting stuff. 0:00:20.680 --> 0:00:22.599 You've ever been to a doctor and they say like, oh, 0:00:22.840 --> 0:00:25.080 it is a between a one and ten. That's one 0:00:25.160 --> 0:00:27.360 kind of pain scale. But they are all kinds of 0:00:27.360 --> 0:00:30.360 pain scales, and believe it or not, they're not arbitrary. 0:00:30.560 --> 0:00:32.479 A lot of thought went into how they were formed 0:00:32.520 --> 0:00:36.280 and built and put together. So check out pain Scales 0:00:36.560 --> 0:00:38.120 colon EOW. 0:00:38.680 --> 0:00:47.040 Right now, welcome to Stuff You Should Know, a production 0:00:47.320 --> 0:00:57.600 of iHeartRadio. 0:00:54.640 --> 0:00:58.240 Pay and welcome to the podcast. I'm Josh Clark, Hi, 0:00:58.680 --> 0:01:05.559 there's Charles Tivchuk hi, and Jerry's over there in silence. Well, 0:01:05.600 --> 0:01:08.840 you put us three together, you get stuff you should know. 0:01:09.600 --> 0:01:13.840 Sorry, in advanced those three you just had a disassociative experience. 0:01:14.240 --> 0:01:17.440 I did because I want to be anywhere but where 0:01:17.440 --> 0:01:19.839 I am right now, which is in a lot of pain. 0:01:20.880 --> 0:01:21.559 Are you in pain? 0:01:22.240 --> 0:01:25.399 Yes? I just hit my hand with a hammer. Really 0:01:25.440 --> 0:01:28.600 hard to get ready for this episode. Nice right in 0:01:28.680 --> 0:01:30.800 the middle of the middle knuckle. 0:01:31.240 --> 0:01:33.639 You know, the one of the very first dumb jokes 0:01:33.680 --> 0:01:34.360 I made. 0:01:34.360 --> 0:01:36.679 Like, really, I think I need to go to the hospital. 0:01:38.760 --> 0:01:44.640 What In my very first podcast appearance with you, I 0:01:44.680 --> 0:01:47.680 said that I was a method podcaster and that I 0:01:47.920 --> 0:01:50.280 just got through brushing my teeth and drinking orange juice. 0:01:50.320 --> 0:01:55.360 Oh yeah, yep, you have revived that dumb joke from 0:01:55.400 --> 0:01:58.920 thirty seven years ago, right with a hammer, And here 0:01:58.960 --> 0:02:03.400 we are, and here we are Chuck talking about pain. Yeah. 0:02:03.440 --> 0:02:07.000 You know, I thought this one, for all its kind 0:02:07.040 --> 0:02:11.679 of sameness and basicness, was way more interesting than I thought. 0:02:11.720 --> 0:02:14.400 Once you dig in a little bit more. Yep, pain, 0:02:14.800 --> 0:02:15.280 how about that? 0:02:15.960 --> 0:02:17.880 Yeah? I thought this one was pretty cool too. We 0:02:17.960 --> 0:02:21.040 need to do like a pain episode just on pain, 0:02:22.480 --> 0:02:23.520 just in general. 0:02:23.560 --> 0:02:24.160 House of pain. 0:02:25.400 --> 0:02:28.440 Yeah, the TV show and the group. 0:02:28.919 --> 0:02:30.120 I didn't know this was a TV show. 0:02:30.240 --> 0:02:31.720 Yeah, it's a Tyler Perry show. 0:02:31.880 --> 0:02:33.200 Oh okay, well that explains it. 0:02:33.200 --> 0:02:36.800 It's about the Pains and their house. 0:02:36.960 --> 0:02:37.640 Yeah, I get it. 0:02:38.800 --> 0:02:40.720 I think it's kind of like Mama's Family a little 0:02:40.760 --> 0:02:45.240 bit that either same production quality, that kind of stuff 0:02:45.320 --> 0:02:47.680 looks like it's recorded on a stage. 0:02:47.960 --> 0:02:52.320 Sure, probably is you know what I'm talking about. Mama's Family. Yeah, 0:02:52.320 --> 0:02:52.960 I didn't watch that. 0:02:54.400 --> 0:02:56.519 Well, had you, you would have known pain. 0:02:56.639 --> 0:02:58.720 Which is weird because I love the Carol Burnett Show. 0:02:59.440 --> 0:03:03.440 Yeah, this is a pretty far cry from that. Mama's House, 0:03:03.919 --> 0:03:08.480 Mama's Family, Mama's Family with Bubba the grandson. Oh man, 0:03:08.560 --> 0:03:15.840 it was bad, it was bad. But anyway, Yeah, there's 0:03:15.840 --> 0:03:18.000 no segue. Let's just get back to pain. 0:03:18.680 --> 0:03:22.040 Yes, and not just pain because like you said, we're 0:03:22.080 --> 0:03:23.800 going to do one on that one day, but pain 0:03:23.919 --> 0:03:28.000 scale specifically, which is are I should say, because there 0:03:28.000 --> 0:03:32.400 are many, many of them. As this article astutely points out, 0:03:32.480 --> 0:03:36.240 there really is no physical instrument, although they have tried 0:03:36.280 --> 0:03:40.000 over the years, that can accurately measure pain, and so 0:03:40.160 --> 0:03:44.440 doctors rely on a couple of methods, which is, hey, dummy, 0:03:44.840 --> 0:03:45.720 how much do you hurt? 0:03:46.640 --> 0:03:50.360 Hey, hey, you stop crying? Tell her how much your pain. 0:03:50.240 --> 0:03:53.760 Is, or I'm going to look at you and talk 0:03:53.800 --> 0:03:55.320 to you a bit, and I'm going to make my 0:03:55.320 --> 0:03:57.200 own assessment because I'm the doctor. 0:03:57.360 --> 0:04:01.800 Right, and I'm going to write like could could brush 0:04:01.920 --> 0:04:04.920 his hair a little more? And it does too. I'm 0:04:04.920 --> 0:04:07.360 gonna make my own observations about you man. 0:04:07.400 --> 0:04:09.720 I haven't used a hair brush since I was probably thirteen. 0:04:10.600 --> 0:04:12.160 I have two once in a while because my hair 0:04:12.240 --> 0:04:15.600 is kind of longish now, and when the wind blows 0:04:15.640 --> 0:04:18.159 it really turns it into a bird's nest. So so you. 0:04:18.160 --> 0:04:19.680 Get out of the comba from her pocket. 0:04:19.960 --> 0:04:22.440 Yep, I stand in front of the mirror like Marsha 0:04:22.520 --> 0:04:26.360 Brady right before bed and count off one hundred brush trucks. 0:04:28.000 --> 0:04:32.000 Yeah, so let's talk about you know, basically we're talking 0:04:32.040 --> 0:04:34.760 about self reporting or observation. Those are the kind of 0:04:34.760 --> 0:04:37.960 the two methods because it's important, you know, you gotta 0:04:38.560 --> 0:04:40.880 There's a lot that goes into determining how much pain 0:04:40.960 --> 0:04:43.800 someone's in, from the kind of meds they get to 0:04:43.880 --> 0:04:47.000 relieve that pain, to diagnosis of what the heck's going on. 0:04:47.320 --> 0:04:50.360 Well, yeah, the medical community just in the last probably 0:04:50.400 --> 0:04:52.640 decade or so, is really waking up to the fact 0:04:52.640 --> 0:04:55.479 that it's doing a lousy job, or traditionally has done 0:04:55.480 --> 0:04:59.159 a lousy job of managing pain. There's a lot of 0:04:59.160 --> 0:05:03.680 assumption that people are big babies who don't really need medication, 0:05:03.839 --> 0:05:06.960 they just need to suck it up. Sure, there's a 0:05:06.960 --> 0:05:10.240 lot of problems with med seeking where people pretend that 0:05:10.279 --> 0:05:13.880 they have pain that they don't actually have, and they 0:05:14.480 --> 0:05:18.640 because they want the drugs. But then there's also just 0:05:18.720 --> 0:05:23.680 this idea that managed pain care isn't quite as good 0:05:23.680 --> 0:05:27.160 as it should be. So part and parcel of that 0:05:27.640 --> 0:05:29.679 is realizing like, well, then we need to be able 0:05:29.680 --> 0:05:33.040 to quantify levels of pain a lot better. And this 0:05:33.160 --> 0:05:35.560 is the idea that they're waking up to. It is 0:05:35.800 --> 0:05:40.080 fairly new, but the idea that we can't quantify pain 0:05:40.520 --> 0:05:43.479 is a pretty old one. People figured it out pretty 0:05:43.480 --> 0:05:47.520 early on that pain is subjective. It's a subjective, horrible, 0:05:47.880 --> 0:05:51.400 terrible experience. And actually ran across one definition of pain 0:05:52.200 --> 0:05:55.480 from a researcher that said pain is whatever the person 0:05:55.560 --> 0:05:57.000 experiencing it says it is. 0:05:57.279 --> 0:05:59.200 Yeah, it's as simple as that. 0:05:59.200 --> 0:06:01.920 That doesn't really help a doctor who's trying to figure 0:06:01.960 --> 0:06:05.520 out how much medication to give you or whether to 0:06:05.680 --> 0:06:08.120 just go ahead and like put a pillow over your 0:06:08.120 --> 0:06:09.280 face or something make. 0:06:09.240 --> 0:06:11.320 You go to sleep, Yeah, because that's what doctors do. 0:06:11.800 --> 0:06:14.520 Well, yeah, it's a last resort, but they it's in 0:06:14.560 --> 0:06:15.400 their toolbox. 0:06:16.560 --> 0:06:20.440 Yeah, and they It's become so important that there's a 0:06:20.480 --> 0:06:23.520 group called the American Pain Society, which is a great 0:06:23.600 --> 0:06:28.279 band name. Oh it really is? Yeah, right, probably some 0:06:28.320 --> 0:06:31.200 sort of metal, right, or I. 0:06:31.160 --> 0:06:35.000 Could see like kind of like a sex pop kind. 0:06:34.800 --> 0:06:36.240 Of I don't even know what that is. 0:06:36.520 --> 0:06:37.200 I don't either. 0:06:37.920 --> 0:06:41.760 You just invented a genre. Yeah, they're calling it the 0:06:41.800 --> 0:06:46.159 fifth vital sign, which means that's important. 0:06:46.400 --> 0:06:51.359 Kind of like thrill Killed cult or who is the 0:06:51.400 --> 0:06:52.880 other Lords of Acid? 0:06:53.160 --> 0:06:57.800 I don't know who they are. What, dude, that's your 0:06:57.839 --> 0:07:02.279 what you got? Requested our San Francisco show to say 0:07:02.320 --> 0:07:04.720 that you're so famous for saying that when I haven't 0:07:04.720 --> 0:07:05.320 heard of something. 0:07:06.240 --> 0:07:10.520 What, Well, go listen to those bands and you'll be like, oh, 0:07:10.600 --> 0:07:14.080 sex pop Okay, but that's more like sex tech. No, 0:07:15.560 --> 0:07:16.520 I don't know what sex pop. 0:07:16.520 --> 0:07:19.000 Way doesn't sound like it's up my alley, okay, but 0:07:19.040 --> 0:07:19.880 I'll give it a shot. 0:07:20.040 --> 0:07:20.440 All right. 0:07:21.040 --> 0:07:27.480 So pain, quantifying pain specifically was or pain in general 0:07:27.520 --> 0:07:30.880 actually was, like you said, misunderstood for a long time, 0:07:31.360 --> 0:07:33.880 and it took all the way into the twentieth century. 0:07:34.120 --> 0:07:37.200 Quite a bit into the twentieth century with doctors still 0:07:38.000 --> 0:07:41.280 kind of struggling with how much you know anesthesia to give, 0:07:41.720 --> 0:07:43.720 how many meds to give? If you were in pain 0:07:43.760 --> 0:07:46.640 if you were in surgery and childbirth, like you know, 0:07:47.520 --> 0:07:51.000 literally people waking up in surgery and going, oh, well, 0:07:51.920 --> 0:07:55.760 we didn't give that person enough anesthetic, And we talked 0:07:55.960 --> 0:07:58.880 about that in our anesthesia episode a little bit. There's 0:07:58.880 --> 0:08:00.800 just a lot of trial and error, like, I guess 0:08:00.880 --> 0:08:03.640 that's not enough because someone's screaming on the table in 0:08:03.680 --> 0:08:04.160 front of me. 0:08:04.480 --> 0:08:09.720 Well. Plus also, so pain apparently is pretty widespread. I 0:08:09.760 --> 0:08:12.040 saw that in the US alone, nine out of ten 0:08:12.120 --> 0:08:17.080 people regularly suffer from pain at any given time. Twenty 0:08:17.080 --> 0:08:20.440 five million people, well I guess, over the course of 0:08:20.440 --> 0:08:23.520 a year suffer acute pain in the US, and another 0:08:23.600 --> 0:08:26.720 fifty million suffer chronic pain, and many of those people 0:08:26.840 --> 0:08:30.960 report suffering chronic pain for five years or more. So. Yeah, 0:08:30.960 --> 0:08:33.200 so the medical community says we need to do something 0:08:33.240 --> 0:08:35.160 about this, and it's like you were saying. The American 0:08:35.200 --> 0:08:38.600 Pain Society, they say that pain is the fifth vital sign. 0:08:38.800 --> 0:08:45.800 Yeah, the fifth beetle. What was his clarence, Yeah, it's 0:08:45.880 --> 0:08:47.240 great Eddie Murphy's gay. 0:08:47.200 --> 0:08:47.400 Yeah. 0:08:48.559 --> 0:08:50.600 So if we go back in time to the time 0:08:50.600 --> 0:08:54.080 where they were trying to be a little more objective 0:08:54.080 --> 0:08:57.640 about it and actually come up with a little more 0:08:57.720 --> 0:09:01.640 what they thought were like foolproof ways to determine pain measurement. 0:09:02.559 --> 0:09:06.920 In nineteen forty, there were some researchers a trio, one 0:09:07.160 --> 0:09:11.600 James Hardy, one Harold Wolf, and one Helen Goodell of 0:09:11.640 --> 0:09:13.000 Cornell University. 0:09:13.559 --> 0:09:18.440 Those are some nineteen forties names. Sure, Harold Wolf, yeah, 0:09:18.640 --> 0:09:19.600 James Hardy. 0:09:19.520 --> 0:09:25.520 Yeah, Helen Goodell, all three of them. They actually built 0:09:25.520 --> 0:09:31.320 a device called a dolarimeter. And what this was was 0:09:31.360 --> 0:09:34.800 basically a one hundred watt lamp with a lens that 0:09:34.840 --> 0:09:37.079 they could focus you know how you do when you're 0:09:38.679 --> 0:09:42.200 burning ants, Yeah, with a magnifying glass. Yeah, that's kind 0:09:42.240 --> 0:09:43.800 of what they were doing. And they were cranking up 0:09:43.800 --> 0:09:46.320 heat on the the you know, they got these nurse 0:09:46.400 --> 0:09:50.640 volunteers apparently, and I think they were all pregnant, which 0:09:50.640 --> 0:09:53.000 is even a little more sadistic, but they what they 0:09:53.000 --> 0:09:55.320 were trying to do was compare it to their pregnancy pains, 0:09:55.440 --> 0:09:56.320 their labor pains. 0:09:56.480 --> 0:09:58.520 Yeah. And I was like, why would you do that 0:09:58.600 --> 0:10:03.400 to like women in Well, you could predict, yeah, that's 0:10:03.440 --> 0:10:05.760 when something was going to happen. It was one of 0:10:05.760 --> 0:10:08.000 those few instances when you can predict somebody's going to 0:10:08.040 --> 0:10:08.480 be a pain. 0:10:08.840 --> 0:10:10.559 Yeah, Yeah, I get it, but it was also the 0:10:10.640 --> 0:10:13.360 nineteen forties, right, so they didn't care. 0:10:13.640 --> 0:10:17.000 Right, so like that hurts a lot, They're like great, great, right. 0:10:17.760 --> 0:10:19.800 But I guess these were volunteers, so take that for 0:10:19.840 --> 0:10:22.599 what it's worth. Sure. And they were either nurses or 0:10:22.640 --> 0:10:25.199 wives of doctors, which is even a bit more sadistic. 0:10:26.679 --> 0:10:29.120 And they would focus this light on the back of 0:10:29.160 --> 0:10:33.400 their hand and make it hotter and hotter and said, 0:10:33.600 --> 0:10:36.000 you know, compare that to your the intensity of your 0:10:36.040 --> 0:10:40.960 labor pains by tricking. I guess yeah. And they even 0:10:41.040 --> 0:10:41.839 made up a unit. 0:10:42.200 --> 0:10:43.600 We've reached equilibrium. 0:10:44.920 --> 0:10:49.440 They even invented a pain unit called Dolls DLS and 0:10:49.840 --> 0:10:52.080 you know, it went supposedly one to ten, but there 0:10:52.200 --> 0:10:56.600 was a lady, one of them, tough Marge, who cranked 0:10:56.600 --> 0:10:59.320 it all the way up to ten point five, maxing 0:10:59.320 --> 0:11:02.640 out the machine, and she was still like, nope, I 0:11:02.679 --> 0:11:05.079 can take it. Yeah, which is amazing. 0:11:05.640 --> 0:11:09.400 Yeah, she was like, oh hurts so good. But she 0:11:09.600 --> 0:11:11.120 loved sex pop music. 0:11:12.600 --> 0:11:15.320 But there was a problem with the dolerometer, which is 0:11:15.360 --> 0:11:18.680 they in subsequent experience by other doctors that could not 0:11:18.760 --> 0:11:20.679 reproduce this, which means it's junk. 0:11:20.920 --> 0:11:24.559 Well not only that, like I don't understand how it 0:11:24.720 --> 0:11:29.120 quantifies pain, right, What you're really saying is compare your 0:11:29.160 --> 0:11:32.920 labor pains to the amount of heat energy that we're 0:11:32.960 --> 0:11:36.000 applying to you. Yeah, I don't. It just didn't translate 0:11:36.040 --> 0:11:40.040 to me. I didn't understand it. But apparently that it 0:11:40.160 --> 0:11:46.360 created this this new cottage industry for machines that were 0:11:46.480 --> 0:11:50.600 used to measure objectively pain. And there's some still around today, 0:11:50.800 --> 0:11:55.040 but they do slightly different things, Like there's one that 0:11:55.040 --> 0:11:58.680 that is like a ray gun that's used to see 0:11:58.720 --> 0:12:04.040 if someone under anesthesia is under deep enough, Right, he 0:12:04.200 --> 0:12:07.400 just there and shoot him with it for fun too. Yeah, 0:12:07.559 --> 0:12:09.920 and if they don't wake up, great. 0:12:10.160 --> 0:12:10.839 The fun gun. 0:12:11.240 --> 0:12:12.400 Yeah, that's right. 0:12:12.559 --> 0:12:14.719 And then in nineteen forty five, I guess this was 0:12:14.760 --> 0:12:16.520 just sort of the decade of trying to perfect these 0:12:16.559 --> 0:12:20.080 things before they realized they couldn't. Time Magazine wrote an 0:12:20.120 --> 0:12:24.000 article on doctor Lauren to Julius Bella glutesk great name, 0:12:24.960 --> 0:12:30.040 and he had a machine. It didn't use heat, but 0:12:30.080 --> 0:12:33.440 it put pressure on the shin bone and increasing amounts. 0:12:33.559 --> 0:12:34.480 That sounds awful. 0:12:34.600 --> 0:12:35.559 Does sound awful? 0:12:35.760 --> 0:12:38.000 The shin is like surprisingly sensitive. 0:12:38.120 --> 0:12:42.040 Oh yeah, like you know, just put a coffee table 0:12:42.040 --> 0:12:42.600 in any room. 0:12:42.800 --> 0:12:44.840 Yeah, it doesn't make any sense. It should be like 0:12:44.880 --> 0:12:47.360 tougher than leather, like run DMC, but it's not. 0:12:47.720 --> 0:12:50.240 No, it's not. And this one, actually I don't know 0:12:50.320 --> 0:12:53.040 what the name of it was, but he measured it 0:12:53.080 --> 0:12:56.640 in grams to quantify it and was supposedly and I 0:12:56.640 --> 0:13:01.360 think this is self reported by doctor Bella Glutes ninety 0:13:01.360 --> 0:13:05.000 seven percent accurate. But since you've not heard of it 0:13:05.320 --> 0:13:07.640 most of you, that probably means that was not true. 0:13:07.920 --> 0:13:11.000 Yeah, he thought if he said ninety eight percent accurate, 0:13:11.040 --> 0:13:13.280 people would have been suspicious of his findings. 0:13:13.520 --> 0:13:16.920 Yeah, that's right, So he seven. The funny thing though, 0:13:16.960 --> 0:13:21.200 is while all this I wasn't gonna call it quackery 0:13:21.240 --> 0:13:24.400 because they were they were trying to legitimately invent something. 0:13:25.080 --> 0:13:26.959 But while the same time all this is going on, 0:13:27.480 --> 0:13:31.719 there was a guy named Kenneth Keel who said, why 0:13:31.720 --> 0:13:33.040 don't we just ask people. 0:13:33.120 --> 0:13:35.040 Let's use our brains people, how about that? 0:13:35.120 --> 0:13:37.520 Why don't we just ask folks and tell them like 0:13:37.720 --> 0:13:41.520 zero one or two or three on the scale of 0:13:41.840 --> 0:13:44.360 you know, not painful to severely painful. Why don't we 0:13:44.360 --> 0:13:45.920 just ask them and see what they say? And that 0:13:46.120 --> 0:13:47.479 kind of caught on as the standard. 0:13:47.720 --> 0:13:49.520 Well, let's take a break, man, then we'll get back 0:13:49.559 --> 0:13:54.360 to when sensible pain scales came into effect. 0:13:54.760 --> 0:13:59.120 That's why I say that you should know that. 0:14:02.760 --> 0:14:21.800 We should knows all right, Chuck, So the forties were 0:14:21.800 --> 0:14:27.280 full of ding bad ideas. The sixties, Well, actually, I 0:14:27.320 --> 0:14:30.920 guess the guy you mentioned, doctor Kenneth Keel. He came 0:14:31.000 --> 0:14:34.080 up with his idea of a pain scale, a subjective 0:14:34.200 --> 0:14:37.280 self reported pain scale, in the forties, but it seems 0:14:37.280 --> 0:14:39.320 to have really caught on in the sixties. 0:14:39.400 --> 0:14:39.720 Agreed. 0:14:40.240 --> 0:14:45.360 And so with a self reported pain scale, with any well, yeah, 0:14:45.400 --> 0:14:48.360 any kind of self reported pain scale. It's basically you 0:14:48.400 --> 0:14:51.720 were asking the patient how much pain are you in? 0:14:52.480 --> 0:14:54.920 And it's not enough for them to be like a lot, 0:14:55.600 --> 0:14:58.640 you know, you have to give them, say, like you said, 0:14:59.120 --> 0:15:01.400 a scale of like zero to ten, or zero to 0:15:01.400 --> 0:15:04.600 twenty or zero to one hundred. Yeah, some people just 0:15:04.640 --> 0:15:09.080 for fun have one that goes up zero to a million. Sure, 0:15:09.760 --> 0:15:12.120 and everyone chooses a million. It's crazy. 0:15:13.480 --> 0:15:15.360 I always have a difficult time because I have a 0:15:15.440 --> 0:15:16.480 high threshold for pain. 0:15:18.600 --> 0:15:22.160 But that's that makes sense because pain is subjective. 0:15:22.440 --> 0:15:24.760 Yeah, but I have a high threshold for pain, but 0:15:24.800 --> 0:15:29.680 I also you know I want the good pills, So 0:15:29.760 --> 0:15:30.120 do you. 0:15:30.120 --> 0:15:33.000 Wink when you're talking? No, Like how I'm in a 0:15:33.040 --> 0:15:35.880 tremendous amount of pain, doctor, please help me. 0:15:36.120 --> 0:15:38.040 I usually try to quantity and this doesn't happen much 0:15:38.080 --> 0:15:42.160 because I don't often need or have an injury to 0:15:42.160 --> 0:15:46.000 where I like would need pain pills or something. But 0:15:46.040 --> 0:15:48.560 I always try to quantify it as if I didn't 0:15:48.600 --> 0:15:52.680 have a high threshold for pain, you know what I'm saying. Like, 0:15:52.720 --> 0:15:54.880 I also think of my number and then I'll add 0:15:54.880 --> 0:15:58.640 a couple so you can I can get juiced up. 0:15:58.920 --> 0:16:03.320 You objectively self report then, rather than subjectively. 0:16:02.760 --> 0:16:06.280 Yeah, which they say is very much wrong. Sure, and 0:16:06.360 --> 0:16:10.920 you should be super honest with your doctor. Yeah, because, 0:16:11.000 --> 0:16:13.440 like you said, there are addicts who seek this out. 0:16:14.480 --> 0:16:14.720 Yeah. 0:16:14.760 --> 0:16:16.840 I'm not one of those, but I'm just like you know, 0:16:16.880 --> 0:16:18.880 the pain pill makes the pain feel a little bit better. 0:16:18.920 --> 0:16:21.280 Even if I have a high threshold, doesn't mean I 0:16:21.280 --> 0:16:23.040 don't want that pain to go away some you know. 0:16:23.440 --> 0:16:25.720 Yeah. Well, the way to get around that though is 0:16:25.720 --> 0:16:27.720 to just like dress up, you know when you go 0:16:27.760 --> 0:16:30.080 to the hospital, like wear a suit to be sure, 0:16:30.720 --> 0:16:31.640 tie that kind of thing. 0:16:31.680 --> 0:16:33.680 Yeah, I walk in with my baseball hat and beard 0:16:33.720 --> 0:16:34.160 and a tie. 0:16:34.560 --> 0:16:36.440 Well, see you would seem med seeking. 0:16:36.560 --> 0:16:37.520 Yeah, I totally would. 0:16:37.600 --> 0:16:39.480 It would at the very least like cross their mind. 0:16:39.480 --> 0:16:44.280 Whereas if you dressed up and you said and shaved, sure, 0:16:45.200 --> 0:16:47.600 they'd be like, what, what drugs can we give you? Right, 0:16:48.200 --> 0:16:50.440 just write it down, write down whatever you want, yeah, 0:16:51.280 --> 0:16:52.080 and we'll sign it. 0:16:52.800 --> 0:16:54.080 I don't know the name of any of them. 0:16:54.120 --> 0:16:57.800 So, Uh, Fentanyl is a big problem these days, is 0:16:57.880 --> 0:17:01.600 making its way into heroine. 0:17:00.920 --> 0:17:02.160 What taken with heroin. 0:17:03.000 --> 0:17:05.720 Yeah, they're using fentanyl to cut heroin. I don't know 0:17:05.760 --> 0:17:08.000 if they still are anymore. But like the little towns 0:17:08.000 --> 0:17:11.000 around America were having, like you know, it'd be normal 0:17:11.040 --> 0:17:13.440 to have one or two overdoses a year, they were 0:17:13.440 --> 0:17:15.919 having like a dozen or so all of a sudden 0:17:15.960 --> 0:17:20.119 because people were like, it's like heroin and then the 0:17:20.200 --> 0:17:26.320 highest grade pharmaceutical heroin mixed in and apparently people didn't 0:17:26.320 --> 0:17:28.480 have any warning or else. Maybe they were told this 0:17:28.520 --> 0:17:30.680 will knock your socks off. I think that's what killed 0:17:30.680 --> 0:17:33.120 Philip Seymour Hoffman too. I think he might have had 0:17:33.160 --> 0:17:36.840 fentanyl in his heroin. But it's like what these people 0:17:36.880 --> 0:17:39.840 are used to, the dose they're used to, right, normally 0:17:39.960 --> 0:17:42.359 with heroin would not be a lethal dose, but with 0:17:42.440 --> 0:17:45.000 fentanyl mixed in, it's they're dead. 0:17:45.359 --> 0:17:49.680 Wow. That reminds me the old, the great Kamal Najiani joke, 0:17:50.440 --> 0:17:52.440 which was my intro to him. I heard on him 0:17:52.440 --> 0:17:55.880 on This American Life. He was talking about a new 0:17:55.960 --> 0:17:59.320 drug that kids were doing, which was thailand ll PM 0:17:59.440 --> 0:18:01.600 with heroin, and he. 0:18:01.720 --> 0:18:04.960 Was just like, you're already doing heroin. It's like, what 0:18:05.040 --> 0:18:08.720 could that possibly add to your experience? Yeah, very funny joke, Yeah, 0:18:09.400 --> 0:18:12.320 but also sad at the same time. 0:18:13.520 --> 0:18:14.520 Aren't the best jokes? 0:18:15.280 --> 0:18:20.440 Yeah, a little sad sometimes. So with self reporting pain scales, 0:18:22.080 --> 0:18:25.000 it sounds, like I said, so basic, like okay, it's 0:18:25.000 --> 0:18:27.919 a no brainer. You ask someone you've got zeroo whatever, 0:18:28.000 --> 0:18:30.639 three or ten or one hundred people say that and 0:18:30.640 --> 0:18:35.080 then the doctor knows. But you don't think about like children, 0:18:35.720 --> 0:18:38.879 or like in their understanding of pain, or maybe the 0:18:38.960 --> 0:18:44.200 elderly and reasons how they experience pain, or people that 0:18:44.280 --> 0:18:48.080 are cognitively impaired and their understanding of pain. And then 0:18:48.119 --> 0:18:50.959 you start to think, oh, wait a minute, well we 0:18:51.040 --> 0:18:53.880 need all kinds of pain scales and ways of asking 0:18:53.920 --> 0:18:56.400 people because not everyone is the same. 0:18:56.640 --> 0:18:59.959 And they do have them. Adults specifically are pretty good 0:19:00.160 --> 0:19:03.760 at rating their pain on a scale using numbers. Yeah, 0:19:04.200 --> 0:19:07.440 they can also use words like I'm in severe pain 0:19:07.600 --> 0:19:11.200 or something like that. And usually if you're being presented 0:19:11.200 --> 0:19:14.240 with the pain scale, it's not open ended, like describe 0:19:14.280 --> 0:19:18.640 your pain in flowery language, it's which of these words 0:19:18.680 --> 0:19:23.320 best describes your pain, like no pain, moderate, severe, intolerable. 0:19:23.640 --> 0:19:28.639 The one that gets me is the worst pain imaginable. Yeah, 0:19:28.760 --> 0:19:31.719 that's that's as bad as it gets. Like, I can't 0:19:31.760 --> 0:19:34.520 conceive of any pain worse than what I'm in right now. 0:19:34.560 --> 0:19:37.159 That's it just runs a chill down my spine. Thinking 0:19:37.200 --> 0:19:41.280 that something could happen that could put any of us 0:19:41.280 --> 0:19:46.639 in that situation where you're experiencing the worst pain imaginable. 0:19:46.920 --> 0:19:49.359 It just I just don't think that should be able 0:19:49.400 --> 0:19:50.439 to happen to a person. 0:19:51.000 --> 0:19:52.760 Yeah, and it's weird too. It seems like a lot 0:19:52.760 --> 0:19:58.919 of times injuries, like whether it's a cut or a 0:19:58.960 --> 0:20:01.920 broken bone or something I've heard. I've never broken a bone, 0:20:01.920 --> 0:20:03.760 but I've been cut open a lot of times. 0:20:03.840 --> 0:20:04.960 You better knock on wood. 0:20:05.119 --> 0:20:09.920 I know I'm knocking right now. It seems like those 0:20:09.960 --> 0:20:13.080 injuries are less painful. A lot of times, and other 0:20:13.200 --> 0:20:15.760 kinds of injuries. Like I hear people say, like, yeah, 0:20:15.800 --> 0:20:17.760 I broke my bone, but it was just sort of 0:20:17.840 --> 0:20:21.880 numb and it looked awful, But I didn't feel actual pain, right, 0:20:22.040 --> 0:20:26.280 whereas like like pulled muscles and things like that are 0:20:26.320 --> 0:20:29.680 the things that really hurt or bad pain, for God's sake, 0:20:29.920 --> 0:20:30.840 is the worst. 0:20:30.720 --> 0:20:32.560 You know. I'd like to do a call out to 0:20:33.600 --> 0:20:39.520 emergency room physicians or nurses or orderlies, anybody who's seen 0:20:39.560 --> 0:20:42.760 people in a lot of pain and tell us what 0:20:42.960 --> 0:20:46.879 is reliably the worst type of injury pain wise? 0:20:47.160 --> 0:20:48.400 I think burns. 0:20:48.760 --> 0:20:50.560 Oh yeah, I'll bet burns. 0:20:50.119 --> 0:20:53.840 I've heard that that's just you know, and you know 0:20:53.880 --> 0:20:57.360 I've I've had small burns that it's just that pain 0:20:57.400 --> 0:21:01.040 that won't stop mm hm. And you know, I can't imagine, 0:21:01.080 --> 0:21:03.040 like working in a burn unit, the kind of pain 0:21:03.080 --> 0:21:03.879 those people suffer. 0:21:04.119 --> 0:21:04.679 Yeah. 0:21:04.920 --> 0:21:09.840 Man. So talking about children, there's this really great story 0:21:10.280 --> 0:21:19.960 about the Wong Baker Faces all caps that's right for 0:21:20.480 --> 0:21:23.880 treating kids with discomfort and pain, And it was developed 0:21:23.880 --> 0:21:28.640 in the early eighties by two women. Donna Wong who 0:21:28.800 --> 0:21:32.560 was a well Connie Baker is I think first started 0:21:33.160 --> 0:21:36.399 with the idea. And Connie Baker was a life child 0:21:37.240 --> 0:21:40.000 child life specialist excuse me, which I had never heard of, 0:21:40.040 --> 0:21:42.720 but it's a really cool job where they work in 0:21:42.720 --> 0:21:45.600 hospitals and they work with children, not in like a 0:21:45.680 --> 0:21:51.520 nursing capacity, but and jeez, I'd love to hear from 0:21:51.520 --> 0:21:53.520