Speaker 1: How to everybody. We're gonna take you back in time
Speaker 1: to March fourteenth, twenty seventeen for this week's Selects episode.
Speaker 1: Pick pain Scales colon eow exclamation point. I know that
Speaker 1: was a Josh title because it's funny and creative and
Speaker 1: he's great at those. So pain scales is pretty interesting stuff.
Speaker 1: You've ever been to a doctor and they say like, oh,
Speaker 1: it is a between a one and ten. That's one
Speaker 1: kind of pain scale. But they are all kinds of
Speaker 1: pain scales, and believe it or not, they're not arbitrary.
Speaker 1: A lot of thought went into how they were formed
Speaker 1: and built and put together. So check out pain Scales
Speaker 1: colon EOW.
Speaker 2: Right now, welcome to Stuff You Should Know, a production
Speaker 2: of iHeartRadio.
Speaker 3: Pay and welcome to the podcast. I'm Josh Clark, Hi,
Speaker 3: there's Charles Tivchuk hi, and Jerry's over there in silence. Well,
Speaker 3: you put us three together, you get stuff you should know.
Speaker 1: Sorry, in advanced those three you just had a disassociative experience.
Speaker 3: I did because I want to be anywhere but where
Speaker 3: I am right now, which is in a lot of pain.
Speaker 1: Are you in pain?
Speaker 3: Yes? I just hit my hand with a hammer. Really
Speaker 3: hard to get ready for this episode. Nice right in
Speaker 3: the middle of the middle knuckle.
Speaker 1: You know, the one of the very first dumb jokes
Speaker 1: I made.
Speaker 3: Like, really, I think I need to go to the hospital.
Speaker 1: What In my very first podcast appearance with you, I
Speaker 1: said that I was a method podcaster and that I
Speaker 1: just got through brushing my teeth and drinking orange juice.
Speaker 1: Oh yeah, yep, you have revived that dumb joke from
Speaker 1: thirty seven years ago, right with a hammer, And here
Speaker 1: we are, and here we are Chuck talking about pain. Yeah.
Speaker 1: You know, I thought this one, for all its kind
Speaker 1: of sameness and basicness, was way more interesting than I thought.
Speaker 1: Once you dig in a little bit more. Yep, pain,
Speaker 1: how about that?
Speaker 3: Yeah? I thought this one was pretty cool too. We
Speaker 3: need to do like a pain episode just on pain,
Speaker 3: just in general.
Speaker 1: House of pain.
Speaker 3: Yeah, the TV show and the group.
Speaker 1: I didn't know this was a TV show.
Speaker 3: Yeah, it's a Tyler Perry show.
Speaker 1: Oh okay, well that explains it.
Speaker 3: It's about the Pains and their house.
Speaker 1: Yeah, I get it.
Speaker 3: I think it's kind of like Mama's Family a little
Speaker 3: bit that either same production quality, that kind of stuff
Speaker 3: looks like it's recorded on a stage.
Speaker 1: Sure, probably is you know what I'm talking about. Mama's Family. Yeah,
Speaker 1: I didn't watch that.
Speaker 3: Well, had you, you would have known pain.
Speaker 1: Which is weird because I love the Carol Burnett Show.
Speaker 3: Yeah, this is a pretty far cry from that. Mama's House,
Speaker 3: Mama's Family, Mama's Family with Bubba the grandson. Oh man,
Speaker 3: it was bad, it was bad. But anyway, Yeah, there's
Speaker 3: no segue. Let's just get back to pain.
Speaker 1: Yes, and not just pain because like you said, we're
Speaker 1: going to do one on that one day, but pain
Speaker 1: scale specifically, which is are I should say, because there
Speaker 1: are many, many of them. As this article astutely points out,
Speaker 1: there really is no physical instrument, although they have tried
Speaker 1: over the years, that can accurately measure pain, and so
Speaker 1: doctors rely on a couple of methods, which is, hey, dummy,
Speaker 1: how much do you hurt?
Speaker 3: Hey, hey, you stop crying? Tell her how much your pain.
Speaker 1: Is, or I'm going to look at you and talk
Speaker 1: to you a bit, and I'm going to make my
Speaker 1: own assessment because I'm the doctor.
Speaker 3: Right, and I'm going to write like could could brush
Speaker 3: his hair a little more? And it does too. I'm
Speaker 3: gonna make my own observations about you man.
Speaker 1: I haven't used a hair brush since I was probably thirteen.
Speaker 3: I have two once in a while because my hair
Speaker 3: is kind of longish now, and when the wind blows
Speaker 3: it really turns it into a bird's nest. So so you.
Speaker 1: Get out of the comba from her pocket.
Speaker 3: Yep, I stand in front of the mirror like Marsha
Speaker 3: Brady right before bed and count off one hundred brush trucks.
Speaker 1: Yeah, so let's talk about you know, basically we're talking
Speaker 1: about self reporting or observation. Those are the kind of
Speaker 1: the two methods because it's important, you know, you gotta
Speaker 1: There's a lot that goes into determining how much pain
Speaker 1: someone's in, from the kind of meds they get to
Speaker 1: relieve that pain, to diagnosis of what the heck's going on.
Speaker 3: Well, yeah, the medical community just in the last probably
Speaker 3: decade or so, is really waking up to the fact
Speaker 3: that it's doing a lousy job, or traditionally has done
Speaker 3: a lousy job of managing pain. There's a lot of
Speaker 3: assumption that people are big babies who don't really need medication,
Speaker 3: they just need to suck it up. Sure, there's a
Speaker 3: lot of problems with med seeking where people pretend that
Speaker 3: they have pain that they don't actually have, and they
Speaker 3: because they want the drugs. But then there's also just
Speaker 3: this idea that managed pain care isn't quite as good
Speaker 3: as it should be. So part and parcel of that
Speaker 3: is realizing like, well, then we need to be able
Speaker 3: to quantify levels of pain a lot better. And this
Speaker 3: is the idea that they're waking up to. It is
Speaker 3: fairly new, but the idea that we can't quantify pain
Speaker 3: is a pretty old one. People figured it out pretty
Speaker 3: early on that pain is subjective. It's a subjective, horrible,
Speaker 3: terrible experience. And actually ran across one definition of pain
Speaker 3: from a researcher that said pain is whatever the person
Speaker 3: experiencing it says it is.
Speaker 1: Yeah, it's as simple as that.
Speaker 3: That doesn't really help a doctor who's trying to figure
Speaker 3: out how much medication to give you or whether to
Speaker 3: just go ahead and like put a pillow over your
Speaker 3: face or something make.
Speaker 1: You go to sleep, Yeah, because that's what doctors do.
Speaker 3: Well, yeah, it's a last resort, but they it's in
Speaker 3: their toolbox.
Speaker 1: Yeah, and they It's become so important that there's a
Speaker 1: group called the American Pain Society, which is a great
Speaker 1: band name. Oh it really is? Yeah, right, probably some
Speaker 1: sort of metal, right, or I.
Speaker 3: Could see like kind of like a sex pop kind.
Speaker 1: Of I don't even know what that is.
Speaker 3: I don't either.
Speaker 1: You just invented a genre. Yeah, they're calling it the
Speaker 1: fifth vital sign, which means that's important.
Speaker 3: Kind of like thrill Killed cult or who is the
Speaker 3: other Lords of Acid?
Speaker 1: I don't know who they are. What, dude, that's your
Speaker 1: what you got? Requested our San Francisco show to say
Speaker 1: that you're so famous for saying that when I haven't
Speaker 1: heard of something.
Speaker 3: What, Well, go listen to those bands and you'll be like, oh,
Speaker 3: sex pop Okay, but that's more like sex tech. No,
Speaker 3: I don't know what sex pop.
Speaker 1: Way doesn't sound like it's up my alley, okay, but
Speaker 1: I'll give it a shot.
Speaker 3: All right.
Speaker 1: So pain, quantifying pain specifically was or pain in general
Speaker 1: actually was, like you said, misunderstood for a long time,
Speaker 1: and it took all the way into the twentieth century.
Speaker 1: Quite a bit into the twentieth century with doctors still
Speaker 1: kind of struggling with how much you know anesthesia to give,
Speaker 1: how many meds to give? If you were in pain
Speaker 1: if you were in surgery and childbirth, like you know,
Speaker 1: literally people waking up in surgery and going, oh, well,
Speaker 1: we didn't give that person enough anesthetic, And we talked
Speaker 1: about that in our anesthesia episode a little bit. There's
Speaker 1: just a lot of trial and error, like, I guess
Speaker 1: that's not enough because someone's screaming on the table in
Speaker 1: front of me.
Speaker 3: Well. Plus also, so pain apparently is pretty widespread. I
Speaker 3: saw that in the US alone, nine out of ten
Speaker 3: people regularly suffer from pain at any given time. Twenty
Speaker 3: five million people, well I guess, over the course of
Speaker 3: a year suffer acute pain in the US, and another
Speaker 3: fifty million suffer chronic pain, and many of those people
Speaker 3: report suffering chronic pain for five years or more. So. Yeah,
Speaker 3: so the medical community says we need to do something
Speaker 3: about this, and it's like you were saying. The American
Speaker 3: Pain Society, they say that pain is the fifth vital sign.
Speaker 1: Yeah, the fifth beetle. What was his clarence, Yeah, it's
Speaker 1: great Eddie Murphy's gay.
Speaker 3: Yeah.
Speaker 1: So if we go back in time to the time
Speaker 1: where they were trying to be a little more objective
Speaker 1: about it and actually come up with a little more
Speaker 1: what they thought were like foolproof ways to determine pain measurement.
Speaker 1: In nineteen forty, there were some researchers a trio, one
Speaker 1: James Hardy, one Harold Wolf, and one Helen Goodell of
Speaker 1: Cornell University.
Speaker 3: Those are some nineteen forties names. Sure, Harold Wolf, yeah,
Speaker 3: James Hardy.
Speaker 1: Yeah, Helen Goodell, all three of them. They actually built
Speaker 1: a device called a dolarimeter. And what this was was
Speaker 1: basically a one hundred watt lamp with a lens that
Speaker 1: they could focus you know how you do when you're
Speaker 1: burning ants, Yeah, with a magnifying glass. Yeah, that's kind
Speaker 1: of what they were doing. And they were cranking up
Speaker 1: heat on the the you know, they got these nurse
Speaker 1: volunteers apparently, and I think they were all pregnant, which
Speaker 1: is even a little more sadistic, but they what they
Speaker 1: were trying to do was compare it to their pregnancy pains,
Speaker 1: their labor pains.
Speaker 3: Yeah. And I was like, why would you do that
Speaker 3: to like women in Well, you could predict, yeah, that's
Speaker 3: when something was going to happen. It was one of
Speaker 3: those few instances when you can predict somebody's going to
Speaker 3: be a pain.
Speaker 1: Yeah, Yeah, I get it, but it was also the
Speaker 1: nineteen forties, right, so they didn't care.
Speaker 3: Right, so like that hurts a lot, They're like great, great, right.
Speaker 1: But I guess these were volunteers, so take that for
Speaker 1: what it's worth. Sure. And they were either nurses or
Speaker 1: wives of doctors, which is even a bit more sadistic.
Speaker 1: And they would focus this light on the back of
Speaker 1: their hand and make it hotter and hotter and said,
Speaker 1: you know, compare that to your the intensity of your
Speaker 1: labor pains by tricking. I guess yeah. And they even
Speaker 1: made up a unit.
Speaker 3: We've reached equilibrium.
Speaker 1: They even invented a pain unit called Dolls DLS and
Speaker 1: you know, it went supposedly one to ten, but there
Speaker 1: was a lady, one of them, tough Marge, who cranked
Speaker 1: it all the way up to ten point five, maxing
Speaker 1: out the machine, and she was still like, nope, I
Speaker 1: can take it. Yeah, which is amazing.
Speaker 3: Yeah, she was like, oh hurts so good. But she
Speaker 3: loved sex pop music.
Speaker 1: But there was a problem with the dolerometer, which is
Speaker 1: they in subsequent experience by other doctors that could not
Speaker 1: reproduce this, which means it's junk.
Speaker 3: Well not only that, like I don't understand how it
Speaker 3: quantifies pain, right, What you're really saying is compare your
Speaker 3: labor pains to the amount of heat energy that we're
Speaker 3: applying to you. Yeah, I don't. It just didn't translate
Speaker 3: to me. I didn't understand it. But apparently that it
Speaker 3: created this this new cottage industry for machines that were
Speaker 3: used to measure objectively pain. And there's some still around today,
Speaker 3: but they do slightly different things, Like there's one that
Speaker 3: that is like a ray gun that's used to see
Speaker 3: if someone under anesthesia is under deep enough, Right, he
Speaker 3: just there and shoot him with it for fun too. Yeah,
Speaker 3: and if they don't wake up, great.
Speaker 1: The fun gun.
Speaker 3: Yeah, that's right.
Speaker 1: And then in nineteen forty five, I guess this was
Speaker 1: just sort of the decade of trying to perfect these
Speaker 1: things before they realized they couldn't. Time Magazine wrote an
Speaker 1: article on doctor Lauren to Julius Bella glutesk great name,
Speaker 1: and he had a machine. It didn't use heat, but
Speaker 1: it put pressure on the shin bone and increasing amounts.
Speaker 3: That sounds awful.
Speaker 1: Does sound awful?
Speaker 3: The shin is like surprisingly sensitive.
Speaker 1: Oh yeah, like you know, just put a coffee table
Speaker 1: in any room.
Speaker 3: Yeah, it doesn't make any sense. It should be like
Speaker 3: tougher than leather, like run DMC, but it's not.
Speaker 1: No, it's not. And this one, actually I don't know
Speaker 1: what the name of it was, but he measured it
Speaker 1: in grams to quantify it and was supposedly and I
Speaker 1: think this is self reported by doctor Bella Glutes ninety
Speaker 1: seven percent accurate. But since you've not heard of it
Speaker 1: most of you, that probably means that was not true.
Speaker 3: Yeah, he thought if he said ninety eight percent accurate,
Speaker 3: people would have been suspicious of his findings.
Speaker 1: Yeah, that's right, So he seven. The funny thing though,
Speaker 1: is while all this I wasn't gonna call it quackery
Speaker 1: because they were they were trying to legitimately invent something.
Speaker 1: But while the same time all this is going on,
Speaker 1: there was a guy named Kenneth Keel who said, why
Speaker 1: don't we just ask people.
Speaker 3: Let's use our brains people, how about that?
Speaker 1: Why don't we just ask folks and tell them like
Speaker 1: zero one or two or three on the scale of
Speaker 1: you know, not painful to severely painful. Why don't we
Speaker 1: just ask them and see what they say? And that
Speaker 1: kind of caught on as the standard.
Speaker 3: Well, let's take a break, man, then we'll get back
Speaker 3: to when sensible pain scales came into effect.
Speaker 4: That's why I say that you should know that.
Speaker 3: We should knows all right, Chuck, So the forties were
Speaker 3: full of ding bad ideas. The sixties, Well, actually, I
Speaker 3: guess the guy you mentioned, doctor Kenneth Keel. He came
Speaker 3: up with his idea of a pain scale, a subjective
Speaker 3: self reported pain scale, in the forties, but it seems
Speaker 3: to have really caught on in the sixties.
Speaker 1: Agreed.
Speaker 3: And so with a self reported pain scale, with any well, yeah,
Speaker 3: any kind of self reported pain scale. It's basically you
Speaker 3: were asking the patient how much pain are you in?
Speaker 3: And it's not enough for them to be like a lot,
Speaker 3: you know, you have to give them, say, like you said,
Speaker 3: a scale of like zero to ten, or zero to
Speaker 3: twenty or zero to one hundred. Yeah, some people just
Speaker 3: for fun have one that goes up zero to a million. Sure,
Speaker 3: and everyone chooses a million. It's crazy.
Speaker 1: I always have a difficult time because I have a
Speaker 1: high threshold for pain.
Speaker 3: But that's that makes sense because pain is subjective.
Speaker 1: Yeah, but I have a high threshold for pain, but
Speaker 1: I also you know I want the good pills, So
Speaker 1: do you.
Speaker 3: Wink when you're talking? No, Like how I'm in a
Speaker 3: tremendous amount of pain, doctor, please help me.
Speaker 1: I usually try to quantity and this doesn't happen much
Speaker 1: because I don't often need or have an injury to
Speaker 1: where I like would need pain pills or something. But
Speaker 1: I always try to quantify it as if I didn't
Speaker 1: have a high threshold for pain, you know what I'm saying. Like,
Speaker 1: I also think of my number and then I'll add
Speaker 1: a couple so you can I can get juiced up.
Speaker 3: You objectively self report then, rather than subjectively.
Speaker 1: Yeah, which they say is very much wrong. Sure, and
Speaker 1: you should be super honest with your doctor. Yeah, because,
Speaker 1: like you said, there are addicts who seek this out.
Speaker 3: Yeah.
Speaker 1: I'm not one of those, but I'm just like you know,
Speaker 1: the pain pill makes the pain feel a little bit better.
Speaker 1: Even if I have a high threshold, doesn't mean I
Speaker 1: don't want that pain to go away some you know.
Speaker 3: Yeah. Well, the way to get around that though is
Speaker 3: to just like dress up, you know when you go
Speaker 3: to the hospital, like wear a suit to be sure,
Speaker 3: tie that kind of thing.
Speaker 1: Yeah, I walk in with my baseball hat and beard
Speaker 1: and a tie.
Speaker 3: Well, see you would seem med seeking.
Speaker 1: Yeah, I totally would.
Speaker 3: It would at the very least like cross their mind.
Speaker 3: Whereas if you dressed up and you said and shaved, sure,
Speaker 3: they'd be like, what, what drugs can we give you? Right,
Speaker 3: just write it down, write down whatever you want, yeah,
Speaker 3: and we'll sign it.
Speaker 1: I don't know the name of any of them.
Speaker 3: So, Uh, Fentanyl is a big problem these days, is
Speaker 3: making its way into heroine.
Speaker 1: What taken with heroin.
Speaker 3: Yeah, they're using fentanyl to cut heroin. I don't know
Speaker 3: if they still are anymore. But like the little towns
Speaker 3: around America were having, like you know, it'd be normal
Speaker 3: to have one or two overdoses a year, they were
Speaker 3: having like a dozen or so all of a sudden
Speaker 3: because people were like, it's like heroin and then the
Speaker 3: highest grade pharmaceutical heroin mixed in and apparently people didn't
Speaker 3: have any warning or else. Maybe they were told this
Speaker 3: will knock your socks off. I think that's what killed
Speaker 3: Philip Seymour Hoffman too. I think he might have had
Speaker 3: fentanyl in his heroin. But it's like what these people
Speaker 3: are used to, the dose they're used to, right, normally
Speaker 3: with heroin would not be a lethal dose, but with
Speaker 3: fentanyl mixed in, it's they're dead.
Speaker 1: Wow. That reminds me the old, the great Kamal Najiani joke,
Speaker 1: which was my intro to him. I heard on him
Speaker 1: on This American Life. He was talking about a new
Speaker 1: drug that kids were doing, which was thailand ll PM
Speaker 1: with heroin, and he.
Speaker 5: Was just like, you're already doing heroin. It's like, what
Speaker 5: could that possibly add to your experience? Yeah, very funny joke, Yeah,
Speaker 5: but also sad at the same time.
Speaker 3: Aren't the best jokes?
Speaker 1: Yeah, a little sad sometimes. So with self reporting pain scales,
Speaker 1: it sounds, like I said, so basic, like okay, it's
Speaker 1: a no brainer. You ask someone you've got zeroo whatever,
Speaker 1: three or ten or one hundred people say that and
Speaker 1: then the doctor knows. But you don't think about like children,
Speaker 1: or like in their understanding of pain, or maybe the
Speaker 1: elderly and reasons how they experience pain, or people that
Speaker 1: are cognitively impaired and their understanding of pain. And then
Speaker 1: you start to think, oh, wait a minute, well we
Speaker 1: need all kinds of pain scales and ways of asking
Speaker 1: people because not everyone is the same.
Speaker 3: And they do have them. Adults specifically are pretty good
Speaker 3: at rating their pain on a scale using numbers. Yeah,
Speaker 3: they can also use words like I'm in severe pain
Speaker 3: or something like that. And usually if you're being presented
Speaker 3: with the pain scale, it's not open ended, like describe
Speaker 3: your pain in flowery language, it's which of these words
Speaker 3: best describes your pain, like no pain, moderate, severe, intolerable.
Speaker 3: The one that gets me is the worst pain imaginable. Yeah,
Speaker 3: that's that's as bad as it gets. Like, I can't
Speaker 3: conceive of any pain worse than what I'm in right now.
Speaker 3: That's it just runs a chill down my spine. Thinking
Speaker 3: that something could happen that could put any of us
Speaker 3: in that situation where you're experiencing the worst pain imaginable.
Speaker 3: It just I just don't think that should be able
Speaker 3: to happen to a person.
Speaker 1: Yeah, and it's weird too. It seems like a lot
Speaker 1: of times injuries, like whether it's a cut or a
Speaker 1: broken bone or something I've heard. I've never broken a bone,
Speaker 1: but I've been cut open a lot of times.
Speaker 3: You better knock on wood.
Speaker 1: I know I'm knocking right now. It seems like those
Speaker 1: injuries are less painful. A lot of times, and other
Speaker 1: kinds of injuries. Like I hear people say, like, yeah,
Speaker 1: I broke my bone, but it was just sort of
Speaker 1: numb and it looked awful, But I didn't feel actual pain, right,
Speaker 1: whereas like like pulled muscles and things like that are
Speaker 1: the things that really hurt or bad pain, for God's sake,
Speaker 1: is the worst.
Speaker 3: You know. I'd like to do a call out to
Speaker 3: emergency room physicians or nurses or orderlies, anybody who's seen
Speaker 3: people in a lot of pain and tell us what
Speaker 3: is reliably the worst type of injury pain wise?
Speaker 1: I think burns.
Speaker 3: Oh yeah, I'll bet burns.
Speaker 1: I've heard that that's just you know, and you know
Speaker 1: I've I've had small burns that it's just that pain
Speaker 1: that won't stop mm hm. And you know, I can't imagine,
Speaker 1: like working in a burn unit, the kind of pain
Speaker 1: those people suffer.
Speaker 3: Yeah.
Speaker 1: Man. So talking about children, there's this really great story
Speaker 1: about the Wong Baker Faces all caps that's right for
Speaker 1: treating kids with discomfort and pain, And it was developed
Speaker 1: in the early eighties by two women. Donna Wong who
Speaker 1: was a well Connie Baker is I think first started
Speaker 1: with the idea. And Connie Baker was a life child
Speaker 1: child life specialist excuse me, which I had never heard of,
Speaker 1: but it's a really cool job where they work in
Speaker 1: hospitals and they work with children, not in like a
Speaker 1: nursing capacity, but and jeez, I'd love to hear from
Speaker 1: someone who does this, but it seems like they kind
Speaker 1: of work in a more of a social services capacity
Speaker 1: and helping a kid just deal with being hospitalized. Does
Speaker 1: that sound about right?
Speaker 3: Yeah, that's my impression, okay.
Speaker 1: And then Donna Wong who was a pediatric nurse consultant
Speaker 1: and apparently an author, well not apparently an author, very
Speaker 1: much an author, but apparently just this legend in the
Speaker 1: nursing industry, and she came to visit in Tulsa where
Speaker 1: Connie Baker worked, and they got to talking and she
Speaker 1: was like, I had this idea where we can do
Speaker 1: better with trying to determine and get self reporting out
Speaker 1: of children, because children don't you know, sometimes they're preverbal
Speaker 1: or nonverbal, and sometimes they don't get like the numbers
Speaker 1: or the color charts. So we need a better way.
Speaker 1: And ingeniously they developed this with children. They started with
Speaker 1: just blank circles and said, hey, you draw a face
Speaker 1: that looks like the pain that you're having.
Speaker 3: Right, And the kid would draw and maybe like this
Speaker 3: is terrible. Do you do a better job than this?
Speaker 3: What is that? Is that a chimney with smoke coming
Speaker 3: out of it?
Speaker 1: They're like that, I feel like I'm on fire. So
Speaker 1: these kids, you know, you look at some of these
Speaker 1: early drawings and it's super cute. You know, they've got
Speaker 1: these crayons, and they put these details like hair and
Speaker 1: noses and you know, the typical kids drawings. And interestingly,
Speaker 1: some of them drew left to right, some of them
Speaker 1: right to left. I don't know how to explain that, huh,
Speaker 1: But I guess maybe kids hadn't learned to read yet
Speaker 1: might have done right to left and not understood that
Speaker 1: that's sort of the opposite of how we learned to read.
Speaker 3: Or they grew up in a culture that reads right
Speaker 3: to left.
Speaker 1: I don't think so. I think these were just like,
Speaker 1: you know, normal dumb American kids.
Speaker 3: Oh gotcha.
Speaker 1: And so these kids actually participated and started drawing these
Speaker 1: little faces that range from smiling to tears, and they
Speaker 1: got a little bit of heat for using tears as
Speaker 1: well as the smiles.
Speaker 3: Why, well, they.
Speaker 1: You know, some researchers said, like, you probably shouldn't use those,
Speaker 1: but they said, no, you know, every kid drew smiles,
Speaker 1: so we think it should kind of. We think that
Speaker 1: is really informative to us and them describing how they feel.
Speaker 1: So let's let's keep that. They kept the tears. But
Speaker 1: they told the kids, and they continue to tell kids
Speaker 1: when they look at this thing, you don't have to
Speaker 1: have tears necessarily to have the worst to be in
Speaker 1: the worst pain, because not everybody cries when they're in pain.
Speaker 3: Gotcha. That's why they said you shouldn't have tears on there.
Speaker 1: Yeah, I think so, uh confuse the kids, yeah, exactly.
Speaker 3: Huh.
Speaker 1: So what they did was then they got a professional
Speaker 1: artist and basically kind of picked out the most frequently
Speaker 1: drawn features and had them draw like a professional composite
Speaker 1: of these faces, you know, and I think they ended
Speaker 1: up on six circles after experimenting with like less or more,
Speaker 1: and children actually help develop the the faces chart, which is,
Speaker 1: you know, it's an awesome story.
Speaker 3: It is. It's pretty cute, yeah, in a sad way,
Speaker 3: which makes it a joke. All right, So Chuck, let's
Speaker 3: take another break and then we'll come back and talk
Speaker 3: about some other ways of assessing pain.
Speaker 4: That's why you should know. That's why s K.
Speaker 3: You should know, Josh Clark, So Chuck, you've got pain
Speaker 3: scales that use numbers, You've got some that use faces
Speaker 3: for little kids. But one of the things they have
Speaker 3: in common is that they exist on a spectrum. One
Speaker 3: of them is so advanced that you you have on
Speaker 3: one end no pain and on the other end extreme pain,
Speaker 3: and an adult or somebody will point to them wherever
Speaker 3: they are on that scale, and then the doctor has
Speaker 3: to get out a ruler and measure it in millimeters, right,
Speaker 3: and then they mark that down and then one of
Speaker 3: the benefits of objectively assessing someone's pain, even through self reporting,
Speaker 3: is that you can track whether it's getting better or
Speaker 3: worse by assessing it several times over time. Right. But
Speaker 3: part of the problem with self reporting pain scales is
Speaker 3: there could be obfuscation. Like we said, like if you're
Speaker 3: med seeking that elderly apparently don't like to talk about
Speaker 3: their pain.
Speaker 1: Yeah, I mean there's a lot of reasons for that,
Speaker 1: from the shame of like getting older and not feeling
Speaker 1: well to well, like you said, just like they don't
Speaker 1: want to be a bother.
Speaker 3: A lot of times, Yeah, I read that they don't
Speaker 3: like to talk about their pain or whether they're in pain,
Speaker 3: but they will respond to other words that are virtually
Speaker 3: the same thing, like sore ache, discomfort, and that. If
Speaker 3: you're a good physician, you're going to figure out what
Speaker 3: word they respond to most and then just replace pain
Speaker 3: with that to get them to talk about the type
Speaker 3: of pain they're in.
Speaker 1: They have a little a little translation chart pretty much.
Speaker 3: Yeah, so it's like a two right, Achy say three point.
Speaker 1: Five and doc oi, this is killing me.
Speaker 3: That's eleven.
Speaker 1: I wonder if there are any pain scales where it's like,
Speaker 1: oh my god, like weather patterns like you know, spring
Speaker 1: day to tornado of pain.
Speaker 3: The tornado of pain. There's another band name.
Speaker 1: And yeah, oh yeah, that probably is a band m
Speaker 1: And then they make them draw that.
Speaker 3: Too, right, draw a better tornado.
Speaker 1: Oh. I meant to say something too about the the
Speaker 1: faces chart for kids. A lot of times they'll still,
Speaker 1: even though they have the chart, let kids draw it
Speaker 1: because they found that kids really enjoy doing it.
Speaker 3: It probably takes their mind off of things.
Speaker 1: Yeah, and the kids will like draw it and then
Speaker 1: take it home and stuff, and yeah, it's kind of cool.
Speaker 3: And while they're busy drawing that, the doctor sneaks up
Speaker 3: behind them and injects them with a heavy dose of
Speaker 3: opioids right into their neck while they're distracted. Bams so
Speaker 3: long pain. Most of those drawings have like a big
Speaker 3: cran streak going off the edge of the page.
Speaker 1: So some other reasons that you might need to pull
Speaker 1: out different chartes. Maybe someone doesn't speak the language that
Speaker 1: the doctor speaks, right, or maybe there's a cultural difference
Speaker 1: that just makes the scale a little more difficult to
Speaker 1: grasp or or translate.
Speaker 3: Or like you said, they could be cognitively challenge Sure,
Speaker 3: there's a lot of different reasons why self reporting scale
Speaker 3: might not work in a situation. And so in that case,
Speaker 3: the doctor needs to rely on his or her own
Speaker 3: observations to come up with a pain assessment. And there's
Speaker 3: actually I found this extremely interesting that wardless of your
Speaker 3: level of consciousness, if you are conscious and receptive to pain,
Speaker 3: your body's going to make you react in predictable and
Speaker 3: from what I can tell, universal ways.
Speaker 1: Yeah.
Speaker 3: Right, so no matter where you are in the world,
Speaker 3: no matter whether you are cognitively challenged or whether you
Speaker 3: have Alzheimer's or whether you are a nonverbal baby, Like,
Speaker 3: there are going to be things that you are going
Speaker 3: to do when you're in pain, like, for example, facial
Speaker 3: expressions tend to change and take on reliably or reliable expressions.
Speaker 1: Yeah, Like if you have back pain and you go
Speaker 1: to sit down, like they're assessing you before they've even
Speaker 1: started asking questions. So you come into the room and
Speaker 1: you do like, you know, you grab the arm in
Speaker 1: the chair and do the ah when you sit down.
Speaker 1: That's a big queue to a doctor. You know, this
Speaker 1: person is having trouble sitting and standing there in so
Speaker 1: much back pain.
Speaker 3: Yeah, and if someone took a picture of you at
Speaker 3: that ex moment, you would see that your eyes are
Speaker 3: drawn shut tightly, your lips are drawn back away from
Speaker 3: your mouth, and your teeth are clenched down. You're grimacing
Speaker 3: and pain and you're doing it involuntarily.
Speaker 1: So yeah, these are behavioral behavioral cues.
Speaker 3: Yeah, there's there's basically two categories you can put observational
Speaker 3: pain assessment into behavioral and physiological. Right. Yeah, So on
Speaker 3: the behavioral hand, you've got facial expressions like grimacing, You've
Speaker 3: got sounds like moans, grunts, even people just talking about
Speaker 3: their pain, but not not because they're being interviewed, but
Speaker 3: just being like, you know this, oh my back or
Speaker 3: something like that, I ache him back. Yeah, they really
Speaker 3: worked me like a dog today.
Speaker 1: And these are super important for all the reasons we
Speaker 1: talked about people either not being able to report their
Speaker 1: pain accurately or and we talked about a couple of
Speaker 1: reasons like the drug seeking, but like little kids may
Speaker 1: not want little kids might be afraid of needles and
Speaker 1: they might think I'm gonna get I mean, I actually
Speaker 1: remember doing this. I remember under reporting pain because I
Speaker 1: was afraid I was going to get a shot if
Speaker 1: I said I was in too much pain. And so
Speaker 1: maybe that's why I have a high threshold now. It
Speaker 1: has something to do with it. But I used to
Speaker 1: be really really needle phobic and am not anymore. Like
Speaker 1: I don't love it still, but the needles have gotten
Speaker 1: so tiny that it's not that big of a deal.
Speaker 3: So you were a needle phobic huh oh.
Speaker 1: When I was a kid, Yeah, needles, you know, they
Speaker 1: were a lot bigger. It wasn't like I mean, obviously
Speaker 1: wasn't like the eighteen hundreds where they had like a
Speaker 1: railroad spike, right, but it's not like today where those
Speaker 1: little tiny, tiny thin needles. I don't know the gauges,
Speaker 1: but yeah, when I was growing up, they were Yeah,
Speaker 1: they I hated getting shots.
Speaker 3: Yeah, I wasn't really big on it either, But I
Speaker 3: don't know if I would be needle phobic.
Speaker 1: Do you watch the needle go in or do you look?
Speaker 3: Sometimes it depends, see, I hapends on my mood.
Speaker 1: Oh really yeah, it depends on your mood.
Speaker 3: Yeah. I mean if I'm feeling curious and frisky, yeah,
Speaker 3: I'll watch it and I'll be like ooh, ooh you
Speaker 3: missed that one and just try to psych them out.
Speaker 1: Yeah that is kind of bad when they can't find
Speaker 1: the vein. Sure, yeah for blood drawing.
Speaker 3: Right, but but yeah, sometimes I'm just like, I'm not
Speaker 3: into it today. Look away.
Speaker 1: The other cool thing too about when you get blood
Speaker 1: drawn today is they used to They've just come so far. Man.
Speaker 1: Remember they used to have to if you had multiple
Speaker 1: blood tests, you would get stuck like six times. And
Speaker 1: now they have those awesome little tubes that they can
Speaker 1: just unscrew.
Speaker 3: Yeah, but I still huh flobotomy is.
Speaker 1: That what that's called it's whoever invented that, mister Flobo
Speaker 1: or missus Flobo, doctor.
Speaker 3: Flobo, Phoebe Flobo. MD.
Speaker 1: I salute you because that has really changed things for me.
Speaker 1: But I still weirdly have this fear of of like
Speaker 1: when they're when they're doing that unscrewing it, I have
Speaker 1: this fear that they're gonna knock the needle and it's
Speaker 1: gonna kind of like rip out of.
Speaker 3: My arm me too.
Speaker 1: Oh okay, so that's is that a common thing? Maybe?
Speaker 3: Oh yeah, for sure. It's so flimsy looking and it's
Speaker 3: basically being held in by the needle, but there's this big,
Speaker 3: top heavy tube that's attached to it. Yeah that Yeah,
Speaker 3: it's just gonna rip it out, and it's gonna pull
Speaker 3: like all of your veins and your muscle out right
Speaker 3: after it like a bunch of bloody party streamers. Yeah,
Speaker 3: I know what you mean.
Speaker 1: And I'm a slightly phobic still about them not being
Speaker 1: able to find the vein so like, you know, they
Speaker 1: give you the ball to squeeze. I turned that thing
Speaker 1: into dust. Oh yeah, because I want I want, like
Speaker 1: and I'm watching them and they're like, I think I
Speaker 1: got one here. I'm like, are you sure. I don't
Speaker 1: see it, like I want to see that vein bulging
Speaker 1: out for them to go in with that needle. I know,
Speaker 1: maybe I'm still needle phobic.
Speaker 3: It sounds a bit like it. Yeah, I don't think
Speaker 3: you like the needles.
Speaker 1: No, but I mean, hats off to the nurses. That's
Speaker 1: a tough job because there are varying degrees of needle phobia,
Speaker 1: and I know it's probably never any fun.
Speaker 3: Sure, well, that's good though. That means your chances of
Speaker 3: becoming an intravenious drug user.
Speaker 1: Like zero, yes, exactly zero chance.
Speaker 3: So chuck. In addition to those behavioral cues, right, like,
Speaker 3: body language is another one too, where like you're you're
Speaker 3: you've got your arm kind of guarding your broken rib
Speaker 3: or something like that.
Speaker 1: Like get back, get back, Yeah, sure, everybody, stay back.
Speaker 3: That's fairly universal from what I understand. There's also physiological
Speaker 3: changes too, like you may become nauseous, or your heartbeat
Speaker 3: or respiration starts increasing, you sweat. There's a lot of
Speaker 3: changes that the body undergoes that can be objectively observed
Speaker 3: with that where it's like, oh, that guy's sweating like
Speaker 3: a like a chuck. Okay, he must be at like
Speaker 3: a ten right now, even though we can't talk. Because
Speaker 3: that's another one too, Like, you may be in so
Speaker 3: much pain that you can't you can't talk, you can't
Speaker 3: focus or concentrate on talking, so you certainly can't self
Speaker 3: report your pain.
Speaker 1: Yeah, or have an injury that keeps you from talking. Yeah,
Speaker 1: you know, like I've almost bit my tongue off when
Speaker 1: I was a kid, oh man, and I you know,
Speaker 1: I couldn't talk very well.
Speaker 3: Yeah, Well now you talk great, so.
Speaker 1: Much so that I do it for a living. Sure,
Speaker 1: And they're all, like I said, there are so many
Speaker 1: of these pain scales, and they some of them can
Speaker 1: get very specific for the kind of person that they're
Speaker 1: they're treating. There's one called the c n p I Checklist,
Speaker 1: and this is specifically for cognitively impaired elderly.
Speaker 3: Oh, that's specific.
Speaker 1: And it's a nonverbal checklist basically that doctors can use.
Speaker 1: And we've talked about cognitive impairments. Doctors have to be
Speaker 1: really skilled and careful there because when they're assessing pain,
Speaker 1: because if you're assessing behavioral traits and someone has a
Speaker 1: cognitive impairment, it can be very confusing to assess that
Speaker 1: because there may be another need not being met, like
Speaker 1: they might be hungry or over stimulated or thirsty, right,
Speaker 1: and that's coming out or anxiety maybe, and that's coming
Speaker 1: out in the way they're acting, and the doctor has
Speaker 1: to be able to kind of wade through that to
Speaker 1: get an accurate reading, right.
Speaker 3: And then so with these observational scales, in some cases
Speaker 3: the doctor will just be like, ooh, that guy's really
Speaker 3: grimacing horribly, so he's probably at like a ten. Other
Speaker 3: ones actually quantify these different observations, like the Cries tool
Speaker 3: for Infants and Pain, which is about as sad a
Speaker 3: thought as there is, but it's basically several different observations
Speaker 3: that fall into behavior and physiological trenches. And then you know,
Speaker 3: the doctor rates each one on I think is zero
Speaker 3: to two or something like that, and then if the
Speaker 3: sum total of each category adds up to four or more,
Speaker 3: then it's the baby's in a type of pain that
Speaker 3: would require some sort of medication.
Speaker 1: Yeah. I looked into this one a bit more. Cr
Speaker 1: i e S stands for crying requires oxygen for saturation
Speaker 1: greater than ninety five percent.
Speaker 3: That is a terrible acronym.
Speaker 1: No I for increased vital signs for expression s for sleepless,
Speaker 1: A zero would be a cry that's not high pitched,
Speaker 1: like a yeah, I guess, like a whimpering cry. A
Speaker 1: two I'm sorry one would be high pitched, but the
Speaker 1: kid is easily consoled, and a two would be high
Speaker 1: pitched and not inconsolable.
Speaker 3: Wow.
Speaker 1: The oxygenation. Basically, then, is there an decrease sorry in
Speaker 1: two at certain levels? Number three the vital signs, which
Speaker 1: is heart rate and blood pressure. In this case zero's
Speaker 1: unchanged increase less is the one greater than twenty percent
Speaker 1: is a two? Expression No, grimace is zero just a
Speaker 1: grimace by itself is a one, and a griminace, sorry,
Speaker 1: a grimace with a non crying grunt. It's a two.
Speaker 3: That's not a good one.
Speaker 1: Well because they've already covered crying, so yeah, a non
Speaker 1: crying grunt. And then sleepless continually sleep zero, awaken frequently
Speaker 1: one and always constantly awake two. Man, And then they
Speaker 1: total those up, like you said, that.
Speaker 3: Is a sad scale.
Speaker 1: It is, man. I think I've said before. I used
Speaker 1: to do pa jobs in LA for this one company
Speaker 1: who did well. They did two hospitals. They did City
Speaker 1: of Hope Cancer Research, which is where I saw the
Speaker 1: head in the bucket, right, and then Children's Hospital Los
Speaker 1: Angeles CHLA oh Man, which was a really rewarding experience,
Speaker 1: but the toughest job I ever had, Like you know,
Speaker 1: the worst stuff you can imagine. And I gotta say,
Speaker 1: kids are the bravest, best attitudeinal they had the best
Speaker 1: attitudes and they were the bravest of it, like any
Speaker 1: humans I ever saw in the face of like the
Speaker 1: most daunting things, like compared to adults. I was just like, man,
Speaker 1: adults need to take some lessons from kids, Yeah, because
Speaker 1: it's amazing, like the attitudes these kids had. Man, that's
Speaker 1: neat it was. And you know, I've also been in
Speaker 1: the emergency room on the flip side and seeing adults
Speaker 1: that I think they think they might be able to
Speaker 1: get soon sooner if they wail in pain.
Speaker 3: Right, like when they're wailing and whaling, and then you
Speaker 3: see them like open one eye and look around.
Speaker 1: And I hate to say that because maybe they are
Speaker 1: in that kind of pain and that's just how they
Speaker 1: express it. But usually when I'm in the emergency room,
Speaker 1: there's one person that's just like oh, and I'm like
Speaker 1: come on, man, you're just trying to You're just trying
Speaker 1: to get to the front of the line.
Speaker 3: H rt S.
Speaker 1: And then I see these kids in the cancer war
Speaker 1: that are just like smiling and playing. I'm like, you know,
Speaker 1: it's hard to not be a little cynical about adults
Speaker 1: and how they handle that stuff.
Speaker 3: Yeah, no, it's true. It does seem like you do
Speaker 3: kind of get warsier as the as you age.
Speaker 1: Yeah, up to a point. Yeah, I agree.
Speaker 3: So you got anything else?
Speaker 1: Uh No, I mean there's you know, there's tons and
Speaker 1: tons of pain scales that we didn't cover, and they're
Speaker 1: all basically after the same thing in slightly different ways.
Speaker 1: So let's just leave it at that.
Speaker 3: Okay, pain scales. Who'd have thought we would do pain
Speaker 3: scales before we did one on pain.
Speaker 1: Well, now when we do one on pain, we can
Speaker 1: just say and there are also pain scales, which we've
Speaker 1: detailed thoroughly.
Speaker 3: Yeah we do that, don't we. All Right, Well, if
Speaker 3: you want to know more about pain scales, type those
Speaker 3: words in the search bar at HowStuffWorks dot com. And
Speaker 3: since I said that, it's time for listener mail.
Speaker 1: Uh, I'm gonna call this just email from the seeming lever,
Speaker 1: nice guy or a big phony. Hey, guys, been a
Speaker 1: listener for three to four years. I think I've always
Speaker 1: wanted to write in but with Shy, I thought it
Speaker 1: was worth mentioning that I listened to about thirty hours
Speaker 1: of podcasts per week and you are in my top
Speaker 1: two favorites. This guy's a pro, which basically that means
Speaker 1: we're number two, or he would have said we're his favorite.
Speaker 3: Yeah, I guess you're right, which is fine.
Speaker 1: I guess I kind of want to know what number
Speaker 1: one is though, Yeah, I'd like to know as well.
Speaker 1: To Scott follow up on this, please second, but related,
Speaker 1: I'm a master's level Board Certified Behavior Analyst a BCBA,
Speaker 1: and I am almost finished with my PhD. And I
Speaker 1: think you might enjoy hearing that you guys actually do
Speaker 1: a pretty decent job handling psychological concepts where many other
Speaker 1: podcasts don't. Oftentimes you are to cursory, too credulous, or
Speaker 1: they oversimplify or something else, and you guys do a
Speaker 1: great job. And it brings me to my third point.
Speaker 1: You guys have been on a super hot streak lately.
Speaker 1: I think the last month contained some of my favorite
Speaker 1: material to date. I don't know what's going on, but
Speaker 1: keep it up.
Speaker 3: I've been listening for two months.
Speaker 1: We're on steroids, that's it. And finally, I really loved
Speaker 1: your episode on pacifism. Actually consider myself on the more
Speaker 1: extreme end of pacifism. I do not wish harm on
Speaker 1: anyone under any circumstance. That's nice, right. I like to
Speaker 1: believe I would die to protect my enemy, to save
Speaker 1: a life. Wow, he really is on the far end. Yeah,
Speaker 1: he makes Gandhi look like Edie. I mean yeah, although
Speaker 1: actually I've never actually tested this to be fair. That
Speaker 1: being said, I also don't think that I could allow
Speaker 1: someone to come to harm if I could do something
Speaker 1: about it, although I'd prefer to take their place and
Speaker 1: then rather than hurt their attacker. Also, similar to what
Speaker 1: Chuck said about his wife, I cannot stand to see
Speaker 1: harm come to animals. As John Lennon said, war is over.
Speaker 1: If you want it, You guys are fantastic. I wish
Speaker 1: you all the best. If you ever have any questions
Speaker 1: about behavioral psychology, be happy to be as much of
Speaker 1: a resource as I can be. And that is from
Speaker 1: Scott Miller of the University of Nebraska.
Speaker 3: Go Corn dogs corn huskers. Oh yeah, that's right.
Speaker 1: You gotta husk the corn before you can make it
Speaker 1: into a corn dog.
Speaker 3: That's true unless you're doing it like farmhouse style, in
Speaker 3: which case you would include the husk into the ultimate
Speaker 3: corn meal.
Speaker 1: Yes, and you can find those at county fairs.
Speaker 3: Thanks a lot, Scott. If you want to get in
Speaker 3: touch with us, like Scott did, you can send us
Speaker 3: an email to Stuff podcast at HowStuffWorks dot com and
Speaker 3: has always joined us at our home on the web,
Speaker 3: Stuff Youshould Know dot com.
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