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