WEBVTT - Pain Scales: Yeeeow! 0:00:01.200 --> 0:00:04.640 Welcome to Stuff you Should Know from how Stuff Works 0:00:04.680 --> 0:00:15.000 dot com. Hey, and welcome to the podcast. I'm Josh Clark. Hi, 0:00:15.520 --> 0:00:20.639 there's Charles to be, Chuck Bryant Hi, and Jerry's over there. Silence. 0:00:22.120 --> 0:00:25.279 Well you put us three together, you get stuff you 0:00:25.280 --> 0:00:28.840 should know. Sorry in advance, those three you just had 0:00:28.880 --> 0:00:33.000 a disassociative experience. I did because I want to be 0:00:33.040 --> 0:00:35.920 anywhere but where I am right now, which is in 0:00:35.960 --> 0:00:39.600 a lot of pain. Are you in pain? Yes? I 0:00:39.960 --> 0:00:42.640 just hit my hand with a hammer really hard to 0:00:42.680 --> 0:00:46.080 get ready for this episode, right in the middle of 0:00:46.120 --> 0:00:49.400 the middle knuckle. You know that one of the very 0:00:49.440 --> 0:00:52.159 first dumb jokes I made, like, like, really, I think 0:00:52.200 --> 0:00:56.920 I need to go to the hospital. What uh? In 0:00:57.040 --> 0:01:01.840 my very first podcast appearance with you, I said that 0:01:01.880 --> 0:01:05.040 I was a method podcaster and that I just got 0:01:05.040 --> 0:01:08.720 through brushing my teeth and drinking orange juice. Yeah, yep, 0:01:08.880 --> 0:01:13.040 you have revived that dumb joke from thirty seven years 0:01:13.040 --> 0:01:17.440 ago with the hammer, and here we are, and here 0:01:17.480 --> 0:01:20.600 we are Chuck talking about pain. Yeah, you know, I 0:01:20.640 --> 0:01:24.920 thought this one, um, for all it's kind of sameness 0:01:25.240 --> 0:01:28.720 and basicness, was way more interesting than I thought. Once 0:01:28.720 --> 0:01:31.200 you did get in a little bit more. Ye pain, 0:01:31.600 --> 0:01:34.000 how about that? Yeah? I thought this one was pretty 0:01:34.000 --> 0:01:37.080 cool too. We need to do like a pain episode 0:01:37.280 --> 0:01:43.039 just on pain, just in general house of pain. Yeah. 0:01:43.240 --> 0:01:46.120 Uh the TV show and the group. I didn't know 0:01:46.160 --> 0:01:49.160 that's a TV show. Yeah, it's a Tyler Perry show. Okay, 0:01:49.320 --> 0:01:54.000 that explains it. It's about the pains in their house. Yeah, 0:01:54.040 --> 0:01:56.880 I get it. I think it's kind of like Mama's 0:01:56.920 --> 0:02:01.480 Family a little bit didn't either, same production quality, that 0:02:01.560 --> 0:02:04.320 kind of stuff. Looks like it's a recorded on a stage. 0:02:05.080 --> 0:02:09.119 Probably is you know what I'm talking about, Mama's Family. Yeah, 0:02:09.120 --> 0:02:12.480 I didn't watch that. Well, had you, you would have 0:02:12.520 --> 0:02:14.920 known pain, which is weird because I love the Carol 0:02:14.919 --> 0:02:18.160 Burnett show. Yeah, this is a pretty far cry from 0:02:18.200 --> 0:02:25.280 that Mama's House, Mama's Family, Mama's Family with Bubba the grandson. Man, 0:02:25.400 --> 0:02:32.360 it was bad, it was bad. But anyway, um yeah, 0:02:32.400 --> 0:02:35.800 there's no segue. Let's just get back to pain. Yes, 0:02:35.919 --> 0:02:39.120 and not just pain because like you said, we're gonna 0:02:39.160 --> 0:02:41.919 do one on that one day, but pain scale specifically, 0:02:42.040 --> 0:02:45.119 which is are I should say, because there are many, 0:02:45.160 --> 0:02:49.280 many of them? Um. As this article astutely points out, 0:02:49.320 --> 0:02:53.080 there really is no physical instrument, although they have tried 0:02:53.080 --> 0:02:56.880 over the ears that can accurately measure pain, and so 0:02:57.000 --> 0:03:01.519 doctors rely on a couple of methods, which is, hey, dummy, 0:03:01.600 --> 0:03:05.680 how much do you hurt? Hey, hey, you stop crying? 0:03:05.840 --> 0:03:09.720 How much pain? Or I'm gonna look at you and 0:03:10.360 --> 0:03:12.120 talk to you a bit, and I'm gonna make my 0:03:12.120 --> 0:03:15.480 own assessment because I'm the doctor, right and I'm gonna 0:03:15.520 --> 0:03:19.799 write like could could brush his hair a little more? 0:03:21.560 --> 0:03:24.200 I'm gonna make my own observations about you. Man. I 0:03:24.240 --> 0:03:26.520 haven't used a hair brush since I was probably thirteen. 0:03:27.400 --> 0:03:28.960 I have two once in a while because my hair 0:03:29.040 --> 0:03:32.400 is kind of longish now and when the wind blows 0:03:32.440 --> 0:03:36.920 it really turns it into a bird's nest. So yep, 0:03:37.280 --> 0:03:39.640 I stand in front of the mirror like Marsha Brady 0:03:39.720 --> 0:03:46.760 right before bed and strokes. Yeah, so let's talk about 0:03:48.040 --> 0:03:50.840 you know, basically we're talking about self reporting or observation. 0:03:50.920 --> 0:03:54.200 Those are the kind of the two methods because it's important, 0:03:54.240 --> 0:03:56.520 you know, you gotta there's a lot that goes into 0:03:56.560 --> 0:03:59.640 determining how much pain someone's in from the kind of 0:03:59.680 --> 0:04:02.800 meds as they get to relieve that pain, to diagnosis 0:04:02.880 --> 0:04:04.760 of what the heck is going on. Well, yeah, the 0:04:05.240 --> 0:04:07.800 medical community just in the last probably decade or so, 0:04:07.840 --> 0:04:10.120 it's really waking up to the fact that it's doing 0:04:10.160 --> 0:04:13.080 a lousy job, or traditionally has done a lousy job 0:04:13.360 --> 0:04:16.640 of managing pain. Um. There's a lot of assumption that 0:04:16.720 --> 0:04:20.840 people are big babies who don't really need medication. They 0:04:20.880 --> 0:04:23.960 just need to suck it up. Um. There's a lot 0:04:24.000 --> 0:04:27.280 of problems with med seeking where people pretend that they 0:04:27.279 --> 0:04:31.240 have pain that they don't actually have, uh and they 0:04:31.320 --> 0:04:35.200 because they want the drugs. Um. But then there's also 0:04:35.320 --> 0:04:40.240 just this idea that managed pain care isn't quite as 0:04:40.279 --> 0:04:43.719 good as it should be. Uh So, part and parcel 0:04:43.760 --> 0:04:46.080 of that is realizing like, well, then we need to 0:04:46.080 --> 0:04:49.279 be able to quantify levels of pain a lot better. 0:04:49.560 --> 0:04:51.919 And this is the idea that they're waking up to. 0:04:52.000 --> 0:04:55.839 It is fairly new, but the idea that we can't 0:04:55.920 --> 0:04:59.760 quantify pain is a pretty old one. People figured it 0:04:59.800 --> 0:05:04.400 out pretty early on that pain is subjective. It's subjective horrible, 0:05:04.720 --> 0:05:07.919 terrible experience. And I actually ran across one definition of 0:05:07.960 --> 0:05:11.919 pain from a researcher that said pain is whatever the 0:05:11.960 --> 0:05:15.279 person experiencing it says it is. Yeah, it's as simple 0:05:15.320 --> 0:05:18.400 as that. That doesn't really help a doctor who's trying 0:05:18.440 --> 0:05:21.800 to figure out how much medication to give you, or um, 0:05:21.920 --> 0:05:24.560 whether to just go ahead and like put a pillow 0:05:24.560 --> 0:05:26.719 over your face or something make you go to sleep, 0:05:27.120 --> 0:05:30.200 because that's what doctors do. Well, yeah, it's the last resort, 0:05:30.240 --> 0:05:34.360 but they it's in their toolbox. Uh yeah, and they 0:05:34.560 --> 0:05:38.200 It's become so important that there's a group called the 0:05:38.240 --> 0:05:41.960 American Pain Society, which is a great band name. Um, 0:05:42.200 --> 0:05:45.680 oh it really is. Yeah right, probably some sort of metal, 0:05:45.800 --> 0:05:49.240 right or I could see like kind of like a 0:05:50.200 --> 0:05:53.040 sex pop kind of I don't even know what that is. 0:05:53.360 --> 0:05:57.920 I don't either. Edith invented a genre. Yeah, um, they're 0:05:57.920 --> 0:06:02.520 they're calling it the fifth vital Sign, which means that's important, 0:06:03.200 --> 0:06:08.080 kind of like thrill kill cult or um. Who is 0:06:08.120 --> 0:06:10.760 the other Lords of Acid? I don't know who they are. 0:06:11.480 --> 0:06:16.919 What dude, that's your what you got requested at our 0:06:16.960 --> 0:06:20.599 San Francisco show to say that you're so famous for 0:06:20.640 --> 0:06:25.400 saying that when I haven't heard of something. What, well, 0:06:25.440 --> 0:06:27.320 go listen to those bands and you'll be like, oh, 0:06:27.400 --> 0:06:32.440 sex pop, but that's more like sex techno. M I 0:06:32.440 --> 0:06:34.560 don't know what sex pop. It doesn't sound like it's 0:06:34.640 --> 0:06:39.360 up my alley, but I'll give it a shot, all right. So, uh, 0:06:39.880 --> 0:06:44.279 pain or quantifying pain specifically was or pain in general 0:06:44.320 --> 0:06:47.640 actually was, like you said, misunderstood for a long time, 0:06:48.200 --> 0:06:50.600 and it took all the way into the twentieth century, 0:06:50.920 --> 0:06:54.040 quite a bit into the twentieth century with dr still 0:06:54.800 --> 0:06:58.080 kind of struggling with how much you know, anesthesia to give, 0:06:58.520 --> 0:07:00.520 how many meds to give if you were in pain, 0:07:00.600 --> 0:07:03.440 if you were in surgery and childbirth, like you know, 0:07:04.360 --> 0:07:08.120 literally people waking up in surgery and going oh, well, 0:07:08.279 --> 0:07:12.120 uh we we didn't give that person enough anesthetic, And 0:07:12.160 --> 0:07:15.000 we talked about that in our anesthesia episode a little bit. 0:07:15.480 --> 0:07:17.400 There's just a lot of trial and error, Like, I 0:07:17.400 --> 0:07:20.200 guess that's not enough because someone screaming on the table 0:07:20.360 --> 0:07:23.760 in front of me. Well. Plus also, so pain, Um, 0:07:23.800 --> 0:07:28.080 apparently it's pretty widespread. I saw that in the US alone, 0:07:28.160 --> 0:07:31.960 nine out of ten people regularly suffer from pain at 0:07:32.000 --> 0:07:36.440 any given time. Twenty five million people, Uh well, I 0:07:36.440 --> 0:07:38.640 guess over the course of a year suffer acute pain. 0:07:38.960 --> 0:07:42.800 In the US, another fifty million suffer chronic pain, and 0:07:42.840 --> 0:07:45.480 many of those people report suffering chronic pain for five 0:07:45.600 --> 0:07:49.000 years or more. So. Yeah, so the medical community says, 0:07:49.240 --> 0:07:50.960 we need to do something about this, and it's like 0:07:51.000 --> 0:07:53.640 you were saying. The American Pain Society, they say that 0:07:53.680 --> 0:07:59.040 pain is the fifth vital sign, the fifth Beatle. What 0:07:59.520 --> 0:08:05.560 was his clarence, Yeah, it's great Neddie Murphy's gid. Uh So, 0:08:05.800 --> 0:08:07.600 if we go back in time to the time where 0:08:07.640 --> 0:08:11.160 they were trying to be a little more objective about 0:08:11.200 --> 0:08:14.440 it and actually come up with um a little more 0:08:14.520 --> 0:08:17.840 what they thought were like foolproof ways to determine pain 0:08:18.000 --> 0:08:23.040 measurement UM. In nineteen forty, there were some researchers a trio, 0:08:23.520 --> 0:08:27.800 one James Hardy, uh, one Harold Wolf, and one Helen 0:08:27.840 --> 0:08:32.920 Goodell of Cornell University. Those are some nineteen names. Sure, 0:08:33.679 --> 0:08:39.079 Harold Wolf, Yeah, James Hardy, Yeah, Helen Goodell, all three 0:08:39.120 --> 0:08:43.640 of them. Uh. They actually built a device called uh 0:08:43.920 --> 0:08:50.000 dollar LiMETER. And what this was was basically a hundred 0:08:50.000 --> 0:08:53.000 what lamp with a lens that they could focus you 0:08:53.000 --> 0:08:57.080 know how you do when you're burning ants, Yeah, with 0:08:57.120 --> 0:08:59.679 a magnifying glass. That's kind of what they were doing. 0:08:59.720 --> 0:09:02.360 And they were cranking up heat on the you know, 0:09:02.400 --> 0:09:05.679 they got these nurse volunteers apparently. Uh, and I think 0:09:05.720 --> 0:09:08.720 they were all pregnant, which is even a little more sadistic. 0:09:09.120 --> 0:09:10.840 But they what they were trying to do was compare 0:09:10.880 --> 0:09:13.640 it to their pregnancy pains, their labor pains. Yeah. And 0:09:13.679 --> 0:09:16.120 I was like, why would you do that to like 0:09:16.200 --> 0:09:20.840 women in labor, And well, you could predict when something 0:09:20.880 --> 0:09:23.440 was gonna happen. It was one of those few instances 0:09:23.480 --> 0:09:26.320 when you can predict somebody's gonna be a pain. Yeah, yeah, 0:09:26.400 --> 0:09:29.320 I get it. But it was also the right so 0:09:29.360 --> 0:09:33.600 they didn't care, so like that hurts a lot. They're like, great, great, right, 0:09:34.559 --> 0:09:36.600 But I guess these were volunteers, so take that for 0:09:36.640 --> 0:09:39.440 what it's worth. And um, they were either nurses or 0:09:39.480 --> 0:09:43.439 wives of doctors, which is even a bit more sadistic. Um. 0:09:43.520 --> 0:09:45.960 And they would focus this light on the back of 0:09:46.000 --> 0:09:50.199 their hand and make it hotter and hotter and said, 0:09:50.400 --> 0:09:52.840 you know, compare that to your the intensity of your 0:09:52.880 --> 0:09:58.040 labor pains by treking, I guess. And they then made 0:09:58.080 --> 0:10:02.760 up a unit. We've reached equal. They even invented a 0:10:02.800 --> 0:10:06.880 pain unit called dolls d O l s and you know, 0:10:06.960 --> 0:10:10.240 it went supposedly one to ten. But there was a 0:10:10.360 --> 0:10:13.480 lady one of them Uh, tough Marge, who cranked it 0:10:13.520 --> 0:10:16.320 all the way up to ten point five, maxing out 0:10:16.320 --> 0:10:19.640 the machine, and she was still like nope, I can 0:10:19.679 --> 0:10:23.480 take it, which is amazing. Yeah, she was like a 0:10:23.880 --> 0:10:29.480 hurt so good, but she loves sex pop music. But 0:10:29.520 --> 0:10:32.319 there was a problem with the dolorometer, which is they 0:10:33.080 --> 0:10:35.520 h in subsequent experience by other doctors that could not 0:10:35.559 --> 0:10:38.720 reproduce this, which means it's a junk. Well not only that, Like, 0:10:38.800 --> 0:10:43.600 I don't understand how it quantifies pain, right, Well, what 0:10:43.640 --> 0:10:46.920 you're really saying is, uh, compare your labor pains to 0:10:47.840 --> 0:10:50.600 the amount of heat energy that we're applying to you. 0:10:51.040 --> 0:10:53.439 I don't. It just didn't translate to me. I didn't 0:10:53.480 --> 0:10:59.240 understand it. But apparently the it created this um this 0:10:59.280 --> 0:11:03.840 new cottage in industry for machines that were used to 0:11:03.880 --> 0:11:07.680 measure objectively paint. And there's some still around today, but 0:11:07.760 --> 0:11:11.680 they do slightly different things like, um, there's one that 0:11:11.840 --> 0:11:15.360 that is like a ray gun that's used to see 0:11:15.520 --> 0:11:20.400 if someone and under anesthesia, UM is under deep enough, right, 0:11:20.800 --> 0:11:23.920 he's just there, and shoot him with it for fun too. Yeah, 0:11:24.360 --> 0:11:27.600 and if they don't wake up, great the fun gun. 0:11:29.360 --> 0:11:31.959 And then I guess This is just sort of the 0:11:32.000 --> 0:11:34.720 decade of trying to perfect these things before they realized 0:11:34.760 --> 0:11:37.800 I couldn't. Uh. Time Magazine wrote an article on Dr 0:11:37.880 --> 0:11:44.079 Lauren to Julius Bella Glutzek, great name, and um he 0:11:45.000 --> 0:11:46.880 had a had a machine. It didn't use heat, but 0:11:46.880 --> 0:11:50.120 it put pressure on the chin bone an increasing amount 0:11:50.400 --> 0:11:53.280 that sounds awful. Does sound awful? The shin is like 0:11:53.400 --> 0:11:58.160 surprisingly sensitive. Oh yeah, so like you know, just put 0:11:58.200 --> 0:12:00.400 a coffee table in any room. Yeah, it doesn't make 0:12:00.400 --> 0:12:02.800 any sense. It should be like tougher than leather, like 0:12:02.920 --> 0:12:06.120 run DMC, but it's not. No, it's not. Uh. And 0:12:06.160 --> 0:12:07.559 this one, actually I don't know what the name of 0:12:07.600 --> 0:12:10.680 it was, but um he measured it in Grahams to 0:12:10.760 --> 0:12:13.920 quantify it and was supposedly and I think this is 0:12:13.920 --> 0:12:21.000 self reported by Dr Bella Glutzek accurate. But since you've 0:12:21.080 --> 0:12:23.560 not heard of it most of you, that probably means 0:12:23.720 --> 0:12:26.080 that was not true. Yeah. He he thought if he 0:12:26.120 --> 0:12:30.560 said accurate, people would have been suspicious of his findings. Yeah, 0:12:30.600 --> 0:12:36.840 that's right. The funny thing though, is while all this, um, 0:12:36.840 --> 0:12:38.800 I wasn't gonna call it quackery because they were they 0:12:38.800 --> 0:12:42.440 were trying to legitimately invent something. But while at the 0:12:42.480 --> 0:12:44.599 same time all this is going on, there was a 0:12:44.600 --> 0:12:48.800 guy named Kenneth Keel who said, uh, why don't we 0:12:48.840 --> 0:12:51.760 just ask people, Let's use our brains, people have that. 0:12:51.920 --> 0:12:54.360 Why don't we just ask folks and tell him like 0:12:54.520 --> 0:12:58.360 zero one or two or three on the scale of 0:12:58.679 --> 0:13:01.120 you know, not painful to severe painful. Why don't we 0:13:01.160 --> 0:13:02.760 just ask them and see what they say? And that 0:13:02.880 --> 0:13:05.079 kind of caught on is the standard. Well let's take 0:13:05.120 --> 0:13:09.040 a breakman, then we'll get back to when sensible pain 0:13:09.200 --> 0:13:37.280 scales came into effect. That's why Josh Clark. Alright, Chuck, 0:13:37.320 --> 0:13:41.360 So the forties were full of um ding bad ideas. 0:13:41.600 --> 0:13:45.880 The sixties, Well, actually, I guess the guy you mentioned, 0:13:46.120 --> 0:13:49.360 Dr Kenneth Keel, he came up with his idea of 0:13:49.360 --> 0:13:52.680 a pain scale, a subjective self reported pain scale, in 0:13:52.720 --> 0:13:55.040 the forties, but it seems to have really caught on 0:13:55.120 --> 0:13:58.920 in the sixties. Agreed. And so with a self reported 0:13:59.000 --> 0:14:02.679 pain scale with any um, well, yeah, any kind of 0:14:02.720 --> 0:14:05.800 self reported pain scale. It's basically you are asking the 0:14:05.840 --> 0:14:10.040 patient how much pain are you in? And it's not 0:14:10.160 --> 0:14:12.640 enough for them to be like a lot, you know, 0:14:13.040 --> 0:14:16.040 you have to give them, say like you said, a 0:14:16.160 --> 0:14:19.000 scale of like zero to ten or zero zero to 0:14:19.040 --> 0:14:22.840 a hundred. Some people just for fun have one that 0:14:22.880 --> 0:14:27.760 goes up zero to a million. Sure, and everyone chooses 0:14:27.800 --> 0:14:31.640 a million. It's crazy. I always have a difficult time 0:14:31.640 --> 0:14:35.560 because I have a high threshold for pain. Um. But 0:14:35.600 --> 0:14:39.720 that that that's that makes sense because pain is subjective. Yeah, 0:14:39.800 --> 0:14:41.720 but I have a high threshold for pain. But I 0:14:41.760 --> 0:14:46.640 also you know, I want the good pills. So do 0:14:46.680 --> 0:14:50.440 you wink when you're talking? Like, I'm in a tremendous 0:14:50.480 --> 0:14:53.560 amount of pain, doctor, please help me. I usually try 0:14:53.600 --> 0:14:55.400 to quanta and this doesn't happen much because I don't 0:14:55.440 --> 0:14:59.280 often need uh or have an injury to where I 0:14:59.360 --> 0:15:02.920 like would need pain pills or something. Um. But I 0:15:02.960 --> 0:15:05.480 always try to quantify it as if I didn't have 0:15:05.520 --> 0:15:09.520 a high threshold for pain. You know what I'm saying, Like, 0:15:09.560 --> 0:15:11.680 I don't think of my number and then I'll add 0:15:11.720 --> 0:15:16.800 a couple so I can get juiced up. You objectively 0:15:16.880 --> 0:15:20.480 self report then, rather than subjectively yeah, which they say 0:15:20.720 --> 0:15:24.320 is very much wrong and you should be super honest 0:15:24.360 --> 0:15:28.440 with your doctor. Yeah uh, Because like you said, there 0:15:28.440 --> 0:15:32.080 are addicts who who seek this out. Yeah, I'm not one. 0:15:32.080 --> 0:15:33.960 Of those. But I'm just like, you know, the pain 0:15:34.000 --> 0:15:35.960 pill makes the pain feel a little bit better. Even 0:15:36.000 --> 0:15:38.280 if I have a high threshold, doesn't mean I don't 0:15:38.320 --> 0:15:41.080 want that pain to go away something, you know. Yeah. Well, 0:15:41.120 --> 0:15:42.840 the way to get around that though, was to just 0:15:42.880 --> 0:15:45.240 like dress up, you know when you go to the hospital, 0:15:45.360 --> 0:15:48.200 like wear a suit to be sure, tie that kind 0:15:48.200 --> 0:15:50.080 of thing. Yeah, I walk up with my baseball hat 0:15:50.080 --> 0:15:52.600 and beard in a tie. Well, see, you would seem 0:15:52.600 --> 0:15:55.480 med seeking. Yeah, it would at the very least like 0:15:55.520 --> 0:15:58.160 cross their mind. Whereas if you dressed up and you said, 0:15:59.000 --> 0:16:03.320 um and sure, uh, they'd be like, what what drugs 0:16:03.320 --> 0:16:06.160 can we give you? Just write it down, write down 0:16:06.160 --> 0:16:09.960 whatever you want and we'll sign it. I don't know 0:16:10.000 --> 0:16:13.320 the name of any of them. So, uh. Fentanyl is 0:16:13.360 --> 0:16:15.840 a big problem these days, is making its way into heroin, 0:16:16.440 --> 0:16:21.320 killing people what taken with heroin. Yeah, they're using fentanol 0:16:21.400 --> 0:16:23.600 to cut heroin. I don't know if they still aren't anymore. 0:16:23.600 --> 0:16:27.040 But like little towns around America, we're having, like you know, 0:16:27.080 --> 0:16:29.640 it would be normal to have one or two overdoses 0:16:29.640 --> 0:16:31.600 a year, they were having like a dozen or so 0:16:32.080 --> 0:16:34.480 all of a sudden, because people were like it's like 0:16:34.760 --> 0:16:41.200 heroin and then the highest grade pharmaceutical heroine mixed in. 0:16:41.800 --> 0:16:44.640 And apparently people didn't have any warning or else maybe 0:16:44.680 --> 0:16:46.600 they were told this will knock your socks off. I 0:16:46.640 --> 0:16:49.240 think that's what killed Philip seymour Offman too. I think 0:16:49.280 --> 0:16:52.440 they might have had fentenl and his heroin. But it's 0:16:52.480 --> 0:16:54.880 like what these people are used to. The dose they're 0:16:54.960 --> 0:16:58.800 used to normally with heroin would not be a lethal dose, 0:16:58.960 --> 0:17:02.640 but with fetinal mixed it's you They're dead. Wow. That 0:17:02.720 --> 0:17:07.199 reminds me the old, the great Kamal Nagianni joke it was, 0:17:07.280 --> 0:17:09.240 which was my intro to him. I heard on him 0:17:09.280 --> 0:17:12.680 on This American Life. He was talking about a new 0:17:12.760 --> 0:17:16.240 drug the kids are doing, which was Thailand all PM 0:17:16.280 --> 0:17:20.440 with heroin, and he was just like, you're already doing heroin. 0:17:21.359 --> 0:17:23.760 It's like, what could that possibly add to your experience? 0:17:24.359 --> 0:17:29.200 Very funny joke but also sad at the same time. 0:17:29.920 --> 0:17:34.160 Aren't aren't the best jokes? Yeah, a little sad sometimes. 0:17:35.160 --> 0:17:39.520 Um So with self reporting pain scales, Uh, it sounds 0:17:39.680 --> 0:17:42.720 like I said, so basic, like Okay, it's a no brainer, duh. 0:17:42.760 --> 0:17:45.240 You asked someone you've got zero to whatever, three or 0:17:45.280 --> 0:17:47.679 ten or a hundred people say that, and then the 0:17:47.720 --> 0:17:51.920 doctor knows. But you don't think about um like children 0:17:52.560 --> 0:17:55.600 or uh like in their understanding of pain, or maybe 0:17:55.640 --> 0:17:59.840 the elderly and reasons uh how they experienced pain, or 0:18:00.680 --> 0:18:04.200 people that are cognitively impaired and their understanding of pain. 0:18:04.640 --> 0:18:06.480 And then you start to think, oh, wait a minute, 0:18:06.880 --> 0:18:10.120 well we need all kinds of pain scales and ways 0:18:10.160 --> 0:18:13.560 of asking people because not everyone is the same, and 0:18:13.600 --> 0:18:17.040 they do have them. Adults specifically are pretty good at 0:18:17.160 --> 0:18:21.320 rating their pain on a scale using numbers. They can 0:18:21.359 --> 0:18:24.800 also use words like I'm in severe pain or something 0:18:24.880 --> 0:18:28.080 like that, um. And usually if you're being presented with 0:18:28.119 --> 0:18:31.240 the pain scale, it's not open ended, like describe your 0:18:31.280 --> 0:18:35.720 pain in flowery language. It's which of these words best 0:18:35.760 --> 0:18:40.640 describes your pain, like no pain, moderate, severe, intolerable. The 0:18:40.640 --> 0:18:44.560 one that gets me is um, the worst pain imaginable. 0:18:45.600 --> 0:18:48.440 That's that's as bad as it gets, Like I can't 0:18:48.520 --> 0:18:51.320 conceive of any pain worse than what I'm in right now. 0:18:51.400 --> 0:18:54.000 That's it just runs a chill down my spine, thinking 0:18:54.040 --> 0:18:58.080 that something could happen that could put any of us 0:18:58.080 --> 0:19:03.480 in that situation where you're seriencing the worst pain imaginable. 0:19:03.760 --> 0:19:06.200 It's just I just don't think that should be able 0:19:06.200 --> 0:19:08.760 to happen to a person. Yeah, and it's weird too. 0:19:08.800 --> 0:19:12.760 It seems like a lot of times, um injuries like 0:19:12.920 --> 0:19:16.960 whether it's a cut or a broken bone or something 0:19:17.040 --> 0:19:19.160 I've heard. I've never broken a bone, but I've been 0:19:19.400 --> 0:19:21.800 cut open a lot of times. You better knock on wood. 0:19:21.920 --> 0:19:26.480 I know I'm knocking right now. Um, it seems like 0:19:26.520 --> 0:19:29.639 those injuries are are less painful a lot of times, 0:19:29.640 --> 0:19:32.560 and other kinds of injuries, like I hear people say like, yeah, 0:19:32.600 --> 0:19:34.560 I broke my bone, but it was just sort of 0:19:34.640 --> 0:19:38.000 numb and it looked awful, but I didn't feel actual pain, 0:19:38.840 --> 0:19:43.120 whereas like like pulled muscles and things like that are 0:19:43.119 --> 0:19:46.280 the things that really hurt or bad pain for God's 0:19:46.280 --> 0:19:48.639 sake is the worst, you know. I'd like to do 0:19:48.680 --> 0:19:53.959 a call out to emergency room physicians or um nurses 0:19:54.119 --> 0:19:57.159 or orderlies, anybody who's seen people in a lot of 0:19:57.160 --> 0:20:02.320 pain and tell us what is reliably the worst type 0:20:02.320 --> 0:20:06.199 of jury pain wise? I think burns. Oh yeah, I'll 0:20:06.240 --> 0:20:09.600 bet burns of of uh. I've heard that. That's just 0:20:09.800 --> 0:20:12.520 you know, and you know, I've I've had small burns 0:20:12.560 --> 0:20:16.359 that it's just that pain that won't stop. Uh. And 0:20:16.720 --> 0:20:19.040 you know, I can't imagine like working in a burn, 0:20:19.119 --> 0:20:23.160 you know, the kind of pain those people suffered. Man. Uh. 0:20:23.200 --> 0:20:26.560 So talking about children, UM, there's this really great story 0:20:27.080 --> 0:20:36.560 about the Wong Baker Faces all caps that's right, um 0:20:36.760 --> 0:20:39.879 for for treating kids with discomfort and pain. Uh. And 0:20:39.920 --> 0:20:43.280 it was developed in the early eighties by two women. 0:20:43.760 --> 0:20:48.439 Donna Wong who was a well, Connie Baker is I 0:20:48.480 --> 0:20:52.119 think first started with the idea, and Connie Baker was 0:20:52.200 --> 0:20:56.159 a life child child life special excuse me, which I 0:20:56.240 --> 0:20:58.440 had never heard of. But it's a really cool job 0:20:58.840 --> 0:21:01.840 where they work in hospital and they work with children. Uh, 0:21:01.880 --> 0:21:07.760 not in like a nursing capacity, but and she's I'd 0:21:07.760 --> 0:21:09.439 love to hear from someone who does this, but it 0:21:09.480 --> 0:21:11.439 seems like they kind of work in a more of 0:21:11.480 --> 0:21:15.400 a social services capacity and helping a kid just deal 0:21:15.480 --> 0:21:21.440 with being hospitalized. Does that sound about right? Yeah, that's 0:21:21.560 --> 0:21:24.680 that's my impression, okay. Uh. And then Donna Wong, who 0:21:24.800 --> 0:21:29.240 was a pediatric nurse consultant and apparently an author, well 0:21:29.320 --> 0:21:32.000 not apparently an author, very much an author, but apparently 0:21:32.040 --> 0:21:34.960 just this legend in the nursing industry, and she came 0:21:35.000 --> 0:21:38.800 to visit uh in Tulsa, where Connie Baker worked, and 0:21:38.880 --> 0:21:41.480 they got to talking and she was like, I had 0:21:41.480 --> 0:21:46.200 this idea where we can do better with with trying 0:21:46.200 --> 0:21:49.160 to determine and get self reporting out of children, because 0:21:49.200 --> 0:21:53.479 children don't you know, sometimes they're pre verbal or nonverbal. Uh, 0:21:53.480 --> 0:21:55.720 and sometimes they don't get like the numbers or the 0:21:55.760 --> 0:21:59.879 color charts. So we need a better way. And ingeniously 0:22:00.040 --> 0:22:03.480 they developed this with children. They started with just blank 0:22:03.600 --> 0:22:07.960 circles and said, hey, you draw a face that that 0:22:08.480 --> 0:22:11.760 looks like the pain that you're having, right, and the 0:22:11.880 --> 0:22:13.919 kid would draw and maybe like this is terrible. Do 0:22:14.000 --> 0:22:16.199 you do a better job than this? What is that? 0:22:16.320 --> 0:22:18.520 Is that a chimney with smoke coming out of it? 0:22:19.640 --> 0:22:22.680 They're like that, I feel like I'm on fire. Uh. 0:22:22.760 --> 0:22:24.399 So these kids, you know, you look at some of 0:22:24.440 --> 0:22:26.439 these early drawings as super cute. You know, they've got 0:22:26.480 --> 0:22:29.280 these crayons and they put these details like hair and 0:22:29.359 --> 0:22:34.280 noses and you know, the typical kids drawings. And um, interestingly, 0:22:34.440 --> 0:22:36.239 some of them drew left or right, some of them 0:22:36.320 --> 0:22:38.520 right to left. I don't know how to explain that, 0:22:39.280 --> 0:22:42.000 but UM, I guess maybe kids hadn't learned to read 0:22:42.080 --> 0:22:45.520 yet might have done right to left and not understood 0:22:45.520 --> 0:22:47.400 that that's sort of the opposite of how we learned 0:22:47.400 --> 0:22:49.479 to read, or they grew up in a culture that 0:22:49.520 --> 0:22:52.280 reads right to left as I don't think so. I 0:22:52.280 --> 0:22:58.120 think these were just like, you know, normal dumb American kids. Uh. 0:22:58.160 --> 0:23:01.399 And so these kids actually participated started drawing these little 0:23:01.400 --> 0:23:06.479 faces that range from smiling, um two tears, And they 0:23:06.520 --> 0:23:09.160 got a little bit of heat for using tears as 0:23:09.160 --> 0:23:13.800 well as the smiles. Well, they you know, some researchers said, like, 0:23:13.800 --> 0:23:16.359 you probably shouldn't use those, but they said, no, you 0:23:16.400 --> 0:23:19.919 know that every kid drew smiles, so we think it 0:23:19.960 --> 0:23:23.159 should kind of we think that is really informative to 0:23:23.280 --> 0:23:26.520 us and them describing how they feel. So let's let's 0:23:26.600 --> 0:23:29.400 keep that. Uh. They kept the tears, but they told 0:23:29.400 --> 0:23:31.159 the kids, and they continue to tell kids when they 0:23:31.200 --> 0:23:33.600 look at this thing, Um, you don't have to have 0:23:33.680 --> 0:23:36.639 tears necessarily to have the worst to be in the 0:23:36.680 --> 0:23:40.800 worst pain, because not everybody cries when they're in pain. Gotcha. 0:23:40.920 --> 0:23:43.800 That's why they said you shouldn't have tears on there. Yeah, 0:23:43.800 --> 0:23:48.639 I think so, Yeah, exactly. So what they did was 0:23:48.680 --> 0:23:53.520 then they got a professional artist and basically kind of 0:23:53.520 --> 0:23:57.280 picked out the most frequently drawn features and had them 0:23:57.359 --> 0:24:00.960 draw like a professional composite of these faces, you know, 0:24:01.000 --> 0:24:03.520 and I think they ended up on six circles after 0:24:03.600 --> 0:24:07.719 experimenting with like less or more and children actually helped 0:24:07.760 --> 0:24:11.160 develop the the faces chart, which is, you know, it's 0:24:11.160 --> 0:24:13.760 an awesome story. It is. It's pretty cute, yeah, in 0:24:13.760 --> 0:24:18.960 a sad way, which makes it a joke. Alright, So Chuck, 0:24:19.040 --> 0:24:20.800 let's take another break and then we'll come back and 0:24:20.840 --> 0:24:25.040 talk about some other ways of assessing pain. That's why 0:24:25.240 --> 0:24:49.480