Dear Dr. Donna Wong and Connie Baker, creators of the pain scale,

Let’s talk about this pain scale business. The scale looks so simple, it’s almost insulting.

If, instead, pain was rated by how many blind monkeys eating peanut butter while being run over by a train on a scale of one to ten, people would totally get that. “I’m at six monkeys with four spoons of chunky peanut butter,” she whimpered. “Ah ha!” the doctor exclaimed, understanding her perfectly.

The problem is people start to think about it. Thoughts start out easy and reasonable, as easy and reasonable as people in a lot of pain can be, but oh, how it goes downhill. Watch it go:

Okay. I get that zero is no pain. Five is moderate pain.

But 10 … the worst pain imaginable. I have a pretty damn good imagination.

Is it worse than being tied to an ant hill, covered in honey?

Is it worse than being eaten by piranhas?

Is it worse than being boiled in oil?

I could go on and on, getting more and more gory and imaginative. I know this because, as a child, one of my English teachers called my mother to discuss a creative writing assignment that disturbed her greatly. My mother was amused. My mother rocks.

This is from a nifty webcomic called xkcd, drawn by Randall Munroe, who has a degree in physics and builds robots for NASA when he’s not entertaining us with stick figure drawings. Go visit him at Buy shit at his store. Make him rich and famous.

There are reasons for the pain scale. As a sweeping generalization, doctors tend to be left brain people. Lefties are about logic, exact mathematics, processes, facts. Right brainers are better at music, estimations, visual imagery (like faces or spatial abilities), language, and people skills.

The pain scale makes sense to these left-brain doctors. Being told you have red hot pokers being shoved into your eyeballs as they melt down your face doesn’t tell the docs enough usable information. It also grosses out the ones with weak stomachs and upsets the tender-hearted.

There is a magic key to the pain scale, summed up in two parts.*

The first and most important part of the magic key is knowing that if you want drugs to numb your pain, you have to give the right answer on this test. Here’s your cheat sheet:

  • Pain up to a five gets Tylenol or its kin.
  • Five to seven gets Schedule 4 drugs, things like Prodrin, Fiorcet or Toradol, or Schedule 3, Tylenol with codeine and all its friends.
  • If you want the good stuff, eight is the lucky number. Once your pain is an eight to a 10, you get the Schedule 2 drugs: hydromorphone, hydrocodone, oxycodone, and the like.

The second part of the magic key is that 10 on the scale means the worst pain YOU have ever felt.

But to rate pain a 10 as your personal worst, it has to be compared to other, previous pain, which is problematic. We forget past pain. It’s a gift our minds give to us, this hazy recall of past hurts.

But it’s also a problem when we’re trying to measure *this pain* on the pain scale against all the past pain we’ve been through. Keeping a pain journal or making an note on a calendar with words like “flaming swords” or “dripping acid” might help.


As much as I hate these things, they do help organize thoughts. At the end of the month, when it’s time to visit the pain management doctor, it’s so easy to forget how many bad days there really were. How many crushing migraines happened that first week? What did I take? Where did the pool boy go? These are questions that need answers so you can get the pills you need to survive the next month.

Yours in pain and in pleasure,


*One of my favorite podcasts, Radiolab, did a show on pain. The last segment has a smart lady talking about exactly this stuff, and how her father, a doctor, recommends gaming the pain-scale system this way. It’s very much worth listening to.


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