When you go to a doctor, physical therapist, or chiropractor, you might recall them asking you to rate your pain on a scale of 1 to 10. This is called the Visual Analog Scale, or VAS. 1 is the mildest pain, while 10 is the worst. The 1 might be visually indicated by a smiling face, and the 10 with a corresponding frowning face.
The VAS gives a provider an idea of the subjective severity of your pain. When I say ‘subjective’, I mean the perceived level of pain. A person’s pain threshold can drastically affect their subjective pain level. While the VAS can have some value, I don’t pay too much attention to it. Instead, I care most about functional improvements such as diminished muscle spasms or increased joint mobility. If a patient tells me that they can sit for 30 minutes without pain, or they can touch their toes and put their shoes on without issue, Those things will let me know that they have made some functional changes.
Those same people may say that their pain scale has remained the same. If I notice they are experiencing objective improvements while the pain rating stays at the same level, this lets me know that what we’re doing in-clinic is working and the patient is progressing. We understand that patients tend to focus on how much pain they are feeling, but they must still recognize their functional improvements. While pain may be the initial reason that patients visit their doctor, it is an indicator that there is an underlying functional problem that must be treated.
I think that education is the key for patients to understand how they are progressing. I’ve spoken in the past about utilizing very specific metrics so we can accurately measure progress. For example, if a patient had 60 degrees right rotation when they started, and they are now able to move 86 degrees, this shows exactly how they have improved. As they functionally improve, we hope that the pain will also decrease as a consequence. At the same time, if there is no functional improvement, then we need to make some changes to our treatment plan or potentially refer them to someone else.
Because a person’s tolerance of pain varies, an 8 on my pain scale might be a 6 for you. A 10 should be debilitating pain that causes someone to be unable to get up or move around. When patients tell me that they are experiencing a 10 on the VAS, but they were able to walk into the office with no difficulty, it illustrates the psychological nature of pain and how it varies from patient to patient.
I’ve also spoken in the past about screening patients comprehensively. When a patient comes in with low back pain, we might end up noticing that they have functional limitations with their right hip. We would decide to treat their hip and spend very little time on their low back. The goal is to treat the actual cause of the pain and not just eliminate the symptom.
If you would like to learn more, contact us so we can give you a thorough exam and customize a treatment plan to address your specific needs. Call us today at (918) 743-3737.
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