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