On Pain Scales and Attunement

I recently saw an xkcd comic about the pain scale. A doctor asks a patient “any pain?” When the patient tells them that their arm really hurts, the doctor asks them to rank it on a scale of one to ten, with ten being “The worst pain you can imagine.” The patient freezes as they think of the worst pain imaginable (what a horrible thought!) and then says that their arm pain is a 1 out of ten. The doctor completely misunderstands the patient’s reaction, deciding there’s something wrong with the patient’s thinking.

Even when you’re not asking a patient to think of the worst pain imaginable (we don’t do that btw) the pain scale remains an imperfect tool. Modern English in general isn’t great for nuanced communication about pain. If you can’t give your pain a number or if the question stresses you out and you make a guess that might not be accurate, that’s ok. 

We ask patients to rate the intensity of symptoms on a scale of 0-10 (with 10 being the worst you’ve ever had and zero being no pain at all) for a few reasons. We’re looking for some idea of severity in order to make a treatment plan (ie, to tell you when you should come back for more acupuncture and how many treatments you’re likely to need) and also to begin to get a rough sense of the degree of your suffering. 

But the pain scale is *not* the only way we figure this stuff out. 

The single most important part of our job is to support you to develop the relationship with acupuncture that’s going to serve you best (while also maintaining the space for other people to do that at the same time). An important part of that involves helping you to enter the zone that will allow change to happen without overwhelming you (this is often referred to as “the window of tolerance”). All of this involves us attuning to you and to the state you’re in, each time we see you. This attunement informs how many needles we use, how quickly or slowly we go, how much information we give as the needles are being placed, and the treatment plan.

Attunement involves a lot of wordless communication. Doing community acupuncture requires being skilled enough to non-verbally attune to a lot of wildly different people with varying needs in the same space — some of whom are very comfortable talking about their physical and emotional states, and and some of whom don’t want to talk much at all. (Of course we don’t always do this perfectly.)

So, if you just can’t answer the question, or it stresses you out and you’d rather not, that’s totally ok. We’ll work with you where you’re at.