If you’re here, you’ve likely been there… Sitting in yet another health and wellbeing appointment and the familiar, most pressing question comes: “On a scale of 1 to 10, how would you rate your pain today?”
Hmm.
Well, your muscles have a dull but persistent, ever-present ache, your head feels foggier than a weather-systemed mountaintop, and you’ve been pushing through this status for months…
But you got dressed ✓ Drove here ✓ And you’re sitting upright having a conversation ✓
Does that make it a “4”? A “6”? And what happens if you say “8” but you don’t “appear” to be wincing in visible agony?
If you’ve ever felt frustrated or dismissed trying to translate your chronic pain, fatigue, stress, or burnout into a simple number, you’re not alone. The traditional pain scales, while useful in some scenarios, don’t translate the nuanced and morphing reality of living with ongoing health challenges.
The Problem with “Rate Your Pain 1-10”
While objectively efficient, the standard and most simplistic pain scale assumes a few things that don’t always apply to chronic concerns.
First, it assumes pain is the only factor. But when you’re dealing with chronic conditions, it’s rarely just about pain; it’s about not feeling up for a work meeting, the struggle to muster the energy to eat, let alone cook, or how the dull ache is enough to distract from watching your favourite TV show.
Secondly, it assumes everyone’s “10” is the same. After all, your “7” might be someone else’s “9,” depending on pain history, coping mechanisms, and what you’ve learned to live with and work around.
To that end, it also assumes pain context. A “7” at the emergency room is very different from a persistent, oppressive “7” you’ve been trying to manage for months while still trying to live your life.
And most importantly, 1-10 pain scales don’t capture functional impact. The number that matters most isn’t necessarily how intense your pain feels, it’s how much your pain is disrupting your ability to live your life.
The Difference Between Acute and Chronic Pain Communication
Acute pain is pretty straightforward to rate; it’s usually new, can be intense, and the scale helps health and wellness providers determine urgency and treatment approach.
Chronic pain is a different beast entirely. You’ve likely developed coping strategies, adapted your daily routine, and learned to function with discomfort that would have stopped you in your tracks years ago. This resilience is remarkable, but it can also make your pain more complex to providers who are more direct cause = direct effect in their outlook.
When you say your pain is a “6,” but you’re dressed, functioning, and in good spirits, some practitioners may think “well, they seem fine enough.” What they don’t see, however, is that getting dressed took you 45 minutes instead of 10, that you’re only here because you planned this appointment around your “good hours,” or that you’ll need to rest for the remainder of the day to recover.
The McGill Pain Questionnaire: A More Nuanced Approach?
The health and wellness field has fortunately recognized some of the limitations around the simplistic 1-10 pain scale, which is why tools like the McGill Pain Questionnaire (MPQ) were developed.
Developed in the ‘70s and revised as recently as 2009, the MPQ is a validated tool that reaches beyond just rating pain intensity, inviting users to tap a series of descriptive words that capture different aspects of the pain experience. This approach takes a giant step towards the notion that pain isn’t just about intensity, it’s about context.
Why This Matters
When practitioners in both the medical and paramedical fields understand your pain is “wrenching, miserable, and radiating” rather than just a “7,” they can:
• Better understand how your pain affects your daily life
• Save you time and resources by choosing more targeted treatment approaches
• Track changes in your pain characteristics, not just intensity
• Communicate more effectively, or help you to, with other members of your healthcare team
That Still Said…
While the MPQ represents a significant improvement and intention over simple numeric scales, it’s worth noting that, to our understanding and experience, it still aims to put numbers and words to metrics that are objectively subjective. Anyone living with chronic pain knows that while symptoms and concerns can mirror others’ experiences, there’s far more to each individual’s complex health puzzle context.
And even within the same individual, pain ratings on a rainy Tuesday after a busy Monday at work might feel completely higher on the points scale versus a sunny Saturday after you’ve been fortunate to sleep well the night before.
All this to say that yes, the MPQ offers a valuable and progressive language platform for describing pain, but we still encourage you to explore beyond any system that restricts your experience into predetermined categories or scores.
The Reality of Time Constraints
Before we go further, we want to say that, in our utmost respect to health and wellness researchers and practitioners, we empathize they are working within time constraints and need efficient, effective, and scientifically sound ways to assess and track conditions. The 1-10 and the MPQ scales provide a quick baseline for comparison during limited appointment times and understanding between practitioners if they’re sharing notes.
But when it comes to conveying your concerns, context is likely going to get you farther every time.
Practitioners should know details such as your pain prevents you from sleeping through the night, working a full week of commitments, or getting in the way of your family time or relationships. It’s critical context for them to be aware your mental health feels like it’s gutter-balled because you’ve had to cancel yet another set of plans, or you just can’t bear to stare at the four walls of your bedroom for one more day, stuck in bed.
They should know this — number scale be darned.
Beyond Numbers: Additional Ways to Describe Your Experience
We say there’s room for both approaches.
Use the number scale for check-ins and progress tracking, while taking some time to understand the fuller picture of your experience through descriptive language.
In an effort to convey these details, try these prompts during future appointments:
Describe Functional Impact
“My pain prevents me from…” (sleeping through the night, picking up my child, sitting for more than 30 minutes, etc)
“On a good day, I can…” (do laundry, attend work meetings, enjoy dinner)
“On a bad day, I can’t….” (get dressed, concentrate on anything, get through without crying)
“This pain means I have to…” (rest after every activity, plan my errands and chores around my energy, work at a reduced capacity)
Use Descriptive Language
Instead of saying “it hurts,” try:
Quality: Burning, stabbing, aching, spreading, tight, cramping, electric, gnawing
Timing: Constant, comes in waves, worse in the morning, builds throughout the day
Triggers: Movement, weather changes, stress, activity levels
Create Context
“Compared to my usual baseline…”
“On my worst days, this pain…”
“This is different from my normal pain because…”
“Even with my usual pain management strategies, …”
Emphasize Daily Life Disruption
This is crucial.
Any pain or discomfort that significantly impacts your daily life activities deserves attention and support, regardless of where it falls on a numerical scale.
Try phrases like:
“This pain is making it hard for me to do my job effectively.”
“I can’t concentrate or cut through the brain fog at work or home.”
“I’m not sleeping well because of the discomfort.”
“Simple tasks are taking much longer than they should, and require too much recovery time.”
Advocating for Validation
Your pain experience is valid, even if:
• You’ve learned to function with it
• It doesn’t show up on tests
• It fluctuates throughout the day
• Others can’t see it
• Others seem to “handle” theirs “better”
• You’re having a “good day” during your appointment
Remember… You’re not trying to prove how much pain you’re in, you’re trying to communicate your experience so you can get appropriate support.
Preparing for Appointments
Before your next appointment, consider:
• Tracking patterns for a week or two — including pain, energy, sleep, and functional capacity
• Writing down specific examples — “Yesterday I had to ask my partner to help me put my jacket on” is more concrete and descriptive than “my shoulders hurt”
• Preparing comparison points around how your current concerns measure up against your baseline
• Listing functional goals, including what you want to be able to do that you currently feel you can’t
When Practitioners Don’t Understand
If you feel unheard or invalidated…
Okay, considering as many as two out of three women have reported feeling dismissed by healthcare and wellness providers about their chronic pain, fatigue, stress, and burnout concerns, let’s try that again.
When you feel unheard or invalidated:
• Redirect to function
”I’m less concerned about the number, and more concerned about being able to sleep through the night again.”
• Provide context
”I know I seem to be handling this well, but it’s requiring significant work and life adjustments that are negatively impacting my relationships, career, finances, etc.”
• Advocate early
”This level of daily disruption and discomfort isn’t sustainable to me, and I’d like to explore options for what treatments might help me.”
The Bottom Line
The goal isn’t to find the “right” number on a pain scale or perfect mix of words to describe your concerns, it’s to communicate your experience clearly enough that practitioners can understand what you’re dealing with and work with you to improve your quality of life.
Your pain doesn’t have to be a 10 to deserve attention.
Your pain doesn’t have to be visible to be real.
And your pain doesn’t have to fit neatly into a numerical scale to be valid.
You know your body, your limitations, and when something is interfering with your ability to live the life you want. That knowledge is valuable, and any practitioner worth working with will want to understand and work with you to honour that.
Methods of Care features practitioners who understand that pain is complex, individual, and deserves compassionate, comprehensive care. Browse our free directory to find paramedical and wellness support practitioners who are known to take the time to truly understand your experience and support your wellbeing.
And as ever, Methods of Care is meant to be for educational purposes. For any concerns and symptom support, please consult with your healthcare and wellness providers directly.
