My clinic follows the generally-accepted practice of asking patients how much it hurts, on a scale of zero to ten, and then recording this number along with such numbers as temperature and blood pressure. Conventional doctrine dictates that this is a “vital sign” no less objective and reliable than recording how many times your heart beats per minute. This was no accident. By 2001, the pseudo-government Joint Commission, which is a federal regulatory body in all but name, dictated that all hospitals and other entities under their purview must record this pain scale at the same time as all other vital signs, and that was that.
The pain scale is also, and has always been, based off of pure and utter bullshit.
A pain of 10 is supposed to represent literally the worst pain of your life, bar none. A 10-pain is not supposed to come from a migraine headache, routine lower back pain or a sprained ankle. Think of someone whose left lower leg was blown apart with a 12-gauge while his ribs were getting cracked with a metal baseball bat — THAT is the patient who is supposed to complain of 10/10 pain.
Yet, hardly a shift goes by when I have a patient who stated their lower back pain is 10/10 sitting calmly, texting away on their phone when I walk in the room.
Meanwhile, patients who are in true extreme pain — with a documented history of injury or condition and displaying gritted teeth, which is generally a reliable sign of pain of at least 8.5 — often merely label their pain at a 6 or less, thus following the old axiom that the patients that have the least wrong with them, complain the most, and vice versa. (The patient least worried about his health within the past month was the guy whom I correctly suspected had advanced cancer. I was literally begging for him to go to the ER. I am not making this up.)
The reason why your nurse asks you to rate your pain from 0-10 is related to why doctors in the late ’90s through the ’00s overprescribed narcotic painkillers such as oxycodone to an alarming degree. It was part of a calculated, organized push by pharmaceutical companies to increase sales of such drugs, backed by the government and the Joint Commission, and as we all now know, boy did it ever work. By 2013, American patients represented 81% of the entire world’s oxycodone use. For hydrocodone, this number approached 100%.
I saw it with my own eyes in med school. Docs routinely writing for 120 oxycodone — with refills. For lower back pain or other chronic yet non-deadly ailments. I don’t care how much willpower you have — taking that or even 30 Vicodin a month will sooner or later turn you into a junkie, no different than the stereotypical street heroin addict.
Drug reps are always trying to think up new strategies to make doctors prescribe their meds. But no marketing strategy can hold a candle to the power of getting patients literally addicted to your product. Just ask 19th-century China.
Of course, now the backlash is in full swing. The JC and the various state and federal agencies, realizing their terrible mistake of pushing Percocets on patients like Halloween candy, did an about-face and started imposing stiff regulations against the prescription of such meds. They required doctors to check online prescription records before writing for controlled substances. ER physicians were allowed only to write for small quantities of these meds at a time. The federal government will soon burden us with yet another required “training” class, drilling through what they see as our thick skulls the new anti-opioid doctrine just as forcefully as they did their pro-opioid doctrine circa 2000. Because America’s opioid addiction epidemic is all our fault, not theirs, of course. They never urged us to prescribe such meds. We have always been at war with Eastasia.
The problem? Millions of junkies don’t get un-junked just because their legal drug dealer closes shop. They instead turn to their not-so-legal drug dealers, leading to the surge in heroin abuse, and resulting overdose deaths, so well documented by the mainstream media.
I had a patient about 2 weeks ago who came in to get cleared for a Suboxone clinic. Hers was the typical story — after a car wreck left her with a bad lower back, her primary care physician started flinging oxycodone at her like Li’l Wayne flinging bills at a stripper, only with less caution. She soon found herself coming in every month for her refill, and thus generating a sweet monthly superbill for this guy, until she herself declared that she had had enough after over a year of this.
Of course, by then it was too late. She was hooked. She had to use every day or else become dopesick. Unlike so many other addicts, however, she refused to go the way of the needle, turning instead to a methadone clinic. But this was arguably even worse than oxycodone — as she put it, methadone “seeps into your bones” — so she quit cold turkey over three months before I saw her.
And over those three months, the addiction never lessened. She still had the cravings; she still got dopesick, complete with nausea and vomiting. So she turned to Suboxone, arguably the least-bad option for patients in her situation. She will most likely remain on it for the rest of her life. All because her caring family doctor chose to get her hooked on powerful narcotics.
Oh, when she came to my clinic? She was asked how much it hurts. On a scale from zero to ten.
It is impossible to overstate just how much bullshit is baked into the practice of medicine in this country, and the farce with the rise and fall of legal narcotic trafficking is just one example. Doctors now deserve the unseemly reputation that ambulance-chasing lawyers garnered a generation ago. (Quick: what do you call a hundred dope-pushing docs at the bottom of the ocean?)
And the bullshit with your next doctor’s appointment will begin before you even see the doctor. There’s the bullshit of our convulated insurance nightmare, of course, but even after you pay your copay, you get asked how much it hurts, zero to ten. Just pick a number, any number. It doesn’t even matter.