A common statement from a new patient in our office (and a lot of chiropractic offices that I’ve talked to) is «I have a high pain tolerance.» It’s usually when they’re describing their pain, during an initial consultation. «The pain levels are like a 100 on a scale of 1 to 10… and I have a high pain tolerance!»
There’s no way for anyone to truly know how much pain you’re in. The only crude and subjective way is a pain scale. All health care providers use the same scale, but patients interpret the scale based on their own perception. A «0″ would be no pain and a «10″ would be «the worse pain you could possibly imagine.» (Think: Childbirth with no epidural) Still, virtually every new patient that comes in to our office describes their pain as a 10.
I’ve talked with MDs that get very upset about this. In the medical definition of a pain scale, a «10″ would indicate such severe pain that you couldn’t perform ADLs (Activities of Daily Living). So, just by the fact that you drove to their office, walked in and filled out paperwork… you’re not a 10. Somehow, barely being able to walk, grabbing my back, using a back brace, and icing like crazy just isn’t a «5.» It’s much closer to being a 5 than being a 10, though.
Strangely enough, if you were to describe your pain as a 2 or a 3, there are insurance plans that might say your treatment is no longer «medically necessary» since you should be able to self-treat. The reality is a 2 or 3 is enough to get your attention that you have a problem that is likely not going to go away on its own.
So do you have a high pain tolerance? Probably not. In nearly 17 years in practice, there are very few patients (2, actually) that I would say had a high pain tolerance. These are people that came into my office indicating pain levels of a 2 or 3, but after treating for several weeks without much improvement, we referred out for an MRI. The advanced imaging study revealed a disc herniation that was well past what I would feel comfortable treating, but they were walking around like they worked out too hard the day before.
For example, I’ve had people arrive in my office after days of no sleep, that can’t complete the initial paperwork prior to their consultation because they can’t sit or stand long enough to get the job done. They may receive an MRI and find that they have a disc bulge of 3 millimeters or less. Three millimeters doesn’t sound like a lot, but it’s plenty in the small spaces in the spine. A 3mm disc bulge is enough to cause a lot of pain in the average person.
The patients that got the MRI and were just complaining of soreness, had disc bulges over 10mm. More than 3 times the disc bulge of the average person that can barely function walking in the door. That’s a high pain tolerance! They tolerated the pain so well, they barely knew they were in pain!
While you main not have a high pain tolerance, it doesn’t mean that you’re not in significant pain. Nor does it mean that we won’t take your pain seriously. When I hear a patient say they are a «10″ — I just know they are in a ton of pain and it’s my job to help them any way I can. I also treat it more as a jumping off point. If they’re a 10 today and a 7 tomorrow, I know they got better.
Philip V. Cordova D.C.