Me: I see.

Jimbo: Yeah, I told the nurse it’s a 20/10.

Me: I see. Did you take anything for it?

Jimbo: Yeah, Dad gave me some Norco yesterday, but it still hurts.

Deep breath.

As physicians, we’re driven by numbers. Blood pressure, temp, pulse, oxygen saturation – all these greatly influence our decision on the best course of action. Our desire to quantify everything often overrules logic. Emergency departments frequently encounter absurd situations rarely seen anywhere else. We crave logic, yet receive insanity, which fuels our desire for more coherence. The pain scale demonstrates this perfectly. It can work well; however, with some patients, it can be a cumbersome and dangerous double-edged sword. No one is arguing against treating pain, just how we quantify it.

Personally, hearing about 20/10 pain is like an unpoppable zit on my soul. Possibly, my own desire to obey the laws of mathematics creates this pet peeve. Ever watch Maury?

TV Guy 1: How sure are you that you are not the father?

TV Guy 2: I’m 200% sure. Nah, wait a minute, I’m 300% sure I’m not the

father!

If we require a scale, then I propose one without numbers. I understand that people demonstrate and experience pain differently, but a non-numeric scale could still provide that information, while at the same time maintaining some semblance of sanity. Here are a few options.

A pain scale based around childhood toys. Nostalgia can be palliative. “Sir, on a scale from Silly Putty to Slinky, would you say your pain is a Furby, or even as bad as a Teddy Ruxpin?”

Perhaps a color-oriented pain scale? “Sir, on a scale from fuchsia to sea foam, you seem to be about a periwinkle.”

I am a little hesitant to use the alphabet. I see myself asking about a scale of A to Z, but patients might respond … “I’m all the way to ‘won’t you sing with me?’ ”

Then I realized the problem. Currently, the scale is set up so that you almost want to have a high number. You do not want to come into an emergency department and complain of a mere 2/10 pain. No way! That’s pathetic! Thus, anything under a 6 is pretty much off limits. Thus, the new pain scale must make being pain free something to desire. This is when I came up with the animal scale.

Read carefully here Cute, cuddly animals are the worst pain, and cool, scary animals are the least pain. If you rate your pain “great white shark,” you have no pain. However, if you are kitten, I will start the morphine. No one wants to be a puppy when you could be a honey badger.