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Pain Management

By Carolyn Magura

Even the word "pain" hurts to those of us who endure levels of pain each day. Pain management is what the doctors tell us to do. This sounds great in theory, but what does it mean, and how does one go about doing it? These are excellent questions. It probably sounds "logical", but the better you are at describing your pain to others, the better you can get help in managing pain. And, pain management is the key!

The best way to document and comunicate pain is to use what I call a "pain" scale. I set this up in what I call a "matrix", where I have a chart with four columns as follows: The left column is for pain "level", from "0" being "NO PAIN" (right, like that's gonna happen!) and "10" being so painful that NOTHING YOU DO seems to decrease the pain level.

In the next column, you describe the pain at different levels. I use the following: 0 = No pain; 02 = low levels of pain, an Over the Counter (OTC) remedy can get rid of it; 04 = moderate pain, need double the strength of the OTC remedy to dull the pain; 06 = heavy moderate pain, need double the strength of OTC remedy, but the pain isn't dulled, and activities are curtailed (decreased); 08 = heavy pain, need something stronger than an OTC remedy, and one must sit/lie still; and, finally, level 10.

The next column is the most important one, where you describe specifically what the pain feels like, and use many VERY SPECIFIC examples of how this specific level of pain impacts your "normal daily living activities". I cannot stress how important it is to be as specific, and as complete with your examples as you can be. Also, you need to "guesstimate" the % of time a day/week that you "routinely" have this pain.

Here are some examples that I use:

02 - The low levels of pain are primarily headaches and backaches. I can take an OTC remedy, and rest for about 30 minutes, and the pain goes away. This level of pain comes about 2X a week, and only lasts for the 30 minutes until the OTC remedy kicks in. This level of pain does not keep me from doing my daily activities. BUT, I need to get on this level of pain immediately, or it will increase in level if not addressed and removed.

04 - This level of pain occurs in my hands, arms, legs, feet, and head. It is like the muscles are hurting, and the joints hurt. This level gets my attention; I take double the advised level of OTC remedy, and get some hot tea, and rest lying down. This level usually takes about an hour to "manage", and I have to stop whatever I am doing to lie down until I get it under control. This level occurs about 10% of the time, every other day, usually in the evening. This level makes me depressed, and when depressed, the level of pain often increases to the 08 level.

08 - I usually go straight from 04 to 08, skipping the 06 level. This level is incapacitating. It feels like the worst flu you have ever had, where EVERY muscle and joint in my body hurts! Even my teeth and scalp hurt. Light hurts my eyes; sound hurts my ears; movement makes me nauseous. I take triple the OTC remedy, and a hot shower. I have a stool in the shower where I can sit and let the hot water shower down on me until I run out of hot water (I do this after I take the meds, and try to stay in the shower until I feel the pain beginning to receed). When out of the shower, I have room temperature ginger ale (hot or cold liquids hurt my head), and lie down with soft music - no words; with a cool washcloth over my eyes in a darkened room. This level of pain occurs 2 or 3 times a week, and lasts for about 20 - 30% of the day. I cannot function in any activity at this level of pain. When the meds kick in, the pain is only reduced to the 04 or 02 level.

10 - at this level, no OTC remedy helps; the shower doesn't help; nothing helps; the pain is just reduced to the 08 level. Need greater help than an OTC remedy. This level occurs about one time each week, and literally knocks me out.

Now for the last column, and, this one is very important for long term pain management. In this column, you document what, SPECIFICALLY you were doing just before this level of pain was triggered! This will help both you and your Doctor determine what will help you.

For me, the doctor really noticed the comment about depression linked with pain, and the comments about taking "above recommended" levels of an OTC remedy. He prescribed for me an anti-depressant, and a pain medication in lieu of the OTC remedy. These meds, in conjunction with the meds for joint pain and for the tingling pains, allows for me to regain some of the normal daily living activities.

Good luck for you in documenting your pain levels!

About The Author
Carolyn Magura ( is a website designed to assist each person in his/her own unique quest to navigate through the difficult and often conflicting and misleading information about coping with disabilities.

Carolyn Magura, noted disability / ADA expert, has written an e-Book documenting the process that allowed her to:

a) continue to work and receive her "full salary while on Long Term Disability; and

b) become the first person in her State to qualify for Social Security Disability the FIRST TIME, in UNDER 30 DAYS.

Click here (" to receive Carolyn 's easy-to-read, easy-to-follow direct guide through this difficult, trying process. If you are disabled, don't let this disabiling process disable you. Read Carolyns Disability Key Blog (

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