Being asked to rate my pain from 0 to 10 gives me anxiety (and here’s one thing that helps me cope)
This blog was originally posted on my Substack on August 22, 2025. The original post can be viewed here.
I saw my occupational therapist this morning, after a very long, sleepless night where I was experiencing a TON of pain. At one point she grabbed a pain scale from the pile of papers beside her. Before she even had a chance to ask me to rate my pain from zero to ten, I told her that I’d developed my own structure for a pain scale, because I’ve had so much trouble in the past trying to rate my pain with a numbered scale.
For me, it’s very hard to respond when medical providers ask me to rate my pain on a numbered scale. I’ve been dealing with chronic pain my entire life, and like many folks who live with chronic pain, I’ve also been minimizing, pushing down, ignoring, and invalidating my pain for my whole life, too.
When a provider asks me to rate my pain on a numbered scale, I’m not just being presented with the challenge of distilling the physical and emotional experience of pain down to a single number. I’m having to do a lot of challenging things, all at once:
I’m confronting the pain that I spend a good portion of my time dissociating from. This means, when I’m tuning in, and paying attention to it, that the pain truly feels more intense, painful, and intolerable.
I’m trying to convince the protective parts of me—that spend so much time and energy trying to numb, ignore, or drown out the pain—that it is safe enough for me to let my guard down to tune into the pain. These parts of me are not easily convinced. Being in pain in front of another human takes great strength and vulnerability. Even more so when I have a lifetime of traumatic experiences in medical settings, having my pain minimized, ignored, and invalidated by doctors and other medical providers.
I’m trying to objectively judge the severity of my pain, even though pain severity is necessarily subjective. There is no objective measurement of pain. So I’m starting from a place of being asked to do the impossible. And being a human living with medical trauma, who has long invalidated and doubted myself as a protective mechanism, trusting that my judgement is reasonably accurate feels, somehow, even more impossible.
I’m worried that if I don’t give the medical professional the answer they are looking for, I won’t get the care that I need, from a system that I know is broken. (And that worry and fear is absolutely founded. I have very real life experiences that tell me that no matter how hard I try to show up the “right” way as a patient, and no matter how deserving I am of care, the medical system could still fail me.)
I’m trying to strategize how to best describe and rate my pain to the provider, in order to increase the chances that I will get the care I need and deserve. This includes making hypotheses about what the provider is thinking about me by analyzing their verbal statements and body language, judging how trustworthy they may be, and modifying my descriptions based on their in-the-moment responses to what I’m saying.
While attempting to do all of the above list items, I am also likely to start to freeze, or panic. I’m worried that I’m overthinking things. I’m judging myself for being ‘fake’ and telling myself I should just show up honestly and authentically (even though I have evidence from past experience that it’s not necessarily safe or productive for me to do that). I’m scared the provider is judging me for freezing. I’m scared the doctor thinks I’m lying, or dramatic, or…
And mind you, this all happened in the 5-10 seconds since the provider said “where would you rate your pain on a scale of 0 to 10?”
Image from a digital art series I created about my experience with chronic pain.
I’m not writing this blog post today to tell you how to handle all of that anxiety. You may not have the same internal process, fears, and coping strategies that I have. And if you do, I can assure you that reading a blog post won’t be the one stop shop to fix this problem for you. I’ve worked with multiple therapists, for several years, including folks who specialize in working with embodiment, trauma recovery, chronic pain, chronic illness, and medical trauma. And yet, I still deal with freeze responses coming up for me in medical appointments. This shit is not easy. There is not an easy solution.
But, I have developed a lot of strategies to help me cope along the way, and one of them is the pain scale I told my occupational therapist about in our session this morning. When I described it, her response was that she really liked my scale, and might start using it with some of her other clients. I joked that maybe I should publish it somewhere, but I didn’t have anywhere to do that. And then, of course, remembered that I do have this blog, and I could at least post it here.
So, here’s the overview. When I’m asked to rate my pain from zero to ten, this is how I think through the answer methodically in my head, to avoid spiraling about it:
Am I in pain?
If the answer is ‘no’ it’s a zero. (Easy peasy lemon squeeze-y). If the answer is yes, I ask myself the next questions:
Is my pain tolerable, or intolerable?
If the pain is tolerable, am I able to ignore it, if I try to focus on other things?
Based on the answers to the above question, I place myself in one of these three number ranges:
My pain is intolerable: 8-10
My pain is tolerable, but I can’t ignore it: 4-7
I can ignore my pain: 1-3
Once I’ve put myself into one of those categories, I think to myself, “what are the other times my pain felt like this?” (As in, other times my pain felt intolerable, ignorable, or tolerable but not ignorable). “Does this pain feel worse than most of those other memories of similar pain? Does it feel less bad? Does it feel kind of average?”
Based on that, I nudge my number either to the beginning, middle, or end of the range I’ve put myself in. For the “ignorable” and “intolerable” categories, these each have three numbers, so that gives me a clear number value, and I don’t have to ask myself any more questions. For the middle category, I’m looking at either a 5 or a 6 for the middle value. And, to be quite honest, I just choose based on vibes, and I don’t expect it to be perfect.
Image from a digital art series I created about my experience with chronic pain.
So, here’s an example. When I woke up at three am this morning, in the worst pain I’ve been in since my surgery a few months ago, I would've gone through this thought process:
Am I in pain? Fuck yes I’m in pain, what kind of question even is that!?!
Does the pain feel tolerable? No, it doesn’t feel tolerable. Which means it’s an 8-10.
Is the pain better, worse, or on par with most of the other times I felt like my pain was intolerable? It’s either about the same or a bit better. I can definitely remember intolerable pain that felt even worse, but I’m not sure if it’s same, or better. Which means we’re looking at an 8-9.
I decide to go with 8, because I feel like I can remember pain that was worse than this pain, AND, pain that was even worse than that.
When I start to second guess myself, I remind myself that there is no objective measure of pain, which also means that to here is no real “right” answer to the pain scale question. It’s not a big deal if I just called a 9 an 8. The world will not end.
One thing that I do want to note here is that I’m not presenting this as a research tool. This is not a tested measure. I have no way of assessing its reliability or validity from an academic perspective. But, this IS a tool that helps me reduce my stress in medical settings, and better advocate for my needs. It helps me get to a number fairly quickly, without giving my brain the leeway to spiral into second guessing myself. And that number is a *good enough* representation of how bad my pain is, so that I can give the doctor the info they need to be able to treat me.
(And hey, I’m not a medical provider, but if any of y’all reading this are, feel free to comment if you have any insight or feedback, especially regarding what medical providers are actually looking for when they ask patients to rate their pain.)
Image from a digital art series I created about my experience with chronic pain.
Another final note I want to make, is that this pain scale is inherently subjective. My 6 might be someone else’s 9. My 6 one day might be an 8 tomorrow. Numeric pain scales are inherently flawed. They aren’t objective or scientific. It feels really important to name this, and to encourage anyone reading to try to give themselves grace.
You are allowed to change. Your experience of being in the world can, will, and even should shift, as you move through different days, months, and stages of life. Bodies change. Minds change. I’m giving you permission to be inconsistent and inexact. This isn’t about “perfect”. It’s about “good enough”.
Hopefully, at some point once I have the spoons to sit down, I can make a pretty diagram and a more polished written piece about this. But, if you’ll excuse me, I didn’t sleep last night, and I need to get my ass to bed. Getting good sleep may not cure chronic pain, but it sure as hell makes it a lot easier to manage, when I can swing it.
Sending good thoughts and good vibes your way 💜
This blog was originally posted on my Substack on August 22, 2025. The original post can be viewed here.
