0883: "Pain Rating"

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TheDoctor
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Re: 0883: "Pain Rating"

Postby TheDoctor » Fri Apr 08, 2011 6:25 pm UTC

Aster Selene wrote:I wonder if Randall knows Brian Regan.

"Uh...8."
"We're gonna prescribe you some novocaine then."

LOL I thought that same exact thing.

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Re: 0883: "Pain Rating"

Postby RogueCynic » Fri Apr 08, 2011 6:59 pm UTC

I had quite a few bumps and bruises over the years. The worst was not when I dislocated my elbow and slept for six hours before seeking treatment. I think I may have had a stroke. I heard this odd pop and slow hiss, as an eardrum popping, got a sudden severe headache, starting at the back of my head and rushing forward, almost causing me to black out. It subsided after 10 maybe 20 seconds and I went back to sleep. The following day I had classic migraine symptoms, severe headache, sensitivity to noise, nausea, and a yellowish tint to my vision. I think both episodes rated a 7.
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Re: 0883: "Pain Rating"

Postby barasawa » Fri Apr 08, 2011 7:04 pm UTC

I use a logarithmic scale for that since my ten is a state where you can't move, or talk, and breathing itself is ragged and causes unending agony. A state where the only semi-coherent thought you can form if any is something along the lines of "kill me". If you ever reach 10 on that scale, you'll never be able to forget it no matter how hard you try.

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Re: 0883: "Pain Rating"

Postby neoliminal » Fri Apr 08, 2011 7:07 pm UTC

SirMustapha wrote:I like the joke, and I'd say it's well executed until the final panel. When will Randall realize that those post-punchline dialogues are entirely unnecessary and only reduce the effect of the joke? End it with "One." and it's perfect.


When was the last post you made that wasn't critical? More curious than troll-ish. I'm curious how long you've been like this, because I remember you not being that way.
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Re: 0883: "Pain Rating"

Postby Tormuse » Fri Apr 08, 2011 7:39 pm UTC

When I was in college, studying to become a massage therapist, we were taught to use a 1-10 pain scale to help us determine how much pressure we should use when treating clients.

Once I was out practicing, I quickly abandoned it. Firstly, because pain is very subjective; there are some clients who say "ow! Ow! OW!" when I'm barely touching them, whereas other clients will continue to demand more pressure even if I'm leaning on them with my full body weight with my elbow. Secondly, it's really difficult to communicate the concept of a pain scale in a manner that gives me useful information even at the best of times; add in a language barrier and it becomes next to impossible.
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Re: 0883: "Pain Rating"

Postby Vash » Fri Apr 08, 2011 9:32 pm UTC

The heads should be attached to the necks. This also is fine, but just is not funny enough.
Last edited by Vash on Sun Apr 10, 2011 10:04 pm UTC, edited 1 time in total.

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Re: 0883: "Pain Rating"

Postby Iranon » Fri Apr 08, 2011 10:12 pm UTC

Hmm... 'worst one can imagine' raises the bar quite high, I can imagine multiple levels above what I can take.

10 - unable to perceive surroundings
9 - unable to express myself meaningfully
8 - begging for release, death if need be
7 - unable to keep from showing it in a major way (screaming, twitching etc)

So if I can answer the question in a moderately calm manner, it can't be higher than 6 which is still totally unacceptable and would be grounds for suicide if constant/untreatable... so timescale definitely matters. As does whether it's just the pain or the total stress of a situation. To use the typical male example, I wouldn't rate a kick in the plums very high unless adding the unpleasantness from nausea/disorientation and general misgivings I'm likely to entertain when someone kicks me in the junk.
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Re: 0883: "Pain Rating"

Postby ifer » Fri Apr 08, 2011 10:34 pm UTC

When I was getting frustrated from doctors asking this while assessing my endometriosis (or more accurately insisting that I didn't have it), I ended up making a chart with pain intensity on the y axis and time on the x. I mapped out at least half a dozen different injuries I'd sustained in different colours to compare against, including but not limited to stubbing my toe, getting hit on the head with a metal shovel, having rubbing alcohol applied to a skinned shin, etc. as well as a line representing at which point I would prefer death than experience it any longer (which the endometrial pain crossed at the peaks of its waveform)
The doctor begged me to keep the chart to show to her future patients as a reference XD

Really, the number system is useless. Not only is it subjective from person to person, but differs based on the time, the type of pain, the presence of shock or other problems correctly percieving the pain, and the fact that to get a trulely accurate number you'll have to take a significant amount of time reviewing and rating past experiences (with memories that have probably faded and distorted with time)
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Re: 0883: "Pain Rating"

Postby alexriehl » Fri Apr 08, 2011 10:38 pm UTC

SirMustapha wrote:I like the joke, and I'd say it's well executed until the final panel. When will Randall realize that those post-punchline dialogues are entirely unnecessary and only reduce the effect of the joke? End it with "One." and it's perfect.

Absolutely true. I've noticed a few unnecessary end dialogues in some of the later xkcd comics. I really prefer the style of the earlier ones, where characters would just stare at another with the appearance of "What the hell are you talking about?"
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Re: 0883: "Pain Rating"

Postby Muffinman42 » Fri Apr 08, 2011 11:32 pm UTC

I feel like curling up now... Really shouldn't have tried imagining the worst pain I could. :(

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Re: 0883: "Pain Rating"

Postby MrBawn » Fri Apr 08, 2011 11:42 pm UTC

If you say your pain goes to 11, they give you a spinal tap. (No, really, this happened to my wife.)

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Re: 0883: "Pain Rating"

Postby Plasma Mongoose » Sat Apr 09, 2011 4:16 am UTC

Tormuse wrote:Once I was out practicing, I quickly abandoned it. Firstly, because pain is very subjective; there are some clients who say "ow! Ow! OW!" when I'm barely touching them, whereas other clients will continue to demand more pressure even if I'm leaning on them with my full body weight with my elbow.


I would be an example of the latter, it is hard to find a masseur/masseuse who could do it hard enough for my back and shoulders..
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Re: 0883: "Pain Rating"

Postby mercutio_stencil » Sat Apr 09, 2011 7:11 am UTC

Once or twice I've actually asked for a reference point; more often the not the nurse or doctor just looks at me like I'm crazy.

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Re: 0883: "Pain Rating"

Postby Faranya » Sat Apr 09, 2011 8:39 am UTC

MrBawn wrote:If you say your pain goes to 11, they give you a spinal tap. (No, really, this happened to my wife.)


Well done sir, your pun has reached a value of 2 on this theoretical pain scale.
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Re: 0883: "Pain Rating"

Postby senmoonsect » Sat Apr 09, 2011 9:33 am UTC

konkonsn wrote:
Plasma Mongoose wrote:As far as I know, Irukandji syndrome is the worth pain ever, most sufferers beg for death after suffering it.


I only read a few articles after a google search, but it seems the begging for death is less about the pain and more about some weird mental thing the poison does, making suffers feel a great sense of doom.


so which of these is true? which is worse? wikipedia says some guys who got stung by irukandji wished they had been stung by the box jellyfish, but i don't know if thats because its more painful or because its harder to treat or whatever and they didnt know when it would end or something.

edit: oh weird i was sure i quoted the guy describing box jellyfish sting but anyway, which is worse. box or irukandji?

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Re: 0883: "Pain Rating"

Postby Baughn » Sat Apr 09, 2011 12:00 pm UTC

My pain imagination scale is pretty much calibrated against http://www.orionsarm.com/xcms.php?r=oa-story&story=dr_yes_jolonah, so.. yes, if someone asked me that question they'd probably get a 1 even if I was missing half my body. That is, assuming I was still coherent enough to answer properly.

Really, it's just a bad question.

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Re: 0883: "Pain Rating"

Postby Azathfeld » Sat Apr 09, 2011 1:47 pm UTC

When in surgery recently, I kept getting asked this question, but I rapidly realized that what they meant was that an answer over 5 would get me morphine and an answer under 5 was assumed to be bearable. So the question was recontextualized; they were really just asking me "Do you want morphine?". I would just answer "seven" if I did and "four" if I did not.

I suspect that this is because they're simply not allowed to ask you outright if you want morphine.

Edit: well, no, while "in" surgery I was certainly not in a position to answer questions. This was afterward.

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Re: 0883: "Pain Rating"

Postby SirMustapha » Sat Apr 09, 2011 2:32 pm UTC

neoliminal wrote:When was the last post you made that wasn't critical? More curious than troll-ish. I'm curious how long you've been like this, because I remember you not being that way.


I have no idea. But if memory serves me, I think it was after comic 500 or so that I started to look at the comics twice before laughing. I think that when The Race happened, I was already looking five times.

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Re: 0883: "Pain Rating"

Postby Piyerus » Sat Apr 09, 2011 4:01 pm UTC

I was recovering from surgery a little while ago, and answered on the low scale whenever they asked me about my pain. However, whenever they did give me pills to help with what "little" I had, I told them it had no effect. They upped the dosage over time until they finally hit the absolute limit of what they could give me, around which point it was actually having an effect. I had just finished having surgery to correct my Trigeminal Neuralgia.

When the last five years of my life had been a rollercoaster of pain where I'd hit and stay at "10" for weeks or months at a time, where I could barely talk or eat at all because of the pain... and since I HAVE to eat, I just had to suffer through it... having a little hole drilled in my head and my nerves played with a bit was barely worth mentioning.

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Re: 0883: "Pain Rating"

Postby Hephaestus16 » Sat Apr 09, 2011 5:55 pm UTC

I think that to plum the dark and sordid death of agony would require modifications to human neurology, the small limited number of brain cells that process pain put a cap on how much agony one can feel. To really ramp up the the pain level one would have to peel back the skull and get the pain centre of the brain to expand until the person is floating and feed via tubes in a mass of pain brain. Then of course you would stimulate the heck out of it.

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Re: 0883: "Pain Rating"

Postby mojo-chan » Sat Apr 09, 2011 7:46 pm UTC

I have suffered from arthritis my whole life so I don't know what it feels like not to be aching all the time. I have literally no idea what normal is or how bad my pain would be if a normal person developed it. It might only be a 1, but then again it could be a 5. Having never been stabbed in the face or ripped open by childbirth the scale is largely unknown to me.

I think you also have to differentiate between acute pain and chronic pain. A chronic 3 is about 100x worse than an acute 3 because it grinds you down slowly over many years and causes more psychological damage than say a nasty and quite painful cut would. Painkillers are also a lot less effective with chronic pain because although they reduce it they never make it go away completely so the psychological effects are still there. They can help you live a reasonable life though, sort of.

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Re: 0883: "Pain Rating"

Postby Dataflashsabot » Sat Apr 09, 2011 8:38 pm UTC

alexriehl wrote:
SirMustapha wrote:I like the joke, and I'd say it's well executed until the final panel. When will Randall realize that those post-punchline dialogues are entirely unnecessary and only reduce the effect of the joke? End it with "One." and it's perfect.

Absolutely true. I've noticed a few unnecessary end dialogues in some of the later xkcd comics. I really prefer the style of the earlier ones, where characters would just stare at another with the appearance of "What the hell are you talking about?"

I agree completely (and also about the floating heads). Here, I fixed it:
Image

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Re: 0883: "Pain Rating"

Postby Sungura » Sat Apr 09, 2011 9:31 pm UTC

There are a few different pain scales and they are starting to use ones with faces. Which helps, but it doesn't solve the problem. A study done and published in Pain actually showed that people experiencing pain tend to smile. But, a "1-10" scale isn't helpful either. Interestingly, if you are interested in rankings of various types of pain, check out the McGill Pain Scale. Causalgia is "burning pain" and is the old term for Reflex Sympathetic Dystrophy, which has been reclassified now as a Complex Regional Pain Syndrome. CRPS is actually the current known worst pain.
Image

Another chart often used in pain clinics specifies certain types of pain, but you still have the 1-10 scale of "imaginable". My mom hates filling out these things (she was diagnosed with CRPS in 1994) although according to her and other people I know who deal with such pains, do seem to prefer the face scale rather than the numbers scale.
Image

Point is, pain is very hard to rate, and somehow doctors need to get a sense of the type of pain and how severe the person is feeling it. And it will never be the same person to person. There are so many ascending and descending influences involved in pain sensation, including even things like emotion playing a factor. So you couldn't make a scale of "dropping a brick on a person" or whatever like that was suggested, because the *exact* same stimuli will give different pain responses. Why? Nociception =/= pain.

In fact, in all of our pain studies (yes, I work in a neuroscience lab studying neuropathic pain, just defended my thesis and passed, woot!) anyway, we use a rat model but we can't even say rats experience pain. We have no clue if they do or not. We only know that they experience nociception. Pain is just a broad term used in the field for simplicity's sake. Often times when we talk about pain, we really mean nociception. Nociception is standard, pain is not. Nociception is sensation of noxious stimuli whereas pain is the unpleasant feeling in response to noxious stimuli.
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Re: 0883: "Pain Rating"

Postby Randomness » Sun Apr 10, 2011 12:24 am UTC

moocow2024 wrote:I work in an ER everyday and it is my job to document each patients medical chart side by side with the physician. Kidney stones, child birth, gallstones, and aortic dissections take the cake. It is extremely interesting to see how similar conditions and ailments affect different people. Some people rate their open tibia fibula fracture as "a 4/10, but only when i try to move it" whereas others have to be woken up from a drooling nap to tell you that "the narcotics didn't work and I am still at a 10/10" for their abdominal pain.



I believe they say that because of a common miss-conception. The drugs don't take away the pain they make you not care that you are in pain. This comes from working in hospice where I have seen patients who are drugged to unconsciousness (and yes are drooling) scream in pain. Also form conversations with various family members (who have had kidney stones, cluster headaches, retinal reattachment surgery, and a punctured lung with 10 breaks in the ribcage) who have all said that they could still tell the pain was there.

Or, of course, they could be drug addicts.

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Re: 0883: "Pain Rating"

Postby raven-hygieneco » Sun Apr 10, 2011 2:37 am UTC

Most pain-rating scales are pointlessly subjective or nondescriptive--like bad, worse, still worse--or stupid smileys and frownies that tie to your emotional state rather than anything you can pin down. As a result, some folks will rate a bad hangnail as a 7 or 8. Vietnam vets might give 8 to a severed limb!

HOWEVER I found one scale at a clinic for neuropathic pain that was actually objective. I wish this could be more common, since it really puts pain in perspective. I'll have to try to find the lower numbers, but I remember (my comments in parens) for the upper end:
8=nausea (ie, hurts so much you're gonna barf)
9=delirium (you're disconnecting from the world)
10=unconsciousness (nowhere to go above that)
I'm a lot more careful about using 7 or 8 after reading that.
Pain rating is logarithmic, or should be.

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Re: 0883: "Pain Rating"

Postby philip1201 » Sun Apr 10, 2011 11:05 am UTC

Dataflashsabot wrote:I agree completely (and also about the floating heads). Here, I fixed it:
Image


That might look better still if the last three panes become narrower (4>5>6 instead of 4<5>6). Oh, and #6's head is still disconnected.

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Re: 0883: "Pain Rating"

Postby Cramulh » Sun Apr 10, 2011 12:17 pm UTC

My girlfriend and I are both nurses. Where she works, she often has to ask patients to scale their pain from one to ten, and most patients just don't understand. That's quite frustrating, they keep answering "eight" with a wide smile on their faces (usually they understand "eight over ten, thats quite good !). So we use this kind of ruler : http://www.ligue-cancer.net/files/national/article/images/eva_reglette.gif (sorry but I can't find the english name for this), which they understand even less. The only situation where rating pain from one to ten really has a meaning is for patients with cancer or other chronic pain, because having a four one day and a seven the next means a lot for us. But I still feel stupid when I fill a form with blood pressure in mmHg, temperature in °C, and add a number supposed to evaluate pain, ignoring fear, sadness, despair, and many other factors that totally change one's feeling.
Adults most of time are like kids who fall down, hurt themselves on the knee, and keep joyfully playing in the garden until the see the small wound on their knee, get scared of the blood, and scream. And it is my firm belief that they really feel the pain getting worse at this exact moment. I give subcutaneous shots everyday, and I always use the same kind of needle (which has more or less the diameter of a hair). People who fear needles usually feel when I insert the needle, while people who have no trypanophobia dont even know if I gave the shot or not, because I disinfect the skin with alcohol which feels cold on the skin.
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Re: 0883: "Pain Rating"

Postby VectorZero » Sun Apr 10, 2011 12:44 pm UTC

Sungura wrote:Nociception =/= pain. ... Often times when we talk about pain, we really mean nociception. Nociception is standard, pain is not. Nociception is sensation of noxious stimuli whereas pain is the unpleasant feeling in response to noxious stimuli.
Similar to noise =/= sound.

I've worked in a few emergency departments, and the most egregious abuse of the pain scale came from a early-20s yuppie who'd only presented after her coworker suggested she get that itchy scalp she'd been complaining about looked at, and was sitting quite comfortably in the waiting room and the examination cubicle. How bad was her pain? "10." *beat* "Right."

On the other hand was the young guy who'd walked into a train and fractured both bones in his forearm. He didn't flinch when I lifted his hand and the bones shifted.

Still, it does have some use, beyond serial reporting. Vague but intense abdominal pain with few physical features may be a sign of impending dead gut, and paying attention to the patient complaining of 10/10 pain may mean them still being alive in a few hours. Same thing with a limb and the early treatment being the difference between keeping the limb or not.
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Re: 0883: "Pain Rating"

Postby Sungura » Sun Apr 10, 2011 1:42 pm UTC

Cramulh wrote:So we use this kind of ruler : http://www.ligue-cancer.net/files/national/article/images/eva_reglette.gif (sorry but I can't find the english name for this), which they understand even less. <snip> I give subcutaneous shots everyday, and I always use the same kind of needle (which has more or less the diameter of a hair). People who fear needles usually feel when I insert the needle, while people who have no trypanophobia dont even know if I gave the shot or not, because I disinfect the skin with alcohol which feels cold on the skin.
Wow...ok that seems like a reverse scale, I've never seen one of those in the States. You are right, that is even more confusing!

As to needles, yeah I have a needle phobia because trying to donate blood makes a sharp stabbing pain that runs up and down my arm in a shooting fashion, and after a bit my hand goes numb but my arm is still shooting. I'd rank it about an 8 as I couldn't control crying and I almost passed out at one point. I lost sensation in my hand for a few days, and it took about a month to regain sensation and full dexterity in my fingers. Turns out, I have a nerve that runs on *top* of my vein instead of below it so whenever blood is drawn, it gets stabbed, basically. Smaller needles though, avoid this, so I always request the small butterflies now. And I'm never donating blood again. But it still gives me a needle-phobia, because damn, that sucked.

VectorZero wrote:
Sungura wrote:Nociception =/= pain. ... Often times when we talk about pain, we really mean nociception. Nociception is standard, pain is not. Nociception is sensation of noxious stimuli whereas pain is the unpleasant feeling in response to noxious stimuli.
Similar to noise =/= sound.
Yurp.

And yeah, I think the pain scale is less helpful for a "one-time" pain incident and more helpful for chronic pain sufferers - who tend to understand the scale a bit better anyway as they daily experience different pains so they know what is worse/better. When you put one on a new painkiller, that number they gave, it should be less than what it was before, sort of thing. I definitely see it's use being more a relative thing for such people. For a fracture, you can tell how much it's bothering someone - wincing a lot, sobbing, or don't even care when you move it...it seems kinda silly to ask them to rank it as they aren't really thinking in terms of what to compare it to, it's more like "not much pain" "yeah it hurts some" or "owwwwwwww wtf stop it!" but asking for a scale...well...not sure how helpful that really is.
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Re: 0883: "Pain Rating"

Postby phlip » Sun Apr 10, 2011 1:46 pm UTC

Sungura wrote:Wow...ok that seems like a reverse scale, I've never seen one of those in the States. You are right, that is even more confusing!

Note that the reverse scale isn't on the side facing the patient... the side the patient sees just says "no pain" on the left and "worst pain imaginable" on the right, with an ungraduated continuum between them. It's the reverse side that actually has the scale on it (which is then reversed, because the patient's left is the doctor's right). So, like, if the patient puts the slider all the way to the right (the "worst pain imaginable" end) then the doctor will see it all the way to their left (the "10" value).

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Re: 0883: "Pain Rating"

Postby Cramulh » Sun Apr 10, 2011 2:22 pm UTC

Note that the reverse scale isn't on the side facing the patient... the side the patient sees just says "no pain" on the left and "worst pain imaginable" on the right, with an ungraduated continuum between them. It's the reverse side that actually has the scale on it (which is then reversed, because the patient's left is the doctor's right). So, like, if the patient puts the slider all the way to the right (the "worst pain imaginable" end) then the doctor will see it all the way to their left (the "10" value)

Yep sorry but I forgot to mention that. With some of these rulers you can add a lot of unnecessary precision (something like "the patient feels a 4.7/10 pain). I still wonder why :| .
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Re: 0883: "Pain Rating"

Postby SirMustapha » Sun Apr 10, 2011 4:59 pm UTC

Dataflashsabot wrote:I agree completely (and also about the floating heads). Here, I fixed it:
Image


Yep, that looks already a lot better. A reaction shot from the nurse could still be added for effect; and the brunette on the second panel is now completely superfluous. Why is she there, anyway? Just to deliver the last dialogue?

The only thing that lacks now is for Randall to get this kind of feedback before publishing his comics, and then we'll have a change for the better.

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Re: 0883: "Pain Rating"

Postby Linux0s » Sun Apr 10, 2011 5:07 pm UTC

I've been through my share of mishaps including surgeries for broken finger (3 temporary pins), deviated septum, hernia, and herniated vertebrae disc on lower back and wisdom teeth with just a local. Twice I've had something lanced in the doctors office without any anesthetic whatsoever. The first of which the doctor commented "we've had to have two people hold the patient down to do that... you didn't even flinch". So I think I have a pretty good tolerance for pain.

Now I'm surprised this hasn't been mentioned by anyone yet but the worst pain I've ever experienced was infection. I developed an abcess on my inner leg and while the area was fairly swollen the feeling was just like a water balloon filled the bursting point. You could graze the area with a fingertip as lightly as can be done and the pain that inflicted was absolutely excruciating. I've never known pain like that. This was the second time I got lanced without any anesthetic. The nurse left it up to me but said putting a needle in there a couple times to numb the area might be worse than just putting the knife to it. So that's what we did.

That and the squeezing to drain it was the worst pain I'd ever felt up to that time. They stuffed a foot long strip of gauze about the width of a shoelace in the incision to allow it to continue to drain for the next couple days. As they put that in there the pain was horrific and the worse yet but the best was yet to come. Infection in tissue takes some time to disperse so the area was still almost as painful as it was from the start. Well 4 days later when they pulled that gauze out, again without anesthetic, that was by far THE worst pain I've ever experienced in my life. It was a sensory overload as my brain could scarcely process that amount of pain. I absolutely mangled that tissue paper sheet they cover the table with.

So in my experience the pain from infection wins hands down over broken this and mangled that by a factor of about 10.
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roflcopter
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Re: 0883: "Pain Rating"

Postby roflcopter » Sun Apr 10, 2011 6:40 pm UTC

I would definitely put a 10 at the point of unconsciousness. Over the summer I broke my arm in four places, although I didn't know it at the time. But after standing up and regaining consciousness from the fall, I attempted to straighten my arm out and woke up laying in the yard again. Also, a week later, I managed to get 3rd degree burns on my arm and without thinking clearly poured rubbing alcohol on the open burns. Just when you think it can't get worse, it proves you wrong.

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Re: 0883: "Pain Rating"

Postby RogueCynic » Sun Apr 10, 2011 7:13 pm UTC

Linux0s wrote: So I think I have a pretty good tolerance for pain.
Just curious, would you say you have a strong tolorance for pain killers as well? When I dislocated my elbow, I was shot up with a Valium/morphene mixture to help put the joint to rights. They shot me up several times, for a total of 25 units of one and 15 units of the other. I think I weighed 120 lbs at the time. The anesthetist was surprised that I was able to walk out of the hospital.
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ColtonProvias
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Re: 0883: "Pain Rating"

Postby ColtonProvias » Sun Apr 10, 2011 8:21 pm UTC

barasawa wrote:I use a logarithmic scale for that since my ten is a state where you can't move, or talk, and breathing itself is ragged and causes unending agony. A state where the only semi-coherent thought you can form if any is something along the lines of "kill me". If you ever reach 10 on that scale, you'll never be able to forget it no matter how hard you try.


I have experienced a 10. I will tell you that a 10 makes you feel like being shot with a pneumatic nail gun to be a 2 at highest. It's the point where you essentially lose all sense of your surroundings. Let me paint you a picture of what I now define as a 10:

I suffer from cluster headaches, commonly referred to as suicide headaches. In my case, they tend to be triggered by temporomandibular joint disorder (TMJ), which is often stress-induced (thus making exam times at college to be quite impossible to survive without having a large drop in grades due to flare-ups mid-exams). When I feel the slightest pain in my jaw, I have to take 800 mg of ibuprofen, stop whatever I am doing, get to someplace quiet to sit down, and start relaxing my jaw immediately. Many things can trigger my jaw such as stress, getting hit in the jaw (even a light hit that gets the jaw to close can do it), clenching the jaw tightly for a few seconds, eating chewy or hard foods, or just opening my jaw too far when yawning. And when my jaw triggers, I have about 5 minutes to deal with it or I prepare to spend at least the next 10-12 hours in hell.

Let's say I'm in the middle of an exam and don't have the chance to relax my jaw properly. Now we start moving into hell. This dull ache slowly becomes more of a pressure on the side of my face. After about 10 minutes, my joint is heavily irritated and has visibly swollen. The nerves in the joint are being pinched and parts of my face may lose sensitivity, twitch, feel painful, or gain extreme sensitivity. I've always had sensitive teeth, but when each breath you take hits your teeth and feels like a sharp attack of cold air freezing all the way through your tooth and into your gums, you start to worry. When this happens, I know I am at the true point of no return and it's all downhill from here quickly.

So here I am an hour after the first bit of pain, clutching my jaw. The pain in my teeth now affects an entire side of my mouth, but is mostly on the lower jaw. I start to rock back and forth in complete fear for I know what is about to happen. Sometime within the next few hours, this pain goes to 10 (unless you follow guitar amp rules, then it goes to 12). The cluster headache begins. A huge, sharp explosion of pain happens deep within my head behind my eye. It comes on quickly, many times taking only a few seconds to hit. It is throbbing with sharp stings every few seconds. I get up and start pacing back and forth in an attempt to get my body focusing on something else. A few minutes later, however, I slam myself on my bed head-first. The pain is still there, so I roll over, sit up, and rock back and forth. I slam my head into the bed again when another spike of pain hits. Another spike and my head hits the wall. I can't control myself now as each spike makes me want to knock whatever is causing the problem out of my head. It feels like somebody is shoving a power drill around my eye and drilling into my skull while somebody else is shoving a stake in through my temple and pulls it out, only to repeat a few seconds later. My jaw now feels like a dozen syringes are being shoved deep into it with a particularly large one at the joint. What makes this infuriating is that this is only happening on the left side of my head. And although it's localized to one side, it covers pretty much the entire front of my head...for now.

Fifteen minutes to half an hour after the cluster headache hits, it's time for it to get even worse. I'm pretty much exhausted, in a state of fear, and in completely agonizing pain. Suddenly I feel a pain in my ear. It feels like somebody is trying to rip my own mind out through my ear canal. I bend over, grabbing my ear, still flinging myself about in pain. I no longer see the room or hear anything else around me. I feel completely alone, even though there may be others in the room. All I want is for everything to end and for me to be put out of my misery. And now, welcome to hell as I feel a huge spike of pain go up the top of the back of my neck, deep into the back of my skull, feeling like I was just shot by a bullet. I lose focus and only feel pain. I know what is about to happen based on past experiences, but the seconds seem to go by like hours. Another spike of pain, like I'm being shot. Followed by another, and another. This continues every few seconds, but I have no idea how long this lasts for as it seems to go on for hours. I lose complete awareness of my surroundings and of myself, too. I am no longer part of the world but rather in a world of pain. I know my body is doing something and yet I no longer have even the tiniest bit of control. It's all fear and darkness. My head is burning up and each section of it is exploding with pain that feels like I'm being shot, drilled, stabbed, or ripped apart from the inside-out.

FInally, 2-3 hours after the cluster headache began, it finally subsides. I gain awareness of my surroundings but know that this is likely to be short-lived. The stress and fear caused by the headache are still there, which in turn trigger my jaw again. The cycle repeats until I am completely exhausted and fall asleep which means I may suffer several cluster headaches in a 12 hour period. But, if I'm lucky and as soon as I gain awareness, I can get my jaw relaxed properly and relax the rest of my body. The pain lingers for the next several hours with some small spikes, but each becoming less painful. In the end, I am laying down, completely exhausted, still shaking and covered in sweat and tears, scared.

I've had roommates. They describe it as the most horrifying thing to witness as they know there isn't anything they can do about it. When I lose awareness, my body wants the pain to end so I scream in howls of pain and keep shouting that I want somebody to kill me to get the pain to end. When your body does that on it's own without you controlling it, you know you are at a 10.

And in case you are wondering, yes, I am using a guard. No, oxygen treatment doesn't work for my headaches. No, I won't be getting surgery as, due to the proximity of my jaw to my ear, there is way to high of a risk of deafness occurring (and as a musician, that would essentially kill my greatest passion in life). It's a pain that flares up every couple of weeks and I'll be suffering it for a while, quite possibly for several more years until a full plan can be worked out that won't cause deafness.

So...yea...that's a 10.

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Re: 0883: "Pain Rating"

Postby Incomitatus » Sun Apr 10, 2011 8:54 pm UTC

Hmmmm... I've had:

2nd degree burns to the face - oddly not that painful, call it a 3, shock is your friend
A broken coccyx - 8 when it first happened, 4-5 for a month and a half after
A cracked vertebrae - 9 when it first happened, 4 for a couple months unless I moved wrong, then back to 7-8
A broken toe - 7, again much lower pain during the healing process
A shattered kneecap - didn't really hurt when it happened, an hour later I was screaming on the floor... call it a 9. That was 12 years ago, still causes occasional chronic pain, up to a 5 some days.
etc. etc... not really wanting to list everything, just provide some perspective for...

The worst pain I've had: A spider bit me. Not sure what kind it was, just remember thinking, "Huh, this isn't good...." and then 20 minutes later I was still screaming after I passed out, I've been told.

The thing that's always fascinated me is that people who say they have a high tolerance for pain tend to fall into two camps: those who don't seem to feel as much pain in response to the same stimuli and those who do feel the pain but are very capable of ignoring it. I tend to fall into the latter camp. With the exception of the spider bite, I could have answered questions with anything listed above, even if it would have been through gritted teeth with most of them. With the kneecap, I lay on the floor for ten minutes, then walked to the medicine cabinet for some ibuprofen, and then walked to bed. It hurt like Hades, but what else was there to do?

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Re: 0883: "Pain Rating"

Postby Stellazira » Sun Apr 10, 2011 10:36 pm UTC

I can't remember the last time I felt a considerable amount of pain, although I did trip over a gate a few weeks ago since I wasn't used to having a barrier there after not having one for 10+ years. I dinged up my legs rather badly and although the bruises seem to be gone the skin needs to do some healing still. :?

When I first saw this comic I though: "What on earth is he thinking about?" I guess I should feel happy I can't think like that. :P

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Re: 0883: "Pain Rating"

Postby Skip » Sun Apr 10, 2011 11:12 pm UTC

I give death a pain rating of 10 out of 10, how about you people?
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Re: 0883: "Pain Rating"

Postby SecondTalon » Mon Apr 11, 2011 1:36 am UTC

Death is.. Death. It's completely separate from pain, and while the two *can* go together, dying of heart failure in your sleep probably doesn't hurt much. Carbon monoxide poisoning is pretty painless as well, which is why it works. People don't realize they're being poisoned, they just feel sleepy.

There's lots of ways to die that have little to no pain. There's lots and lots and lots to feel worlds of pain without dying.
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