To Your Good Health: Off-the-charts pain has arthritis sufferer looking for a better scale
BY KEITH ROACH, M.D.
DEAR DR. ROACH: Why is pain measured by numbers? I have severe pain, and doctors do not know what to do when I say it is an 11 on a scale of 1-10. My pain can’t be measured by numbers. It depends on the time of day, what I have done during the day and the weather.
I have arthritis in most of my joints, specifically my spine and hips. Having had five spine surgeries, epidurals and hip shots, I have pain every day. There is not much more that can be done but to take opioids. It can be hard to make the decision either to take an opioid and go out shopping or for coffee feeling like I am in a vacuum, or to go out in pain.
There is no chronic pain support group in my area, and no one can understand how I feel, even the professionals, unless they have gone through it. So when asked how I am, I say “fine.” Other people don’t want to hear about my pain.
Why is there not another way the doctor can measure your pain? I have given up everything I love to do in life because of pain. There’s no way to get “better” from pain. — M.L.D.
ANSWER: I am very sorry to hear your story, as it is similar to those I have heard before from people with chronic pain due to many different causes. It is disappointing for me to hear that you haven’t found a pain specialist in your area who seems to care about helping you.
Although the 1-10 pain scale is thoroughly entrenched, it has its flaws. The biggest one is that what one person might consider a two, another person might consider a nine.
I’ve seen people with horrifying injuries gritting their teeth and saying their pain is a three while other people claim their pain from what seems to be a minor condition is a 10 (I had one person tell me the pain from getting his blood pressure taken was a 10). Because pain is subjective, there is no way of standardizing what a person means with their pain rating. However, a 10 on a scale of 1-10 is supposed to be the worst pain imaginable.
DEAR DR. ROACH: A recent visit to the doctor included some blood tests. I was concerned that the eGFR reading decreased by 23 points (from 93 to 69) in a year’s time. Both my cardiologist and my preferred care provider advised that since the reading of 69 was still in the safe zone, there is no reason to be concerned. I have had protein in my urine for years.
My concern is not that it is still acceptable, but that the rate of decrease indicates to me that something is going on with my kidneys. My creatinine level has risen steadily from 0.8 in January 2018 to 0.9 in March; 0.95 in August, and 1.1 in January 2019. Is my concern warranted? — D.L.L.
ANSWER: That’s a steady increase in creatinine, meaning a steady decrease in kidney function. Combined with the protein, I certainly would recommend you ask your doctor again about seeing a kidney specialist, a nephrologist. Your primary care doctor is right that the creatinine is still in the normal range, but the trend shows a 30 percent loss of kidney function in a year. That deserves an evaluation before the kidney function becomes worse. It is also appropriate to review any medications or supplements you might be taking. For example, if your cardiologist started you on an ACE inhibitor, a 25 percent apparent decrease in eGFR may be due to the medication affecting blood flow to the kidney.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.