When I wrote up the pain scales yesterday, I was aiming to make it as clear and easy to use as possible – both for those needing to describe and those needing to assess someone else’s pain. That meant that I left a lot of things out. Things that have often frustrated me about interactions with health care professionals.

I have no idea how much training is given to spotting someone in pain and assessing it accurately, or what form that takes, but if my own experiences are anything to go by then it’s variable, to say the least.

Asking someone how much pain they’re in on a scale of 1 -10, where 0 is no pain at all and 10 is the worst pain you can imagine, is completely useless. Especially if that person has lived with periods of intense pain for decades and has a vivid imagination. If you ask me that question then I’m never, ever, going to answer ‘10’. On the basis that I’m awake to answer, and I assume I’ll pass out when the pain gets that bad.

Also, calibrate your scale. Or ask the person to calibrate it for you. If you think that something commonly acknowledged to be extremely painful, such as childbirth, is 10, but the person in pain thinks it’s mostly 5-6, peaking at 7 at most, then you’re not ever going to have an accurate idea of how much pain someone is in. Yes, that has happened to me.

If someone doesn’t visit their GP for years on end except for hayfever meds, and then suddenly turns up week after week for more than 6 months, saying they’re in unbearable pain and by the way the painkillers they’ve been prescribed aren’t working and the pain is seriously impacting their ability to parent, then for the love of all that you hold holy, take them seriously. Investigate. Do not brush it off as something that will get better by itself. That kind of pain will not be a pulled muscle. Trust me.

Also, pain isn’t always shown by a patient rolling around and screaming. This is incredibly important.

The initial onset of pain may well make someone gasp, recoil, yell out. But when they have lived with it for nearly a year then they go quiet. Very, very, quiet. Withdrawn. Trying to not move. It can totally change their personality from smiley and bubbly to morose and monosyllabic. Yes, that was me too. Sorry.

If you’re a health care professional, then read the signs. Don’t dismiss a patient, just because they don’t look like your idea of pain. A good friend of mine risked losing her son because the doctors repeatedly dismissed her concerns of appendicitis, because he didn’t ‘look’ in enough pain. She took him in repeatedly with extremely high temperatures, but they kept getting sent home. He got very weak and seriously dehydrated as a result. It was only when they happened to be on a ward next to another mother and son they knew from school, that the hospital started investigating properly. The other mother took one look at him, and commented on how much his personality had changed. Fortunately this was overheard by a nurse. Before that, the medical staff had threatened my friend with investigating her for Munchausen’s by proxy, because she was so insistent something was wrong and she wanted them to investigate properly.

In the end the operation went ahead, and the appendix ruptured as they were taking it out, which was an incredibly close call. A few hours later and he could have had a severe case of peritonitis to contend with, in a very weakened state.

So please, if you’re in the position of assessing someone’s pain, do it properly.