Selects: Pain Scales: Yeeeow! | STUFF YOU SHOULD KNOW

howdy everybody we're going to take you. back in time to March 14th 2017 for this. week's selects episode pick pain scales. colon exclamation point I know that was. a Josh title because it's funny and. creative and he's great at those so uh. pain scales is pretty interesting stuff. you've ever been to a doctor and they. say like what is it between a one and. Tin that's one kind of Pain Scale but. there are all kinds of pain scales and. believe it or not they're not arbit.

a lot of thought went into how they were. formed and built and put together so. check out pain scales. colon right. [Music]. now welcome to stuff you should know a. production of iHeart. [Music]. Radio hey and welcome to the podcast I'm. Josh Clark hi there's Charles W CH Brown. all right hi and Jerry's over there.

silence well you put us three together. you get stuff you should know sorry in. advance those three you just had a. disassociative experience I did because. I I want to be anywhere but where I am. right now which is in a lot of pain are. you in pain yes I just hit my hand with. a hammer really hard to get ready for. this episode nice right in the middle of. the middle knuckle you know the one of.

the very first dumb jokes I made like. like really I think I need to go to the. hospital what uh in my very first. podcast appearance with. you I said that I was a method. podcaster and that I just got through. brushing my teeth and drinking orange. juice oh yeah you have revived that dumb. joke. from 37 years ago right with a hammer. and here we are and here we are Chuck.

talking about pain yeah you know I. thought this one um for all its kind of. sameness and basicness MH was way more. interesting than I thought once you dig. in a little bit more Yep pain how about. that yeah I thought this one was pretty. cool too I we need to do like a pain. episode just on pain mhm just in general. House of. Pain yeah uh the TV show and the CP I. didn't know that was a TV show yeah it's.

a Tyler Perry show oh okay that explains. it it's about the. pains and their house yeah I get it I. think it's kind of like Mama's Family a. little bit I didn't watch that either. same production quality that kind of. stuff looks like it's a recorded on a. stage sure probably is you know what I'm. talking about mhm Mama's Family yeah I. didn't watch. that well had you you would have known. pain which is weird cuz I love the Carol. Bernett show yeah this is a pretty Far.

Cry from that mama's house mama's family. Mama's Family with Bubba the grandson oh. man it was. bad it was bad but anyway. um yeah there's no segue let's just get. back to pain yes and not just pain uh. because like you said we're going to do. one on that one day but Pain Scale. specifically which is R I should say. because there are many many of them mhm. um as this article astutely points out.

there really is no physical instrument. although they have tried over the years. that can accurately measure pain and so. doctors rely on a couple of methods. which is hey dummy how much do you hurt. hey hey you stop crying tell me how much. your your pain is or I'm going to look. at you and talk to you a bit and I'm. going to make my own assessment because. I'm the doctor right and I'm going to. write like.

could could brush his hair a little more. than he does too I'm G to make my own. observations about you man I haven't use. a hairbrush since I was probably 13 I. have to once in a while cuz my hair is. kind of longish now uhhuh and when the. wind blows it really turns it into a. bird's nest so the comb from your pocket. yep I I stand in front of the mirror. like Marsha Brady right before bed and. count off 100 brush. Strokes yeah so let's talk.

about you know basically we're talking. about self-reporting or observation. those are the kind of the two. methods because it's important you know. you got to there's a lot that goes into. determining how much pain someone's in. from the kind of meds they get to. relieve that pain to diagnosis of what. the heck's going on well yeah the um. medical community just in the last. probably decade or so is really waking. up to the fact that it's doing a lousy. job or traditionally has done a lousy. job of managing pain um there's a lot of. assumptions that people are big babies.

who don't really need medication they. just need to suck it up um there's a lot. of problems with Med seeking where. people pretend that they have pain that. they don't actually have uh and they. because they want the drugs um but then. there's also just this idea that managed. Pain Care isn't quite as good as it. should be uh so part and parcel of that. is realizing like well then we need to. be able to quantify levels of pain a lot.

better and this is the idea that they're. waking up to it is fairly new but the. idea that we can't quantify pain is is a. pretty old one they people figured it. out pretty early on that pain is. subjective it's a subjective horrible. terrible experience and I actually ran. across one definition of pain from a. researcher that said pain is whatever. the person experiencing it says it is. yeah it's as simple as that that does. doesn't really help a doctor who's.

trying to figure out how much medication. to give you or um whether to just go. ahead and like put a pillow over your. face or something make you go to sleep. yeah because that's what doctors do well. yeah it's a last resort but they it's. it's in their. toolbox uh yeah and they it it's become. so important that uh there's a group. called The American pain society which. is a great band name um oh it really is. yeah right probably some sort of metal. right.

or I could see like kind of like a sex. pop kind of I don't even know what that. is I don't either he just invented a. genre yeah um they're calling it The. Fifth Vital. sign which means that's important kind. of like Thrill Kill CT or. um uh who was the other Lords of acid I. don't know who they are. what dude that's your what you you got. requested at our San Francisco show oh.

yeah to say that you're so famous for. saying that when I haven't heard of. something. what well go listen to those bands and. you'll be like oh sex pop okay but. that's more like sex. techno I don't know what sex pop would. be doesn't sound like it's up my alley. okay but I'll give it a shot all right. so uh pain or quantifying pain. specifically was uh or pain in general. actually was like you said misunderstood.

for a long time and it took all the way. into the 20th century quite a bit into. the 20th century with doctors still kind. of struggling with how much you know. anesthesia to give how many meds to give. if you were in pain if you were having. surgery and child birth like you know. literally people waking up in surgery. and going oh well uh we we didn't give. that person enough anesthetic and we. talked about that in our anesthesia. episode a little bit oh man there was. just a lot of trial and error like I.

guess that's not enough because someone. screaming on the table in front of me. well plus also so pain um apparently. it's pretty widespread I saw that in the. us alone nine out of 10 people regularly. suffer from Pain yeah at any given time. uh 25 million people uh well I guess. over the course of a year suffer acute. pain in the US and another 50 million. suffer chronic pain many of those people. report suffering chronic pain for 5. years or more so sad so yeah so the.

medical community says we need to do. something about this and it's like you. were saying the American pain Society. they say that pain is the fifth Vital. sign yeah the fifth. Beetle what was his uh Clarence yeah. great Eddie Murphy's SK yeah uh so if we. go back in time to the time where they. were trying to be a little more. objective about it and actually come up. with um a little more what they thought. were like foolproof ways. to determine pain measurement MH um in.

1940 there were some researchers uh a. trio uh one James Hardy uh one Harold. wolf and one Helen Goodell of Cornell. University those are some 1940s names. sure Harold wolf yeah James Hardy yeah. Helen Goodell all three of them uh they. actually built a device called a a doar. Rimer and what this was was basically a.

100 watt lamp with a lens that they. could focus you know how you do when. you're uh burning ants yeah with a. magnifying glass yeah that's kind of. what they were doing and they were. cranking up heat uh on the you know they. got these nurse volunteers apparently uh. and I think they were all pregnant which. is even a little more sadistic but they. what they were trying to do was compare. it to their pregnancy pains their labor. pains yeah and I was like why would you. do that to like women in labor and then.

was like 1940s well you could predict. that when something was going to happen. you it was one of those few instances. when you can predict somebody's going to. be in pain yeah yeah I get it but it was. also the. 1940s right so they didn't care right so. like that hurts a lot they're like great. great right uh but I guess these were. volunteers so take that for what it's. worth sure and um they were either. nurses or wives of doctors which is even. a bit more sadistic um and they would. focus this light on the back of their. hand and make it hotter and hotter and.

said you know compare that to your the. intensity of your labor. pains by shrieking I guess yeah and they. made up a unit we've reached. equilibrium they even invented a pain. unit called dolls DS MH and you know it. went supposedly 1 to 10 but there was uh. a lady one of them uh tough Marge who. cranked it all the way up to. 10.5 maxing out the machine and she was.

still like nope I can take it yeah which. is amazing yeah she was like oh hurts so. good uh but she loves sex pop. music uh but there was a problem with. the Doomer which is they uh in. subsequent experience by other doctors. they could not reproduce this which. means it's junk well not only that like. I I don't understand how it quantifies. pain right what you're really saying is. uh compare your labor pains to the.

amount of heat energy that were applying. to you I don't it just didn't translate. to me I didn't understand it but. apparently the it created this um this. new cottage industry for machines that. were used to measure objectively pain. and there's some still around today but. they do slightly different things like. um there's one that that is like a ray. gun that's used to see if someone an. under anesthesia um is under deep enough.

right you just sit there and shoot him. with it for fun too yeah and if they. don't wake up great the fun gun yeah. that's right uh and then in 1945 I guess. this is just sort of the decade of. trying to perfect these things before. they realize they couldn't uh Time. Magazine wrote an article on Dr Lauren. Julius Bella glut great name and. um he had a had a machine it didn't use. heat but it put pressure on the shin.

bone in increasing amounts that sounds. awful it does sound awful the shin is. like surprisingly sensitive oh yeah to. like you know just put a coffee table in. any room yeah it doesn't make any sense. it should be like Tougher Than Leather. like Run DMC but it's not no it's not uh. and this one actually I don't know what. the name of it was but um he measured it. in grams to quantify it and was. supposedly and I think this is. self-reported by Dr. Bella glut uh 97% accurate but since.

you've not heard of it most of you that. probably means that was not true yeah he. he thought if he said 98% accurate. people would have been suspicious of his. findings yeah that's right 97 the funny. thing though is while all this. um uh I wasn't going to call it quackery. because they were they were trying to. legitimately invent something right but. while the same time all this is going on. there was a guy named Kenneth keel. who said uh why don't we just ask people.

let's use our brains people how about. that why don't we just ask folks and. tell them like 0 one or two or three. right on uh the scale of you know not. painful to severely painful why don't we. just ask them and see what they say and. that kind of caught on as the standard. well let's take a break man then we'll. get back to when sensible pain scales. came into. effect. y you should know.

[Music]. y Josh. [Music]. Clark all right Chuck so the 40s were. full of um ding bad ideas the. 60s well actually I guess um the the guy. you mention Dr Kenneth Keel he came up.

with his idea of a Pain Scale a. subjective self-reported Pain Scale in. the 40s but it seems to have really. caught on in the 60s yeah agreed and so. with a self-reported pain scale with any. um well yeah any kind of self-reported. Pain Scale it's basically you are asking. the patient how much pain are you in and. it's not enough for them to be like oh a. lot right you know you have to give them. say like you said a a scale of like Z to.

10 or Z to 20 or zero to 100 yeah some. people just for fun have one that goes. up zero to a million sure and everyone. chooses a million it's. crazy I I always have a difficult time. because I have a high threshold for. pain um but that that that's that makes. sense because pain is subjective yeah. but I have a high threshold for pain but. I also you know I want the good. pills oh you know what I'm saying so do. you wink when you're talking no oh I'm.

in a tremendous amount of pain doctor. please help me I usually try to Quant. and this doesn't happen much because I. don't often need uh or have an injury to. where I like would need pain pills or. something um but I always try to. quantify it as if I didn't have a high. threshold for pain you know what I'm. saying like I'll think of my number and. then I'll add a. couple so I can get so I can get Juiced. up you objectively self-report then.

rather than subjectively yeah which they. say is very much wrong sure and you. should be super honest with your doctor. yeah uh because like you said there are. addicts who who seek this out yeah I'm. not one of those but I'm just like you. know the pain pill makes the pain feel a. little bit better even if I have a high. threshold doesn't mean I don't want that. pain to go away some you know yeah well. the way to get around that though is to. just like dress up you know when you go. to the hospital wear a suit to be true. sure tie that kind of thing yeah I walk.

in with my baseball hat and beard and a. tie well see you would seem Med seeking. yeah I totally would it would at the. very least like cross their mind whereas. if you dressed up and you said um and. shaved sure uh they'd be like what what. drugs can we give you right just write. it down write down whatever you want. yeah and we'll sign it I don't know the. name of any of them so uh fentanyl is a. big problem these days making its way. into heroin killing people what taken.

with Heroin yeah they're using fentanyl. to cut heroin I don't know if they still. are anymore but like the little towns. around America were having like you know. it'd be normal to have one or two. overdoses a year they were having like a. dozen or so all of a sudden because. people were like it's like heroin and. then the highest grade pharmaceutical. heroin mixed in and apparently people. didn't have any warning or else maybe. they were told will knock your socks off. I think that's what killed Philip.

Seymour Hoffman too I think he might. have had fentanyl in his heroin but it's. like what these people are used to the. dose they're used to right normally with. Heroin would not be a lethal dose but. with fentanyl mixed in it's they're dead. wow that reminds me the old uh the great. Kamal Nani joke was which was my intro. to him I heard on him on This American. Life he was talking about a a new drug. the kids were doing which was Tha all PM. with.

heroin and he was just like you're. already doing heroin he like what could. that possibly add to your experience. yeah very funny joke yeah uh but also. sad at the same time aren't aren't the. best jokes yeah a little sad uhhuh. sometimes um so with self-reporting pain. scales uh it sounds like I said so basic. like okay it's a no-brainer duh you ask. someone you've got zero to whatever. three or 10 or 100 people say that and.

then the doctor knows but you don't. think about um like children or uh like. in their understanding of pain or maybe. the elderly and reasons uh how they. experience pain or uh people that are. cognitively impaired and their. understanding of pain and then you start. to think oh wait a minute well we need. all kinds of pain scales right and ways. of asking people because not everyone is. the same and they do have them uh adults. specifically are pretty good at rating.

their pain on a scale using numbers yeah. they can also use words like I'm in. severe pain or something like that right. um and usually if you're being presented. with a Pain Scale it's not open-ended. like describe your pain in Flowery. language it's which of these words best. describes your pain like no pain. moderate severe intolerable the one that. gets me is um the worst pain imaginable. yeah. that's that's as bad as it gets like I.

can't conceive of any pain worse than. what I'm in right now that's it just. runs a chill on my spine thinking that. yeah something could happen that could. put any of us in that situation where. you're experiencing the worst pain. imaginable it just I just don't think. that should be able to happen to a. person yeah and it's weird too it seems. like a lot of times um. injuries like whether it's a a cut or a. broken bone or something I've heard I've.

never broken a bone but I've been cut. open a lot of times you better knock on. wood I know I'm knocking right now. um it seems like those injuries are are. less painful a lot of times than other. kinds of injuries like I hear people say. like Yeah I broke my bone but it was. just sort of numb and it looked awful. but I didn't feel actual pain right. whereas like like pulled muscles and. things like that are the things that. really hurt or back pain for God's sake. is the worst you know what I'd like to.

do a call out to Emergency Room. Physicians or um nurses or orderlies. anybody who's seen people in a lot of. pain and tell us what is reliably the. worst type of injury pain wise I think. Burns oh yeah I'll bet Burns i' I've. I've uh I've heard that that's just you. know and you know I've had small Burns. that it's just that pain that won't stop. mhm uh and you know I can't imagine like.

working in a burn you know the kind of. pain those people suffer yeah man uh so. talking about children um there's this. really great story about the Wong Baker. faces all caps f for something that's. right um for for treating kids with. discomfort and pain uh and it was. developed in the early 80s uh by two. women uh Donna Wong who was a uh well.

Connie Baker is I think first started. with the idea and Connie Baker was a. lifechild uh Child Life specialist. excuse me which I had never heard of but. it's a really cool job where they work. in hospitals and they work with children. uh not in like a nursing capacity. but and gez I'd love to hear from. someone who does this but it seems like. they kind of work in a more of a social. services capacity and helping a kid just. deal. with being.

hospitalized does that sound about right. yeah that's that's my impression okay uh. and then Donna Wong who was uh a. pediatric nurse consultant and. apparently an author well not apparently. an author very much an author uh but. apparently just this legend in the. nursing industry and she came to visit. uh in Tulsa where Connie Baker worked. and they got to talking and she was like. I had this idea where we can do better. with with trying to determine and get.

self-reporting out of children cuz. children don't you know sometimes. they're preverbal or. non-verbal uh and sometimes they don't. get like the numbers or the color charts. right so we need a better way and. ingeniously they developed this with. children they started with just blank. circles and said hey you draw a face. that that looks like the pain that. you're having right and the the kid. would draw and they'd be like this is. terrible you do a better job than this. what is that is that a a chimney with.

smoke coming out of it they're like that. I feel like I'm on. fire uh so these kids you know you look. at some of these early drawings and it's. super cute you know they've got these. crayons and they put these details like. hair and noses and you know typical kids. drawings and um interestingly some of. them Drew left to right some of them. right to left I don't know how to. explain that huh but um I guess maybe. kids that hadn't learned to read yet. might have done right to left and not. understood that that's sort of the. opposite of how we learned to read or.

they grew up in a culture that reads. right to left uh I don't think so I. think these were just like you know. normal dumb American kids oh. gotcha uh and so these kids actually. participated and started drawing these. little faces that range from smiling um. to tears and they got a little bit of. heat for using tears as well as the. smiles why well they you know some. researchers said like you probably. shouldn't use those but they said no you. know every kid Drew Smiles so we think.

it should kind of we think that is. really informative to us and Them. describing how they feel so let's let's. keep that and they kept the tears but. they told the kids and they continue to. tell kids when they look at this thing. um you don't have to have tears. necessarily to have the worst to be in. the worst pain because not everybody. cries when they're in pain gotcha that's. why they said you shouldn't have tears. on there yeah I think so. confuse the kids yeah exactly huh so.

what they did was then they they got a. professional artist and basically kind. of picked out the most frequently drawn. features and had them draw like a a. professional composite of these faces. you know and I think they ended up on. six circles after experimenting with. like less or more and uh children. actually helped develop the uh the the. faces chart which is you know it's an. awesome story it is it's pretty cute. yeah in a sad way which makes it a.

joke all right so Chuck let's take. another break and then we'll come back. and talk about some other ways of. assessing. pain. ysk should. know. [Music]. [Music]. ysk. [Music].

so Chuck you've got uh paint scales that. use numbers uhhuh you've got some that. use faces for little kids M but one of. the things they have in common is that. they exist on a spectrum so one of them. is so Advanced that you you have on one. end no pain and on the other end extreme. pain and an adult or somebody will point. to the wherever they are on that scale. and then the the doctor is to get out a. a ruler yeah and measure it in.

millimeters right mhm and then they Mark. that down and then one of the benefits. of. of objectively assessing someone's pain. even through self-reporting is that you. can track whether it's getting better or. worse by by assessing it several times. over time right right um but part of the. problem with self-reporting pain scales. is there's there can be obfuscation like. we said like if you're Med seeking um.

the elderly apparently don't like to. talk about their pain yeah I mean. there's a lot of reasons for that from. uh shame of like getting older and not. feeling well to um well like you said. just like they don't want to be a bother. a lot of times yeah I read that they. they don't like to talk about their pain. or whether they're in pain but they will. respond to other words that are. virtually the same thing like sword. ache discomfort and that if you're a.

good um physician you're going to figure. out what what word they respond to most. and then just replace pain with that to. get them to talk about the type of pain. they're in they have a little uh little. translation chart pretty pretty much. yeah. sore it's like a two right achy say 3.5. and Doc oi this is killing me that's 11. I wonder if there are any pain scales. where it's like like like weather.

patterns like you know spring day to. tornado of pain tornado of pain there's. another band name and you oh yeah that. probably is a band uh and then they make. them draw that. too right draw a better tornado oh I I. meant to say something too about the uh. the the faces chart for kids a lot of. times they'll still even though they. have the chart let kids draw it because. they found that kids really enjoyed. doing it uh probably takes their mind. off of things yeah and the kids will. like draw it and then take it home and.

stuff and uh yeah it's kind of cool and. while they're busy drawing that the. doctor sneaks up behind them and injects. them with a heavy dose of opioids right. into their neck while they're. distracted and they and then bam so long. pain most of those drawings have like a. big cray streak going off the edge of. the. page so um some other reasons that you. might need to pull out different charts. is uh maybe someone doesn't speak the.

language that the doctor speaks right or. maybe there's a cultural difference that. just makes the scale a little more. difficult to grasp or or translate or. like you said they could be cognitively. challenged sure um there's a lot of. different reasons why a self-reporting. scale might not work in a situation and. so in that case the doctor needs to rely. on his or her own observations to come. up with a pain assessment and there's. actually I found this extremely. interesting that regardless of your.

level of Consciousness if you are. conscious and receptive to pain your. body is going to make you react in. predictable and from what I can tell. Universal ways yeah right so no matter. where you are in the world no matter. whether you um are cognitively. challenged or whether you have uh. Alzheimer's or whether you are a. nonverbal baby like there are going to. be things that you are going to do when. you're in pain like for example facial.

expressions tend to change and take on. uh reliably uh or reliable um. Expressions yeah like if if you have. back pain and you go to sit down like. they're they're assessing you before. they've even started asking questions M. so you come into the room and you do. like you know you grab the arm in the. chair and do the H when you sit down MH. that's a big you know cue to a doctor. like you know this person is having. trouble sitting and standing there in so. much back pain yeah and if someone took. a picture of you at that exact moment.

you would see that your eyes are drawn. shut tightly your lips are drawn back. away from your mouth and your teeth are. clenched down you're you're grimacing in. pain uh and you're doing it. involuntarily so yeah these are. behavioral behavioral cues yeah there's. there's basically two categories you can. um put observational pain assessment. into behavioral and physiological right. yeah so on the behavioral hand you've. got um facial questions like grimacing. you've got sounds like moans grunts um.

even people just talking about their. pain but not not because they're being. interviewed but just being like you know. this this oh my back or something like. that my a and back yeah they really. worked me like a dog. today uh and these are super important. for all the reasons we talked about. people either not being able to report. their pain accurately or um and you we. talked about a couple of reasons like. the drug seeking but like little kids. may not want little kids might be afraid.

of needles and they might think I'm. going to get I mean I actually remember. doing this I remember Under reporting. pain because I was afraid I was going to. get a shot if I said I was in too much. pain M and so maybe that's why I have a. high threshold now it has something to. do with it but um I used to be really. really needle phobic and am not anymore. like I don't love it still but the. needles have gotten so tiny that it's. not that big of a deal. so you needle phobic huh oh when I was a.

kid yeah needles you know they were a. lot. bigger it wasn't like I mean obviously. wasn't like the 1800s where they had. like a railroad spike right but uh it's. not like today where those little tiny. tiny thin needles um I don't know the. gauges but yeah when I was growing up. they were yeah they I hated getting. shots yeah I wasn't really big on it. either but I don't know if I would i' be. needle phobic do you watch the needle go. in or do you look sometimes it depends. depends depends on my mood oh really.

yeah it depends on your mood yeah I mean. if I'm feeling curious and frisky yeah. I'll watch it and I'll be like o oh you. missed that one and just try to psych. them out yeah that is kind of bad when. they can't find the uh vein sure yeah. for blood drawing right but but yeah. sometimes I'm just like I I'm not into. it today and I'll look. away uh the other cool thing too about. when you get blood drawn today is they. used to um they've just come so far man. remember they used to have to if you had. multiple blood tests you would get stuck.

like six times mhm and now they have. those awesome little tubes that they can. just unscrew yeah um but I still photomy. huh photomy is that what that's called. mhm it it's whoever invented that M Mr. flobo or Mrs flobo Dr flobo Phoebe flobo. MD I salute you uh because that has. really changed things for me um but I. still weirdly had this fear of. uh of like when they're when they're.

doing that and unscrewing it I have this. fear that they're going to knock the. needle and it's going to kind of like. rip out of my arm yeah me too oh okay so. that's is that a common thing maybe oh. yeah for sure it's so flimsy looking and. it's basically being held in by the. needle but there's this big topheavy. tube that's attached to it yeah that. yeah it's just going to rip it out and. it's going to pull like all of your. veins and your muscle out right after it. like a bunch of bloody party streamers. yeah I know what you mean and slightly. phobic still about them not being able. to find the vein so like you know they.

give you the ball to squeeze I turn that. thing into dust oh yeah because I want I. want like and I'm watching them and. they're like I think I got one here I'm. like are you sure I don't see it like I. want to see that vein bulging out MH for. them to go in with that. needle maybe I'm still needle phobic it. sounds a bit like. it yeah I don't think you like the. needles no but I mean hats off to the. nurses that's a tough job because there. are varying degrees of needle phobia and. I know it's probably never any fun sure.

well that's good though that means your. chances of becoming an intravenous drug. user are like zero yes exactly zero. chance so um Chuck in addition to those. behavioral cues right like body language. is another one too where like you're. you're you've got your arm kind of. guarding your broken rib or something. like that like get back get back yeah. sure everybody stay back um that's. fairly Universal from what I understand. there's also phys olcal changes too like. uh you may become nauseous or your um.

heartbeat or respiration starts. increasing you sweat um there's a lot of. changes that the body undergoes that can. be objectively observed right with that. where it's like oh that guy's sweating. like a a like a Chuck okay um he he must. be at like a 10 right now even though he. can't talk because that's another one. too like you may be in so much pain that. you can't you can't talk you you can't.

focus or concentrate on talking so you. certainly can't self-report your pain. yeah or have an injury that keeps you. from talking yeah you know like I bit. almost bit my tongue off when I was a. kid oh man and uh I you know I couldn't. talk very well yeah well now you talk. great so much so that i' do it for a. living sure uh and there all like I said. there are so many of these pain scales. and they some of them uh can get very. specific for the kind of person that the. they're they're uh treating um there's.

one called the cnpi checklist and this. is specifically for uh cognitively. impaired. elderly oh that's specific and it's a. non-verbal checklist basically that. doctors can use and we've talked about. cognitive impairments doctors have to be. really uh skilled and careful there. because uh when they're assessing pain. because if if you're assessing Behavior. AV havioral traits and and someone has a. cognitive impairment it it can be very.

confusing to assess that because there. may be another need not being met like. they might be hungry or overstimulated. or thirsty right and that's coming out. or anxiety maybe and that's coming out. in in the way they're acting and the. doctor has to be able to kind of Wade. through that to get an accurate reading. right and then so with with these. observational um scales in some cases. the doctor will just be like oo that guy. is really grimacing horribly so he he's. probably at like a 10 um other ones.

actually quantify these different. observations like the cries tool yeah. for for um infants in pain which is. about as sad a thought as there is yeah. but um it's it's basically several. different uh observations like that fall. into behavioral and physiological uh. tranches and then you know the doctor. rates each one on I think 0 to two or. something like that and then if the sum.

total of each category adds up to four. or more then it's the the baby's in a. type of pain that would require some. sort of medication yeah I looked into. this one a bit more um c i s stands for. crying uh requires oxygen. for saturation greater than 95% that is. a terrible acronym no uh I for increased. Vital Signs e for expression s for. Sleepless uh zero would be a cry that's. not high-pitched just be like.

a yeah I guess like a whimpering cry a. two I'm sorry a one would be high-. pitched but the the kit is easily. consoled and a two would be high pitched. and not and andc consolable wow uh the. oxygenation um. basically is there an in is there an a. decrease sorry and O2 at certain levels. MH uh number three the vital signs which. is heart rate and blood pressure in this. case uh zero is unchange increase less. than 20% is a one greater than 20% is a.

two right uh expression no Grimace is. zero just a Grimace by itself is a one. and a grimus sorry a Grimace with a non-. crying grunt it's a two that's not a. good one well because they've already. covered crying so yeah a non- crying. Grunt and then uh Sleepless continually. sleep zero awaken frequently one and. always is constantly awake. too man and then they total those up.

like you said that is a sad scale it is. man I I think I've said before I used to. do um PA jobs in La for this one company. who did uh well they did two two. hospitals they did City of Hope cancer. research which is where I saw the head. in the bucket right uh and then. children's uh Hospital Los Angeles chla. oh man which was a really rewarding. experience but the toughest job I ever. had like you know the worst stuff you.

can imagine and I got to say kids are. the. bravest uh be best attitudinal they had. the best attitudes and they were the. bravest of like any humans I ever saw in. the face of like the most daunting. things like compared to adults I was. just like man adults need to take some. lessons from kids yeah because it's. amazing like the attitudes these kids. had man that's neat it was and you I've. also been in the emergency room on the. flip side and seen adults that I think.

they think they might be able to get. soon sooner if they wail in. pain. right like when they're wailing and. wailing and then you see him like open. one eye and look around and I hate to. say that cuz maybe they are in that kind. of pain and that's just how they express. it but usually when I'm in the emergency. room there's one person that's just like. oh and I'm like come on man you're. hurts I say you're just trying to get to. the front of the line huur TS and then I.

see these kids in the cancer war that. are just like smiling and playing I'm. like you know it's hard to not be a. little cynical about adults and how they. handle that stuff yeah no it's true it. does seem like you do kind of get. russier as the as you age yeah up to a. point yeah I agree so you got anything. else uh no I mean there's you know. there's tons and tons of pain scales. that we didn't cover and they're all. basically after the same thing in. slightly different ways so let's just.

leave it at that okay pain scales who'. have thought that we would do pain. scales before we did one on pain well. now when we do one on pain we can just. say and there are also pain scales which. we've detailed thoroughly yeah we do. that don't we MH all right well if you. want to know more about pain scales type. those words in the search bar at house. upworks.com and since I said that it's. time for listener. mail uh I'm going to call this just. email from a seemingly very nice.

guy or a big. phony hey guys been a listener for 3 to. four years I think I've always wanted to. write in but was shy I thought it was. worth mentioning that I listen to about. 30 hours of podcasts per week and you. are in my top two favorites this guy's a. pro which basically that means we're. number two or he would have said we're. his favorite yeah I guess you're right. which is fine I guess I kind of want to. know what number one is though yeah I'd. like to know as well to Scott follow up. on this please uh second but related I'm.

a master's level board certified. Behavior Uh analyst a bcba and I am. almost finished with my PhD and I think. you might enjoy hearing that you guys. actually do a pretty decent job handling. uh psychological Concepts where many. other podcasts don't often times they're. too cursory too credulous or they. oversimplify or something else and you. guys do a great job uh and it brings me. to my third point you guys have been on. a super hot Street lately I think the. last month contained some of my favorite. material to date I don't know what's.

going on but keep it up I've been. listening for 2 months we're on steroids. that's. it uh and finally I really loved your. episode on pacifism I actually consider. myself on the more extreme end of. pacifism I do not wish harm on anyone. under any circumstance uh that's that's. nice right mhm um I like to believe I. would die to protect my enemy to Save a. Life wow. he really is on the far end yeah he. makes Gandhi look like ID Amin yeah uh.

although i' never actually I've never. actually tested this to be fair uh that. being said I also don't think that I. could allow someone to come to harm if I. could do something about it although I'd. prefer to take their place and then uh. rather than hurt their attacker uh also. similar to what Chuck said about his. wife I cannot stand to see harm come to. animals as John lenen said war is over. if you want it uh you guys are fantastic. I wish wish you all the best if you ever. have any questions about behavioral. psychology be happy to be as much of a.

resource as I can be and that is from. Scott Miller of the University of. Nebraska go corn dogs Corn Huskers oh. yeah that's right you got to husk the. corn before you can make it into a corn. dog that's true unless you're doing it. like farmhouse style in which case you. would include the husk into the ultimate. cornmeal yes and you can find those at. county fairs uh thanks a lot Scott if. you want to get in touch with us like. Scott did uh you can send us an email to.

stuff podcast howstuffworks.com and as. always join us at our home on the web. stuff should know.com. stuff you should know is a production of. iHeart radio for more podcasts my heart. radio visit the iHeart Radio app Apple. podcasts or wherever you listen to your. favorite. [Music]. shows.