The Broken Counsellor - Part 4 Pain Scaling and Chronic Pain Misunderstanding

A Personal Experience: When the Pain Is Dismissed

I’ve had two very different experiences in the same hospital — both real, both painful, yet treated worlds apart.

In one instance, I was in acute pain. I couldn’t speak. I couldn’t be touched — even brushing near my neck sent tears streaming down my face. I was met with immediate concern, compassion, and treatment. The pain was visible, undeniable, and acknowledged.

But another time, I presented with chronic, ongoing pain on the left side of my body. I was completely depleted — physically and emotionally. I could barely function. I was slow, disoriented, and deeply unwell. But because I could still make it to the toilet (even though I collapsed into a doorframe and hurt myself in the process), the doctor determined I was simply anxious and advised me to “go home and rest.”

That moment stuck with me — not just because of the pain, but because of the dismissal. I was confused, invalidated, and deeply hurt. It was the beginning of my realisation: The medical system often does not know how to see or respond to chronic pain.

And that realisation is what led me to question the limitations of the 1–10 pain scale, and how it fails those of us living with invisible but life-altering conditions.

Living with chronic pain often means dealing with systems that weren’t designed for you — like the widely used 1–10 pain scale. This scale is deeply flawed for people with long-term conditions, and it’s time we talked about why.

What Is the Pain Scale and Why Doesn’t It Work for Chronic Pain?

When you're asked, “How would you rate your pain from 1 to 10?” the assumption is that you’re able to objectively assess your physical pain.

But what about the mental and emotional load that comes with chronic illness or persistent pain conditions?

Chronic pain is complex. It changes daily. And many people in pain feel like they have to throw out a number — often just to move the appointment along. But giving the wrong number can have real consequences.

Why Chronic Pain Sufferers Struggle with Rating Their Pain

If you live with long-term pain, you may rate it a 9 or 10 because:

• You're mentally exhausted

• You’ve hit your emotional threshold

• You're desperate for relief and support

Yet medical staff might dismiss this response if you’re still walking or talking, interpreting it as an exaggeration rather than a cry for help.

Physical Pain vs Emotional Distress: A Misunderstood Distinction

Here’s the core issue: Medical systems often separate physical pain from emotional distress, but for chronic pain sufferers, they’re intertwined.

You might be experiencing a 6 physically — but a 10 mentally, because of:

• Sleep deprivation

• Anxiety

• Financial pressure

• Caregiver burnout

• Hopelessness from no improvement

And when you're misunderstood, it can worsen the very symptoms you're trying to manage.

Reframing the Pain Scale for Real Life

Here are three things we can do to bridge this gap:

Add Emotional Context to Your Pain Rating

Try this phrasing:

“Physically it’s a 6. Mentally, I’m at a 10 today — I’m struggling.”

This alerts your care team to look beyond just pain intensity.

Use Descriptive Pain Language

Swap numbers for metaphors or sensory words:

• “It feels like grinding glass behind my eyes.”

• “Like a tight band squeezing my chest.”

• “It’s like walking on bruised bones.”

This gives your provider better insight into the quality of your pain.

Advocate for Holistic Pain Assessment

Medical teams should be encouraged to ask:

“How is this pain affecting your mental health today?”

This shift can validate your experience and help create more personalised care.

Chronic Pain and Mental Health: A Call for Compassion

The current system is flawed, not you. Your pain is real. Your frustration is valid. You shouldn’t have to fight to be taken seriously.

It’s time for us to reimagine how we talk about pain, how we support those living with it, and how we design systems that truly listen.

You’re not alone — and your experience deserves to be understood.

You Deserve to Be Heard

If you’re living with chronic pain and feel like the current system isn’t working for you — you’re right. It wasn’t built to understand the complexity of pain that never fully goes away.

But that doesn’t mean we can’t start building something better.

Let’s talk more about how we describe our pain — and how we make room for the emotional weight it carries. Because chronic pain is real. It’s exhausting. And you shouldn’t have to prove it just to be taken seriously.